{ "slug": "dp_003-q03-codex", "dp": "dp_003", "files": 20, "qid": "q03", "family": "multi_hop", "prompt": "Hugo Marchetti was discharged after his NSTEMI on a specific dual antiplatelet regimen. Later he was readmitted with a gastrointestinal bleed and an endoscopy was performed. What was the finding on endoscopy, what medication exposure immediately preceded the GI bleed, and what antiplatelet change was made at the second discharge?", "gold": "Endoscopy (EGD on 2025-11-21) showed erosive gastritis in the antrum with no active bleeding. The precipitant was ibuprofen 600 mg taken twice on 2025-11-18. At the second discharge (2025-11-22) ticagrelor was stopped and clopidogrel 75 mg PO daily was started.", "agent": "codex", "fs": { "agent": "codex", "success": true, "steps": 1, "inputTokens": 219959, "outputTokens": 3010, "totalTokens": 222969, "cost": 2.7298, "durationMs": 47354, "answer": "Hugo\u2019s initial post-NSTEMI DAPT was **aspirin 81 mg daily + ticagrelor 90 mg BID**.\n\nAt the GI-bleed readmission:\n\n- **Endoscopy finding:** erosive gastritis in the gastric antrum, with shallow erosions/friable mucosa; **no active bleeding, no ulcer, no varices**.\n- **Immediate medication exposure:** **ibuprofen 600 mg twice on 2025-11-18** for back pain, while on DAPT.\n- **Second-discharge antiplatelet change:** **ticagrelor was stopped and replaced with clopidogrel 75 mg daily**, while **aspirin 81 mg daily was continued**.", "judgeReason": "covers all asked facts", "toolCalls": 8, "trajectory": [ { "step": 1, "inputTokens": 219959, "outputTokens": 3010, "text": "I\u2019ll search the local `agent_memory` first, since the project instructions say the answer is there, then read the relevant records around Hugo Marchetti\u2019s admissions.\nI found the Hugo Marchetti case references. I\u2019m going to read the discharge and GI/endoscopy notes now to pin down the exact wording rather than rely on the summary snippets.\nHugo\u2019s initial post-NSTEMI DAPT was **aspirin 81 mg daily + ticagrelor 90 mg BID**.\n\nAt the GI-bleed readmission:\n\n- **Endoscopy finding:** erosive gastritis in the gastric antrum, with shallow erosions/friable mucosa; **no active bleeding, no ulcer, no varices**.\n- **Immediate medication exposure:** **ibuprofen 600 mg twice on 2025-11-18** for back pain, while on DAPT.\n- **Second-discharge antiplatelet change:** **ticagrelor was stopped and replaced with clopidogrel 75 mg daily**, while **aspirin 81 mg daily was continued**.", "toolCalls": [ { "name": "command_execution", "input": "{\"command\": \"/bin/zsh -lc 'rg -n \\\"Hugo|Marchetti|NSTEMI|gastrointestinal|GI bleed|endoscopy|antiplatelet|dual antiplatelet|DAPT\\\" agent_memory'\"}", "outputPreview": "agent_memory/correspondence/patient/patient-portal-messages.md:4: Account: H. Marchetti \u2014 MRN R-487293012\nagent_memory/correspondence/patient/patient-portal-messages.md:7: Thread: \"Hugo Marchetti \u2014 Cardiac/GI care 2025-11-08 \u2192 2025-12-01\"\nagent_memory/correspondence/patient/patient-portal-messages.md:21:### Message 01 \u2014 Family update questions \u2014 Hugo Marchetti room 412\nagent_memory/correspondenc\u2026", "outputChars": 148613 }, { "name": "command_execution", "input": "{\"command\": \"/bin/zsh -lc 'find agent_memory -maxdepth 2 -type f | sort | head -200'\"}", "outputPreview": "", "outputChars": 0 }, { "name": "command_execution", "input": "{\"command\": \"/bin/zsh -lc 'find agent_memory -type f | sort | rg \\\"(discharge|egd|endosc|gi|bleed|marchetti|hugo)\\\"'\"}", "outputPreview": "agent_memory/clinical/specialty/gi-consult-egd-2025-11-21.md\nagent_memory/correspondence/patient/patient-symptom-journal-hugo.md\nagent_memory/memory/conditions/antiplatelet-gi-bleed-reference.md\nagent_memory/memory/profiles/hugo-marchetti-patient-profile.md\nagent_memory/tests/imaging/cxr-day0-report.md\nagent_memory/tests/imaging/echo-day2-report.md\nagent_memory/tests/reports/discharge-summary-2025\u2026", "outputChars": 469 }, { "name": "command_execution", "input": "{\"command\": \"/bin/zsh -lc \\\"rg -n \\\\\\\"EGD|endosc|gastritis|erosive|Forrest|H\\\\\\\\. pylori|ibuprofen|ticagrelor|clopidogrel|second discharge|re-discharge|readmission|GI bleed\\\\\\\" agent_memory -g \\\\\\\"*.md\\\\\\\"\\\"\"}", "outputPreview": "agent_memory/correspondence/patient/patient-symptom-journal-hugo.md:59:At 8 PM I took my first **ticagrelor**, the loading dose: two of the pink-and-white pills, I think 180 mg total. They told me I will take this twice a day. The pharmacist on the floor, a quiet woman with reading glasses pushed up onto her hair, walked through every pill with me like a stagehand walking through an act:\nagent_mem\u2026", "outputChars": 121021 }, { "name": "command_execution", "input": "{\"command\": \"/bin/zsh -lc \\\"nl -ba agent_memory/memory/conditions/antiplatelet-gi-bleed-reference.md | sed -n '450,476p'\\\"\"}", "outputPreview": " 450\t---\n 451\t\n 452\t## 29. Notes on personal experience\n 453\t\n 454\tThis reference accumulated as I worked through H.M.'s case. I recommend colleagues maintain similar reference files as case-driven studying \u2014 the value is not in the content but in the structure of *this is what I needed when I needed it*. Reference files written by yourself, for yourself, get used.\n 455\t\n 456\t---\n \u2026", "outputChars": 2441 }, { "name": "command_execution", "input": "{\"command\": \"/bin/zsh -lc \\\"nl -ba agent_memory/clinical/specialty/gi-consult-egd-2025-11-21.md | sed -n '1,260p'\\\"\"}", "outputPreview": " 1\t# Riverside General Hospital \u2014 Department of Gastroenterology \u2014 Inpatient Consultation + EGD \u2014 11/20\u201311/21/2025\n 2\t\n 3\t```\n 4\t[Epic \u2014 GI Consult v4.2]\n 5\t[Epic \u2014 EGD Procedure Report v6.0]\n 6\t```\n 7\t\n 8\t**Patient:** Marchetti, Hugo\n 9\t**MRN:** R-487293012\n 10\t**DOB:** 1973-04-22 (age 52)\n 11\t**Sex:** M\n 12\t**Location at consult:** Riverside General \u2014\u2026", "outputChars": 27494 }, { "name": "command_execution", "input": "{\"command\": \"/bin/zsh -lc \\\"nl -ba agent_memory/tests/reports/discharge-summary-2025-11-22.md | sed -n '1,260p'\\\"\"}", "outputPreview": " 1\t```\n 2\t================================================================================\n 3\tEpic \u2014 Discharge Summary v8 \u2014 generated 2025-11-22 13:42 \u2014 User: QOKAFOR\n 4\t================================================================================\n 5\t```\n 6\t\n 7\t# Riverside General Hospital \u2014 Discharge Summary \u2014 11/22/2025\n 8\t\n 9\t**Department:** Internal Medic\u2026", "outputChars": 23134 }, { "name": "command_execution", "input": "{\"command\": \"/bin/zsh -lc \\\"nl -ba agent_memory/tests/reports/discharge-summary-2025-11-12.md | sed -n '120,190p'\\\"\"}", "outputPreview": " 120\tPlt (k/uL) 224 \u2014 \u2014 218 \u2014 212 215 221\n 121\tMCV (fL) 88 \u2014 \u2014 88 \u2014 87 87 87\n 122\tNa (mEq/L) 139 \u2014 \u2014 140 \u2014 139 140 139\n 123\tK (mEq/L) 4.0 \u2014 \u2014 4.1 \u2014 4.2 4.0 4.1\n 124\tCl (mEq/L) 10\u2026", "outputChars": 4934 } ] } ] }, "smfs": { "agent": "codex", "success": true, "steps": 1, "inputTokens": 340084, "outputTokens": 4528, "totalTokens": 344612, "cost": 4.2168, "durationMs": 69779, "answer": "Hugo\u2019s initial post-NSTEMI DAPT was **aspirin 81 mg daily + ticagrelor 90 mg BID**.