dp_003 q03 20 files multi_hop Codex

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 Won View raw JSON
Input
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Output
3k
Steps
1
Tools
8
Latency
47.4s
Cost
$2.73
#1 Ran rg -n "Hugo|Marchetti|NSTEMI|gastrointestinal|GI bleed|endoscopy|antiplatelet|dual antiplatelet|DAPT" agent_memory 148,613 chars
Command command_execution
rg -n "Hugo|Marchetti|NSTEMI|gastrointestinal|GI bleed|endoscopy|antiplatelet|dual antiplatelet|DAPT" agent_memory
Result 4 lines
agent_memory/correspondence/patient/patient-portal-messages.md:4:  Account: H. Marchetti — MRN R-487293012
agent_memory/correspondence/patient/patient-portal-messages.md:7:  Thread: "Hugo Marchetti — Cardiac/GI care 2025-11-08 → 2025-12-01"
agent_memory/correspondence/patient/patient-portal-messages.md:21:### Message 01 — Family update questions — Hugo Marchetti room 412
agent_memory/correspondenc…
#1 Ran find agent_memory -maxdepth 2 -type f | sort | head -200
Command command_execution
find agent_memory -maxdepth 2 -type f | sort | head -200
#1 Ran find agent_memory -type f | sort | rg "(discharge|egd|endosc|gi|bleed|marchetti|hugo)" 469 chars
Command command_execution
find agent_memory -type f | sort | rg "(discharge|egd|endosc|gi|bleed|marchetti|hugo)"
Result 7 lines
agent_memory/clinical/specialty/gi-consult-egd-2025-11-21.md
agent_memory/correspondence/patient/patient-symptom-journal-hugo.md
agent_memory/memory/conditions/antiplatelet-gi-bleed-reference.md
agent_memory/memory/profiles/hugo-marchetti-patient-profile.md
agent_memory/tests/imaging/cxr-day0-report.md
agent_memory/tests/imaging/echo-day2-report.md
agent_memory/tests/reports/discharge-summary-2025…
#1 Ran rg -n \"EGD|endosc|gastritis|erosive|Forrest|H\\. pylori|ibuprofen|ticagrelor|clopidogrel|second discharge|re-discharge|readmission|GI bleed… 121,021 chars
Command command_execution
rg -n \"EGD|endosc|gastritis|erosive|Forrest|H\\. pylori|ibuprofen|ticagrelor|clopidogrel|second discharge|re-discharge|readmission|GI bleed\" agent_memory -g \"*.md\"
Result 2 lines
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:
agent_mem…
#1 Ran nl -ba agent_memory/memory/conditions/antiplatelet-gi-bleed-reference.md | sed -n '450,476p' 2,441 chars
Command command_execution
nl -ba agent_memory/memory/conditions/antiplatelet-gi-bleed-reference.md | sed -n '450,476p'
Result 8 lines
   450	---
   451	
   452	## 29. Notes on personal experience
   453	
   454	This reference accumulated as I worked through H.M.'s case. I recommend colleagues maintain similar reference files as case-driven studying — 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.
   455	
   456	---
   …
#1 Ran nl -ba agent_memory/clinical/specialty/gi-consult-egd-2025-11-21.md | sed -n '1,260p' 27,494 chars
Command command_execution
nl -ba agent_memory/clinical/specialty/gi-consult-egd-2025-11-21.md | sed -n '1,260p'
Result 12 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 —…
#1 Ran nl -ba agent_memory/tests/reports/discharge-summary-2025-11-22.md | sed -n '1,260p' 23,134 chars
Command command_execution
nl -ba agent_memory/tests/reports/discharge-summary-2025-11-22.md | sed -n '1,260p'
Result 9 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 Medic…
#1 Ran nl -ba agent_memory/tests/reports/discharge-summary-2025-11-12.md | sed -n '120,190p' 4,934 chars
Command command_execution
nl -ba agent_memory/tests/reports/discharge-summary-2025-11-12.md | sed -n '120,190p'
Result 5 lines
   120	Plt  (k/uL)        224      —        —        218      —        212      215      221
   121	MCV  (fL)           88      —        —         88      —         87       87       87
   122	Na   (mEq/L)       139      —        —        140      —        139      140      139
   123	K    (mEq/L)       4.0      —        —        4.1      —        4.2      4.0      4.1
   124	Cl   (mEq/L)       10…
Answer
Hugo’s initial post-NSTEMI DAPT was **aspirin 81 mg daily + ticagrelor 90 mg BID**. At the GI-bleed readmission: - **Endoscopy finding:** erosive gastritis in the gastric antrum, with shallow erosions/friable mucosa; **no active bleeding, no ulcer, no varices**. - **Immediate medication exposure:** **ibuprofen 600 mg twice on 2025-11-18** for back pain, while on DAPT. - **Second-discharge antiplatelet change:** **ticagrelor was stopped and replaced with clopidogrel 75 mg daily**, while **aspir…
Judge: covers all asked facts
SMFS View raw JSON
Input
340k
Output
5k
Steps
1
Tools
8
Latency
1.2m
Cost
$4.22
#1 Ran cat /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/smfs/dp_003/agent_memory/profile.md 1,599 chars
Command command_execution
cat /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/smfs/dp_003/agent_memory/profile.md
Result 10 lines
# Memory Profile
# This file is auto-generated from your memories.
# It is not editable. To update, modify the source files
# that contain this information.

