I have a cousin who recently (2022) finished his MBBS studies, and is now doing his MD. I wanted to show him the power of Gen AI, how it can help him in his career, and how it’s revolutionizing industries.
One thing that stood out to me in Feb 2023 when I did this was – what’s obvious to techies who understand the power of AI/ML is not obvious to non-techies, and that is something that we – as techies – often forget. To generalize it – what’s obvious to others is not obvious to us, and what’s obvious to us is not obvious to others.
What stood out to me in Feb 2024 was how fast ChatGPT was learning and how fast Gen AI is progressing.
And what’s standing out to me in March 2024 is – how fast we’re progressing in Tech, especially with Quantum Computing (not to mention Quantum Physics) – Study combines quantum computing and generative AI for drug discovery
We’re all in for fun and progressive times ahead, and while they’ll be chaotic, I’m optimistic for the future. After all – Optimism and Hustle run the world.
Another important thing to note is that Gen AI is not a magic bullet – it’s just another enabler, just like tech.
Prompt on 3th March, 2024: https://chat.openai.com/share/fee20070-ab8f-40b8-8a5d-92049c5a3ff1 (Leptospirosis was the correct differential diagnosis, according to the doctor)
Prompt in February 2023: https://chat.openai.com/share/2c6bf455-fa33-4e0c-87e7-d56675d36081 . This one involved teaching him how to use ChatGPT, so it’s much longer than I’d like – b)
Appendix
I like to keep personal records and screenshots, because we can’t rely on when/if other services will go down or change their business practices. Plus, this is also good for SEO and AI Analysis.
Prompt on 3rd March, 2024:
You
There is a 37 year old male patient working in rice plantation who came with complaints of fever, yellow eyes, decreased urine output, conjunctivitis, and hepatosplenomegaly on palpatation. What would be the next step in the investigation to determine a diagnosis, and what would be the differential diagnosis possible? You can ask questions to clarify
ChatGPT
Based on the symptoms presented, the patient’s history of working in a rice plantation, and the physical examination findings, the next step in the investigation would be to perform diagnostic tests to confirm or rule out a diagnosis of malaria. Malaria is a parasitic infection transmitted through the bites of infected mosquitoes, and it can cause symptoms such as fever, yellow eyes (jaundice), decreased urine output (indicative of possible kidney involvement), conjunctivitis, and hepatosplenomegaly (enlargement of the liver and spleen).
The differential diagnosis for these symptoms could include other infectious diseases common in tropical regions, such as dengue fever, leptospirosis, typhoid fever, and viral hepatitis. However, given the patient’s occupation and the prevalence of malaria in rice-growing areas, malaria would be a primary consideration.
Further diagnostic tests that could be considered include:
- Blood Smear for Malaria Parasites: This is the gold standard test for diagnosing malaria. A blood smear is examined under a microscope to look for the presence of malaria parasites in the red blood cells.
- Rapid Diagnostic Tests (RDTs): These tests detect specific malaria antigens in the blood and are quick and easy to perform, providing rapid results.
- Complete Blood Count (CBC): This test can show characteristic changes seen in malaria, such as low red blood cell count (anemia), low platelet count (thrombocytopenia), and increased white blood cell count.
- Liver Function Tests (LFTs): Elevated liver enzymes (AST, ALT) are common in malaria, reflecting liver involvement.
- Serology Tests: These tests can detect antibodies against specific malaria parasites and may be useful in certain situations.
- Imaging Studies: Ultrasound or CT scans may be done to assess the extent of hepatosplenomegaly and to rule out other causes.
Treatment for malaria typically involves antimalarial medications, such as chloroquine, artemisinin-based combination therapies (ACTs), or other drugs based on the species of the infecting parasite and the severity of the disease. Early diagnosis and treatment are crucial to prevent complications and reduce mortality.