\n\nThe EGD found **antral erosive gastritis** with shallow erosions and patchy hyperemia, but **no active bleeding, ulcer, clot, or visible vessel**. The GI bleed followed **ibuprofen 600 mg x 2 doses on 2025-11-18**. At the second discharge, **ticagrelor was stopped and clopidogrel 75 mg daily was started**, with aspirin continued.\n\nSources: [discharge summary](/Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/smfs/dp_003/agent_memory/tests/reports/discharge-summary-2025-11-22.md:114), [antiplatelet update](/Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/smfs/dp_003/agent_memory/clinical/progress/hugo-marchetti-antiplatelet-update-2025-11-22.md:1)", "judgeReason": "covers all asked facts", "toolCalls": 8, "trajectory": [ { "step": 1, "inputTokens": 340084, "outputTokens": 4528, "text": "I\u2019ll search the Supermemory mount using its semantic index first, then open only the relevant records once I have candidate matches.\nThe profile confirms this is about Hugo\u2019s November 2025 PCI and later NSAID-associated upper GI bleed. I\u2019m pulling the EGD and antiplatelet update notes now to pin down the exact wording.\nHugo\u2019s initial post-NSTEMI DAPT was **aspirin 81 mg daily + ticagrelor 90 mg BID**.\n\nThe EGD found **antral erosive gastritis** with shallow erosions and patchy hyperemia, but **no active bleeding, ulcer, clot, or visible vessel**. The GI bleed followed **ibuprofen 600 mg x 2 doses on 2025-11-18**. At the second discharge, **ticagrelor was stopped and clopidogrel 75 mg daily was started**, with aspirin continued.\n\nSources: [discharge summary](/Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/smfs/dp_003/agent_memory/tests/reports/discharge-summary-2025-11-22.md:114), [antiplatelet update](/Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/smfs/dp_003/agent_memory/clinical/progress/hugo-marchetti-antiplatelet-update-2025-11-22.md:1)", "toolCalls": [ { "name": "command_execution", "input": "{\"command\": \"/bin/zsh -lc 'cat /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/smfs/dp_003/agent_memory/profile.md'\"}", "outputPreview": "# Memory Profile\n# This file is auto-generated from your memories.\n# It is not editable. To update, modify the source files\n# that contain this information.\n\n## Core Knowledge\n- Hugo Marchetti is a 52-year-old retired NYC public-school history teacher living in an Inwood, Manhattan 2nd-floor walk-up.\n\n## Recent Context\n- Hugo Marchetti recovered well by early December 2025, with hemoglobin returni\u2026", "outputChars": 1599 }, { "name": "command_execution", "input": "{\"command\": \"/bin/zsh -lc 'smfs grep \\\"Hugo Marchetti NSTEMI discharge dual antiplatelet regimen GI bleed endoscopy finding ibuprofen antiplatelet change second discharge\\\" /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/smfs/dp_003/agent_memory/'\"}", "outputPreview": "/memory/profiles/hugo-marchetti-patient-profile.md:Hugo Marchetti developed erosive gastritis and a GI bleed in November 2025 due to an NSAID lapse (ibuprofen use) while on DAPT.\n\n/memory/conditions/antiplatelet-gi-bleed-reference.md:Hugo Marchetti experienced erosive gastritis in late 2025 due to ibuprofen use after DAPT treatment, requiring a medication swap to clopidogrel and a course of pantop\u2026", "outputChars": 4688 }, { "name": "command_execution", "input": "{\"command\": \"/bin/zsh -lc 'smfs grep \\\"Hugo Marchetti EGD endoscopy finding erosive gastritis no active bleeding H pylori November 2025\\\" /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/smfs/dp_003/agent_memory/'\"}", "outputPreview": "/memory/conditions/antiplatelet-gi-bleed-reference.md:Hugo Marchetti's H. pylori test from his November 2025 EGD returned negative.