Id |
Subject |
Object |
Predicate |
Lexical cue |
T1 |
0-65 |
Sentence |
denotes |
A novel presentation of COVID-19 via community acquired infection |
T2 |
67-80 |
Sentence |
denotes |
1 Discussion |
T3 |
81-157 |
Sentence |
denotes |
COVID-19 is a novel coronavirus first detected in Wuhan, China in late 2019. |
T4 |
158-235 |
Sentence |
denotes |
Shortly after, it was detected in the United States by mid-January 20201 , 3. |
T5 |
236-402 |
Sentence |
denotes |
The virus can cause severe respiratory tract infections in its host more often in the elderly, immunocompromised, or individuals with multiple medical comorbidities3. |
T6 |
403-654 |
Sentence |
denotes |
Current data suggests that while up to 80% of those infected are either asymptomatic or experience mild symptoms, 15% of those infected will have severe disease requiring hospitalization, and 5% will require intensive care and mechanical ventilation2. |
T7 |
655-832 |
Sentence |
denotes |
Typical symptoms include fever (88.7%), dry cough (67.8%), and fatigue, with symptoms such as sputum production, sore throat, headache, and GI symptoms occurring less commonly2. |
T8 |
834-859 |
Sentence |
denotes |
2 Visual case discussion |
T9 |
860-950 |
Sentence |
denotes |
A 76 year old male patient presented with his wife for altered mental status and lethargy. |
T10 |
951-1045 |
Sentence |
denotes |
The patient's wife stated that for the last three days the patient ``had not seemed himself''. |
T11 |
1046-1109 |
Sentence |
denotes |
She described some confusion at home and decreased interaction. |
T12 |
1110-1225 |
Sentence |
denotes |
She reported the patient had not had fevers at home or dry cough, however she had recently experienced a dry cough. |
T13 |
1226-1311 |
Sentence |
denotes |
The couple spent the previous weekend at a nearby casino after taking public transit. |
T14 |
1312-1453 |
Sentence |
denotes |
The patient and wife had no recent long distance of international travel and no known sick contacts or known exposure to COVID-19 + patients. |
T15 |
1454-1508 |
Sentence |
denotes |
The patient had no known history of pulmonary disease. |
T16 |
1509-1610 |
Sentence |
denotes |
When vital signs were obtained the patient was found to have an oxygen saturation of 70% on room air. |
T17 |
1611-1754 |
Sentence |
denotes |
The patient was tachypneic to a rate of 23 but did not appear to be in respiratory distress and was able to answer questions in full sentences. |
T18 |
1755-1790 |
Sentence |
denotes |
Lung sounds were clear bilaterally. |
T19 |
1791-1884 |
Sentence |
denotes |
The patient was moved to an isolation room and was placed on 15 L O2 via non-rebreather mask. |
T20 |
1885-1984 |
Sentence |
denotes |
The patient was then weaned and able to maintain oxygen saturation of 93% on 5 L via nasal cannula. |
T21 |
1985-2040 |
Sentence |
denotes |
Cell counts and electrolytes were within normal limits. |
T22 |
2041-2121 |
Sentence |
denotes |
The patient was negative for Flu A/B and had a negative respiratory viral panel. |
T23 |
2122-2199 |
Sentence |
denotes |
Chest X-ray obtained showed nonspecific bibasilar airspace disease (Fig. 1 ). |
T24 |
2200-2314 |
Sentence |
denotes |
Of note, the patient's D-dimer was elevated to 2574 and CT imaging was ordered to evaluate for pulmonary embolism. |
T25 |
2315-2378 |
Sentence |
denotes |
CTA of the chest with PE protocol revealed bibasilar opacities. |
T26 |
2379-2479 |
Sentence |
denotes |
The patient was admitted to the progressive care unit for respiratory support and COVID-19 rule out. |
T27 |
2480-2514 |
Sentence |
denotes |
Fig. 1 Chest Radiograph (AP view): |
T28 |
2515-2548 |
Sentence |
denotes |
Upper lung emphysematous changes. |
T29 |
2549-2691 |
Sentence |
denotes |
Nonspecific bibasal airspace disease which could represent atypical infection or pulmonary edema superimposed on chronic inflammatory changes. |
T30 |
2692-2734 |
Sentence |
denotes |
Stable mediastinal contour and heart size. |
T31 |
2735-2769 |
Sentence |
denotes |
No large effusion or pneumothorax. |
T32 |
2770-2874 |
Sentence |
denotes |
On follow-up, patient tested positive for COVID-19 with declining respiratory status over the next 24 h. |
T33 |
2875-2975 |
Sentence |
denotes |
He was upgraded to the intensive care unit for high flow nasal cannula at 25 L/min with FiO2 of 0.6. |
T34 |
2977-2986 |
Sentence |
denotes |
Questions |
T35 |
2987-3017 |
Sentence |
denotes |
1 What is the R° for COVID-19? |
T36 |
3018-3100 |
Sentence |
denotes |
How does this compare to the R° for typical influenza?a 0.5, less than typical flu |
T37 |
3101-3131 |
Sentence |
denotes |
b 1.3, the same as typical flu |
T38 |
3132-3167 |
Sentence |
denotes |
c 1.5–1.8, the same as pandemic flu |
T39 |
3168-3199 |
Sentence |
denotes |
d 2.2, higher than pandemic flu |
T40 |
3200-3232 |
Sentence |
denotes |
e 3.0, the same as pandemic SARS |
T41 |
3233-3309 |
Sentence |
denotes |
2 What lab abnormalities can be expected in COVID-19+ patients?a Lymphopenia |
T42 |
3310-3335 |
Sentence |
denotes |
b Elevated pro-calcitonin |
T43 |
3336-3354 |
Sentence |
denotes |
c Elevated D-dimer |
T44 |
3355-3364 |
Sentence |
denotes |
d A and B |
T45 |
3365-3374 |
Sentence |
denotes |
e A and C |
T46 |
3375-3384 |
Sentence |
denotes |
f B and C |
T47 |
3385-3403 |
Sentence |
denotes |
g All of the above |
T48 |
3405-3412 |
Sentence |
denotes |
Answers |
T49 |
3413-3448 |
Sentence |
denotes |
1 Correct Answer = D, Explanation: |
T50 |
3449-3565 |
Sentence |
denotes |
The R0 is the expected number of secondary cases produced by a single typical infection in a susceptible population. |
T51 |
3566-3757 |
Sentence |
denotes |
Based on the most up-to-date statistics, COVID-19 is considered highly virulent with an expected R0 of at least 2.2 much higher than the R0 of seasonal flu, which is typically closer to 1.3.1 |
T52 |
3758-3793 |
Sentence |
denotes |
2 Correct Answer = E, Explanation: |
T53 |
3794-3869 |
Sentence |
denotes |
Patient typically present with lymphopenia and mildly elevated AST and ALT. |
T54 |
3870-3894 |
Sentence |
denotes |
Procalcitonin is normal. |
T55 |
3895-4007 |
Sentence |
denotes |
Patient who present with severe lymphopenia and elevated D-dimer has an associated increased risk of mortality.1 |
T56 |
4009-4042 |
Sentence |
denotes |
Declaration of Competing Interest |
T57 |
4043-4047 |
Sentence |
denotes |
None |