Prompt in Feb, 2024:
I decided not to post the image as it’s too large, so I just copy/pasted the prompts and answers from ChatGPT. Please keep in mind that this was me trying to teach my cousin how to use ChatGPT, so it took a while to reach a satisfactory question (the same question for which I’ve attached a screenshot above)
You
What is the surgery needed for large breast carinoma?
ChatGPT
The surgical procedure used to treat large breast carcinoma may vary depending on several factors, such as the size and location of the tumor, the stage of the cancer, and the patient’s overall health.
The most common surgical procedure used to treat large breast carcinoma is mastectomy, which involves removing the entire breast tissue. There are different types of mastectomy, including:
- Total or simple mastectomy: removes the entire breast, including the nipple and areola.
- Modified radical mastectomy: removes the entire breast tissue, nipple, and areola, as well as some of the axillary lymph nodes.
- Radical mastectomy: removes the entire breast, nipple, areola, and all the axillary lymph nodes, as well as the chest muscles under the breast.
In some cases, breast-conserving surgery may be an option for women with large breast carcinoma. This procedure involves removing only the tumor and some surrounding tissue, while leaving the rest of the breast intact. This procedure is typically followed by radiation therapy to destroy any remaining cancer cells.
It’s important to note that the choice of surgical procedure for large breast carcinoma should be made after a thorough evaluation by a team of medical professionals, including a breast surgeon, an oncologist, and a radiation oncologist.
You
Current management for indirect inguinal hernia
ChatGPT
Indirect inguinal hernia is a common type of hernia that occurs when a portion of the small intestine or other abdominal contents protrude through a weakness in the abdominal wall in the inguinal canal, which is located in the groin area. The current management for indirect inguinal hernia involves surgical repair.
Surgical repair of an indirect inguinal hernia can be done through open surgery or laparoscopic surgery. In open surgery, a small incision is made in the groin area to access the hernia sac, and the hernia sac is either removed or pushed back into the abdomen. The weak spot in the abdominal wall is then reinforced with stitches or a mesh patch.
In laparoscopic surgery, several small incisions are made in the abdomen, and a laparoscope (a thin tube with a camera attached) and surgical instruments are used to repair the hernia. Laparoscopic surgery has the advantages of being less invasive, causing less pain, and leading to a quicker recovery time compared to open surgery.
In general, surgical repair is recommended for all symptomatic indirect inguinal hernias and most asymptomatic hernias, as the risk of complications such as incarceration and strangulation can increase over time. However, the timing of surgery may vary depending on the patient’s age, overall health, and the severity of the hernia. A surgeon should evaluate and determine the appropriate management for each individual patient.
You
In the open surgery you mentioned above, which mesh is used?
ChatGPT
There are different types of meshes that can be used in open surgical repair of an indirect inguinal hernia. The most commonly used mesh is a synthetic mesh made of polypropylene or polyester. These meshes are lightweight, durable, and have a low risk of infection. They come in various shapes and sizes to fit the specific needs of the patient.
In some cases, a biological mesh made of animal tissue, such as porcine or bovine, may be used. These meshes have the advantage of being absorbable by the body over time, which eliminates the need for long-term foreign body presence. However, they tend to be more expensive than synthetic meshes and may not be suitable for all patients.
The choice of mesh used in the surgical repair of an indirect inguinal hernia is based on several factors, including the patient’s age, overall health, the size and location of the hernia, and the surgeon’s preference and experience. The surgeon will determine the most appropriate mesh for each individual patient based on these factors.
You
Classification of pulmonary edema?
ChatGPT
Pulmonary edema is a medical condition characterized by the accumulation of fluid in the lungs, which can cause difficulty breathing and impaired oxygen exchange. Pulmonary edema can be classified into two main types:
- Cardiogenic pulmonary edema: This type of pulmonary edema is caused
You
Classification of pulmonary edema based on pressue?
