dp_003 q03 20 files multi_hop Claude Code

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 answer

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.

Filesystem View raw JSON
Input
294k
Output
283
Steps
9
Tools
6
Latency
24.0s
Cost
$4.44
#2 Ran ls /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/fs/dp_003/agent_memory/ 36 chars
Command Bash
ls /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/fs/dp_003/agent_memory/

{
  "description": "List agent_memory contents"
}
Result 4 lines
clinical
correspondence
memory
tests
#3 Edited /Users/prasanna/.claude/projects/-Users-prasanna-Documents-supermemoryai-supermemoryfs/memory/reference_hugo_marchetti_stent.md 1,095 chars
Command Read
{
  "file_path": "/Users/prasanna/.claude/projects/-Users-prasanna-Documents-supermemoryai-supermemoryfs/memory/reference_hugo_marchetti_stent.md"
}
Result 4 lines
<system-reminder>This memory is 6 days old. Memories are point-in-time observations, not live state — claims about code behavior or file:line citations may be outdated. Verify against current code before asserting as fact.</system-reminder>
1	---
2	name: Hugo Marchetti — stent and antiplatelet history
3	description: Clinical note: Boston Scientific Synergy DES in mid-LAD (2025-11-09), GI bleed, an…
#5 Ran ls /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/fs/dp_003/agent_memory/clinical/ /Users/prasanna/Docum… 565 chars
Command Bash
ls /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/fs/dp_003/agent_memory/clinical/ /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/fs/dp_003/agent_memory/correspondence/ /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/fs/dp_003/agent_memory/memory/ /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/fs/dp_003/agent_memory/tests/

{
  "description": "List agent_memory subdirectories"
}
Result 11 lines
/Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/fs/dp_003/agent_memory/clinical/:
admission
progress
specialty

/Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/fs/dp_003/agent_memory/correspondence/:
family
patient
provider

/Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/fs/dp_003/agent_memory…
#6 Read /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/fs/dp_003/agent_memory/ 1,210 chars
Command Grep
{
  "pattern": "Marchetti|Hugo",
  "path": "/Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/fs/dp_003/agent_memory/",
  "output_mode": "files_with_matches"
}
Result 7 lines
Found 19 files
agent_memory/correspondence/patient/patient-portal-messages.md
agent_memory/correspondence/patient/patient-symptom-journal-hugo.md
agent_memory/correspondence/provider/pcp-handoff-letter-2025-11-12.md
agent_memory/correspondence/provider/cohort-followup-velasquez-personal.md
agent_memory/clinical/specialty/cardiology-followup-clinic-2025-11-17.md
agent_memory/clinical/specialty/card…
#7 Edited agent_memory/clinical/specialty/gi-consult-egd-2025-11-21.md 33,848 chars
Command Read
{
  "file_path": "/Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/fs/dp_003/agent_memory/clinical/specialty/gi-consult-egd-2025-11-21.md"
}
Result 13 lines
1	# Riverside General Hospital — Department of Gastroenterology — Inpatient Consultation + EGD — 11/20–11/21/2025
2	
3	```
4	[Epic — GI Consult v4.2]
5	[Epic — EGD Procedure Report v6.0]
6	```
7	
8	**Patient:** Marchetti, Hugo
9	**MRN:** R-487293012
10	**DOB:** 1973-04-22 (age 52)
11	**Sex:** M
12	**Location at consult:** Riverside General — Tower 4 East, room 4E-12 (med-surg / GI step-down)
13	**…
#8 Edited agent_memory/tests/reports/discharge-summary-2025-11-22.md 35,198 chars
Command Read
{
  "file_path": "/Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/fs/dp_003/agent_memory/tests/reports/discharge-summary-2025-11-22.md"
}
Result 10 lines
1	```
2	================================================================================
3	Epic — Discharge Summary v8 — generated 2025-11-22 13:42 — User: QOKAFOR
4	================================================================================
5	```
6	
7	# Riverside General Hospital — Discharge Summary — 11/22/2025
8	
9	**Department:** Internal Medicine / Hospitalist Service
10	**Attending of r…
#9 Reasoning 987 chars
Verified against the source documents.