## Core Knowledge
- Hugo Marchetti is a 52-year-old retired NYC public-school history teacher living in an Inwood, Manhattan 2nd-floor walk-up.

## Recent Context
- Hugo Marchetti recovered well by early December 2025, with hemoglobin returni…
#1 Ran smfs grep "Hugo Marchetti NSTEMI discharge dual antiplatelet regimen GI bleed endoscopy finding ibuprofen antiplatelet change second dischar… 4,688 chars
Command command_execution
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/
Result 3 lines
/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.

/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…
#1 Ran smfs grep "Hugo Marchetti EGD endoscopy finding erosive gastritis no active bleeding H pylori November 2025" /Users/prasanna/Documents/super… 4,893 chars
Command command_execution
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/
Result 5 lines
/memory/conditions/antiplatelet-gi-bleed-reference.md:Hugo Marchetti's H. pylori test from his November 2025 EGD returned negative.

/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.

/memory/profiles/hugo-marchetti-patien…
#1 Ran smfs grep "second discharge 2025-11-22 ticagrelor stopped clopidogrel aspirin continued pantoprazole Hugo Marchetti" /Users/prasanna/Documen… 4,385 chars
Command command_execution
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/
Result 5 lines
# supermemory semantic search — 10 results for "second discharge 2025-11-22 ticagrelor stopped clopidogrel aspirin continued pantoprazole Hugo Marchetti"
# 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> (chun…
#1 Ran sed -n '114,123p' /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/smfs/dp_003/agent_memory/tests/reports/… 798 chars
Command command_execution
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
Result 6 lines
### Day 13 (Friday, 2025-11-21) — Endoscopy and continuation

Mr. 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):

- Esophagus: normal; no varices, no esophagitis.
- Stomach: **erosive gastritis** in the antrum with multiple shallow erosions and patchy mucosal hyperemia; no active bleeding; n…
#1 Ran sed -n '1,12p' /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/smfs/dp_003/agent_memory/clinical/progress… 2,421 chars
Command command_execution
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
Result 7 lines
# Hugo Marchetti — Antiplatelet / GI Bleed Update

Hugo Marchetti's stent is a Boston Scientific Synergy DES 3.0 × 23 mm placed on 2025-11-09 in the mid-LAD.

He was originally on ticagrelor 90 mg BID after the procedure.

After a gastrointestinal bleed caused by ibuprofen 600 mg × 2 doses on 2025-11-18, his antiplatelet therapy was changed at the second discharge on 2025-11-22: ticagrelor was sto…
#1 Ran sed -n '210,238p' /Users/prasanna/Documents/supermemoryai/supermemoryfs/.scratch/eval/eval/workspace/smfs/dp_003/agent_memory/tests/reports/… 4,436 chars
Command command_execution
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
Result 4 lines
Medication                  Pre-readmit (as of 11/19)         Inpatient                         Discharge (effective 11/22)
-------------------------------------------------------------------------------------------------------------------------------
Aspirin 81 mg PO daily       CONTINUE                          CONTINUE                          CONTINUE
Ticagrelor 90 mg PO BID      CONTINUE     …
#1 Ran smfs grep "Discharged 2025-11-12 on ASA 81 ticagrelor 90 mg BID after NSTEMI PCI Hugo Marchetti" /Users/prasanna/Documents/supermemoryai/sup… 4,715 chars
Command command_execution
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/
Result 5 lines
# supermemory semantic search — 10 results for "Discharged 2025-11-12 on ASA 81 ticagrelor 90 mg BID after NSTEMI PCI Hugo Marchetti"
# 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 f…
Answer
Hugo’s initial post-NSTEMI DAPT was **aspirin 81 mg daily + ticagrelor 90 mg BID**. The 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. Sources: [discharge summary](/Users/prasanna/Documents/supermemoryai/supermemoryfs…
Judge: covers all asked facts