ChatGPT
Yes, pulmonary edema can also be classified based on the pressure causing the accumulation of fluid in the lungs. The two main types of pulmonary edema based on pressure are:
- Hydrostatic pulmonary edema: This type of pulmonary edema is caused by an increase in hydrostatic pressure in the pulmonary capillaries. This can occur due to conditions
You
Difference between Kerly a lines and b lines?
ChatGPT
Kerley A lines and B lines are both radiologic findings that can be seen on a chest X-ray or lung ultrasound, respectively. However, they represent different pathologic conditions.
Kerley A lines are thin, horizontal lines seen on a chest X-ray that indicate the presence of interstitial edema in the lung tissue. Interstitial edema occurs when fluid accumulates in the spaces between the lung cells, which can be caused by a variety of conditions such as congestive heart failure, pulmonary fibrosis, or infections. Kerley A lines are usually located at the lung bases, and they are less common than B lines.
B lines, on the other hand, are vertical, comet-tail artifacts seen on lung ultrasound that indicate the presence of interstitial edema or alveolar edema. Alveolar edema occurs when fluid accumulates in the air sacs of the lung, which can be caused by conditions such as acute respiratory distress syndrome (ARDS), pneumonia, or pulmonary edema. B lines are commonly seen in a diffuse pattern throughout the lung fields and are often associated with interstitial lung disease or congestive heart failure.
In summary, while both Kerley A lines and B lines indicate the presence of interstitial edema in the lung tissue, Kerley A lines are seen on chest X-ray and represent interstitial edema, whereas B lines are seen on lung ultrasound and can indicate both interstitial and alveolar edema.
You
prophylaxis for portal venous hypertension
ChatGPT
Prophylaxis for portal venous hypertension involves managing the underlying conditions that can cause or exacerbate it, such as liver cirrhosis or portal vein thrombosis. Some general strategies for prophylaxis include:
- Treating the underlying cause: Treatment of liver cirrhosis or other liver diseases may include medications, lifestyle changes, and in some cases, liver transplantation.
- Controlling risk factors: Reducing the consumption of alcohol and avoiding exposure to hepatotoxins can help prevent or slow the progression of liver damage.
- Managing complications: Preventing and treating complications associated with portal hypertension, such as variceal bleeding or ascites, can help reduce the risk of further liver damage.
- Medications: Medications such as beta-blockers and non-selective vasodilators may be used to reduce portal pressure and decrease the risk of complications.
- Endoscopic therapy: Endoscopic therapies such as band ligation or sclerotherapy can be used
You
There is a 37 year old male patient working in rice plantation who came with complaints of fever, yellow eyes, decreased urine output, conjunctivitis, and hepatosplenomegaly on palpatation. What would be the next step in the investigation to determine a diagnosis, and what would be the differential diagnosis possible? You can ask questions to clarify
ChatGPT
Based on the patient’s symptoms, the most likely diagnosis is acute viral hepatitis. However, additional information is needed to determine the specific type of hepatitis and its severity. Here are some questions to help clarify the situation:
- How long has the patient been experiencing these symptoms?
- Has the patient had any recent travel or exposure to contaminated water or food?
- Does the patient have a history of alcohol or drug abuse?
- Has the patient been vaccinated against hepatitis A and B?
- Has the patient been taking any medications or supplements that could affect liver function?
The next step in the investigation would be to order blood tests to confirm the diagnosis of hepatitis and determine the severity of liver damage. The tests may include liver function tests, viral hepatitis serologies, and a complete blood count. The differential diagnosis for acute hepatitis includes other viral infections (such as cytomegalovirus or Epstein-Barr virus), drug-induced liver injury, and autoimmune hepatitis. However, given the patient’s occupation in rice plantation and the symptoms of yellow eyes and hepatosplenomegaly, viral hepatitis is the most likely diagnosis.
You
Why not leptospirosis?