- **EGD finding (2025-11-21):** Diffuse erosive gastritis of the gastric antrum — multiple shallow erosions concentrated along the incisura and prepyloric region, friable mucosa with contact oozing. No ulcer, no varices, no visible vessel, no active bleeding. Biopsies negative for H. pylori (both rapid urease and histology).
- **Medication exposure immediately preceding the bleed:** Ibuprofen 600 mg PO × 2 doses on 2025-11-18 (day 10 post-PCI), self-administered for a gardening-related low-back strain — taken despite explicit post-discharge instructions to avoid NSAIDs on DAPT.
- **Antiplatelet change at the second discharge (2025-11-22):** Ticagrelor 90 mg BID was stopped and replaced with clopidogrel 75 mg PO daily. Aspirin 81 mg daily continued. Pantoprazole 40 mg PO BID × 8 weeks added for mucosal healing (pantoprazole specifically chosen over omeprazole/esomeprazole to avoid CYP2C19-mediated reduction of clopidogrel activation).
Answer
Verified against the source documents. - **EGD finding (2025-11-21):** Diffuse erosive gastritis of the gastric antrum — multiple shallow erosions concentrated along the incisura and prepyloric region, friable mucosa with contact oozing. No ulcer, no varices, no visible vessel, no active bleeding. Biopsies negative for H. pylori (both rapid urease and histology). - **Medication exposure immediately preceding the bleed:** Ibuprofen 600 mg PO × 2 doses on 2025-11-18 (day 10 post-PCI), self-admini…
Judge: covers all asked facts
SMFS Won View raw JSON
Input
125k
Output
1
Steps
4
Tools
2
Latency
10.3s
Cost
$1.88
#2 Edited /Users/prasanna/.claude/projects/-Users-prasanna-Documents-supermemoryai-supermemoryfs/memory/reference_hugo_marchetti_stent.md 1,095 chars
Command Read
{
  "file_path": "/Users/prasanna/.claude/projects/-Users-prasanna-Documents-supermemoryai-supermemoryfs/memory/reference_hugo_marchetti_stent.md"
}
Result 4 lines
<system-reminder>This memory is 6 days old. Memories are point-in-time observations, not live state — claims about code behavior or file:line citations may be outdated. Verify against current code before asserting as fact.</system-reminder>
1	---
2	name: Hugo Marchetti — stent and antiplatelet history
3	description: Clinical note: Boston Scientific Synergy DES in mid-LAD (2025-11-09), GI bleed, an…
#3 Ran smfs grep "Hugo Marchetti endoscopy GI bleed finding" /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/smf… 2,130 chars
Command Bash
smfs grep "Hugo Marchetti endoscopy GI bleed finding" /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/smfs/dp_003/agent_memory/

{
  "description": "Search for endoscopy finding details"
}
Result 7 lines
# supermemory semantic search — 10 results for "Hugo Marchetti endoscopy GI bleed finding"
# searches by meaning across files in this container. usage:
#   grep "natural language query"          search all files
#   grep "query" path/to/dir/              search within directory
# output: <filepath>:<line_start>-<line_end>:<chunk> (chunk text is verbatim from the file)

/memory/profiles/hugo-marche…
#4 Reasoning 494 chars
The memory is consistent with the agent_memory mount. Answer:

- **Endoscopy finding:** Erosive gastritis (EGD on 2025-11-18; H. pylori negative).
- **Medication exposure immediately preceding the bleed:** Ibuprofen 600 mg × 2 doses (NSAID lapse while on DAPT with aspirin + ticagrelor).
- **Antiplatelet change at second discharge (2025-11-22):** Ticagrelor 90 mg BID was stopped and replaced with clopidogrel 75 mg PO daily (aspirin 81 mg continued; pantoprazole 40 mg BID added for 8 weeks).
Answer
The memory is consistent with the agent_memory mount. Answer: - **Endoscopy finding:** Erosive gastritis (EGD on 2025-11-18; H. pylori negative). - **Medication exposure immediately preceding the bleed:** Ibuprofen 600 mg × 2 doses (NSAID lapse while on DAPT with aspirin + ticagrelor). - **Antiplatelet change at second discharge (2025-11-22):** Ticagrelor 90 mg BID was stopped and replaced with clopidogrel 75 mg PO daily (aspirin 81 mg continued; pantoprazole 40 mg BID added for 8 weeks).
Judge: covers all asked facts