\n\n/memory/conditions/antiplatelet-gi-bleed-reference.md:Hugo Marchetti experienced erosive gastritis in late 2025 due to ibuprofen use after DAPT treatment, requiring a medication swap to clopidogrel and a course of pantoprazole.\n\n/memory/profiles/hugo-marchetti-patien\u2026", "outputChars": 4893 }, { "name": "command_execution", "input": "{\"command\": \"/bin/zsh -lc 'smfs grep \\\"second discharge 2025-11-22 ticagrelor stopped clopidogrel aspirin continued pantoprazole Hugo Marchetti\\\" /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/smfs/dp_003/agent_memory/'\"}", "outputPreview": "# supermemory semantic search \u2014 10 results for \"second discharge 2025-11-22 ticagrelor stopped clopidogrel aspirin continued pantoprazole Hugo Marchetti\"\n# searches by meaning across files in this container. usage:\n# grep \"natural language query\" search all files\n# grep \"query\" path/to/dir/ search within directory\n# output: :-: (chun\u2026", "outputChars": 4385 }, { "name": "command_execution", "input": "{\"command\": \"/bin/zsh -lc \\\"sed -n '114,123p' /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/smfs/dp_003/agent_memory/tests/reports/discharge-summary-2025-11-22.md\\\"\"}", "outputPreview": "### Day 13 (Friday, 2025-11-21) \u2014 Endoscopy and continuation\n\nMr. Marchetti was taken to the endoscopy suite at 10:32 and EGD commenced at 10:47 by Dr. Bell. Findings (see `gi-consult-egd-2025-11-21.md` for full report):\n\n- Esophagus: normal; no varices, no esophagitis.\n- Stomach: **erosive gastritis** in the antrum with multiple shallow erosions and patchy mucosal hyperemia; no active bleeding; n\u2026", "outputChars": 798 }, { "name": "command_execution", "input": "{\"command\": \"/bin/zsh -lc \\\"sed -n '1,12p' /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/smfs/dp_003/agent_memory/clinical/progress/hugo-marchetti-antiplatelet-update-2025-11-22.md && sed -n '180,210p' /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/smfs/dp_003/agent_memory/tests/reports/discharge-summary-2025-11-22.md\\\"\"}", "outputPreview": "# Hugo Marchetti \u2014 Antiplatelet / GI Bleed Update\n\nHugo Marchetti's stent is a Boston Scientific Synergy DES 3.0 \u00d7 23 mm placed on 2025-11-09 in the mid-LAD.\n\nHe was originally on ticagrelor 90 mg BID after the procedure.\n\nAfter a gastrointestinal bleed caused by ibuprofen 600 mg \u00d7 2 doses on 2025-11-18, his antiplatelet therapy was changed at the second discharge on 2025-11-22: ticagrelor was sto\u2026", "outputChars": 2421 }, { "name": "command_execution", "input": "{\"command\": \"/bin/zsh -lc \\\"sed -n '210,238p' /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/smfs/dp_003/agent_memory/tests/reports/discharge-summary-2025-11-22.md\\\"\"}", "outputPreview": "Medication Pre-readmit (as of 11/19) Inpatient Discharge (effective 11/22)\n-------------------------------------------------------------------------------------------------------------------------------\nAspirin 81 mg PO daily CONTINUE CONTINUE CONTINUE\nTicagrelor 90 mg PO BID CONTINUE \u2026", "outputChars": 4436 }, { "name": "command_execution", "input": "{\"command\": \"/bin/zsh -lc 'smfs grep \\\"Discharged 2025-11-12 on ASA 81 ticagrelor 90 mg BID after NSTEMI PCI Hugo Marchetti\\\" /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/smfs/dp_003/agent_memory/'\"}", "outputPreview": "# supermemory semantic search \u2014 10 results for \"Discharged 2025-11-12 on ASA 81 ticagrelor 90 mg BID after NSTEMI PCI Hugo Marchetti\"\n# searches by meaning across files in this container. usage:\n# grep \"natural language query\" search all files\n# grep \"query\" path/to/dir/ search within directory\n# output: :-: (chunk text is verbatim f\u2026", "outputChars": 4715 } ] } ] } }