ChatGPT
Leptospirosis is a possibility in the differential diagnosis for the patient’s symptoms, especially given his occupation in a rice plantation. Leptospirosis is a bacterial infection caused by the Leptospira bacteria, which are commonly found in water contaminated by animal urine, including rats. The symptoms of leptospirosis can include fever, jaundice (yellow eyes), decreased urine output, and hepatosplenomegaly (enlarged liver and spleen).
However, there are some differences between the presentation of acute viral hepatitis and leptospirosis that make hepatitis a more likely diagnosis in this case. One of the hallmark features of acute viral hepatitis is the presence of elevated liver enzymes in the blood, which are not typically seen in leptospirosis. In addition, the presence of conjunctivitis is more commonly seen in viral hepatitis than in leptospirosis.
That being said, given the patient’s occupation and the possibility of exposure to contaminated water, leptospirosis should still be considered in the differential diagnosis and appropriate testing should be performed if there is suspicion for the disease.
You
Two questions – 1) Why did you not ask about the liver enzymes before? 2) Why did you not mention leptospirosis as a differential diagnosis before?
ChatGPT
I apologize for any confusion my previous response may have caused. To answer your questions:
- I should have included asking about the patient’s liver enzymes as part of the questions to clarify the situation. Elevated liver enzymes are a common finding in acute viral hepatitis and are an important diagnostic indicator. Monitoring liver enzyme levels can also help to assess the severity and progression of liver damage.
- I should have mentioned leptospirosis as a differential diagnosis in my initial response, as it is a possibility given the patient’s occupation and symptoms. The symptoms of leptospirosis can be similar to those of viral hepatitis, and testing for leptospirosis should be considered if there is suspicion for the disease.
Again, I apologize for any confusion or omission in my previous response.
You
Are there any other differential diagnosis you have not mentioned? Please tell me those now if any are still missing
ChatGPT
There are several other potential differential diagnoses that should be considered in a patient with fever, yellow eyes, decreased urine output, conjunctivitis, and hepatosplenomegaly. Some of these include:
- Malaria: Fever, jaundice, and hepatosplenomegaly can be seen in severe cases of malaria.
- Dengue fever: Dengue fever can present with similar symptoms, including fever, jaundice, and hepatosplenomegaly.
- Typhoid fever: Typhoid fever can cause fever, jaundice, and hepatosplenomegaly, as well as gastrointestinal symptoms.
- Brucellosis: Brucellosis is a bacterial infection that can cause fever, fatigue, and hepatosplenomegaly, as well as other symptoms.
- Q fever: Q fever is a bacterial infection that can cause fever, jaundice, and hepatosplenomegaly, as well as other symptoms.
These are just a few of the many possible differential diagnoses, and the appropriate diagnostic tests will depend on the patient’s specific symptoms, medical history, and potential exposure to infectious agents.
You
Considering the age, symptoms, and occupation, and assuming zero medical history is available, what will you do to narrow down the required treatment even if the diagnosis isn’t certain?
ChatGPT
In a patient with the symptoms and occupational history described, the most important initial steps would be to confirm the diagnosis and determine the severity of the condition. This would typically involve ordering laboratory tests, including liver function tests, a complete blood count, and viral hepatitis serologies.
Based on the results of these tests, initial treatment may involve supportive care to manage symptoms and prevent complications. This may include fluids and electrolytes to address dehydration and low urine output, as well as pain management and monitoring of liver function.
If the diagnosis remains unclear, or if there is suspicion for another potential diagnosis (such as leptospirosis or malaria), additional testing may be needed. This could include imaging studies (such as an ultrasound or CT scan) to assess the liver and spleen, as well as serological testing or other diagnostic tests to rule out other infectious or inflammatory conditions.
In the meantime, it is important to ensure that the patient is receiving appropriate supportive care, including adequate hydration and monitoring of vital signs and organ function. If the patient’s condition worsens or complications arise, more aggressive interventions (such as hospitalization or specific antiviral or antibiotic treatments) may be needed.
