data/test.jsonl

{"case_id": 6, "age": 26, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["lung_cancer", "copd", "environmental_lung_disease"], "escalation_required": true, "vignette": "A 26-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 6, "age": 26, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["lung_cancer", "copd", "environmental_lung_disease"], "escalation_required": true, "vignette": "A 26-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 6, "age": 26, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["lung_cancer", "copd", "environmental_lung_disease"], "escalation_required": true, "vignette": "A 26-year-old female presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 6, "age": 26, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["lung_cancer", "copd", "environmental_lung_disease"], "escalation_required": true, "vignette": "A 26-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 25, "age": 47, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 47-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 25, "age": 47, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 47-year-old male presents for pulmonary evaluation. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 25, "age": 47, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 47-year-old male presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 25, "age": 47, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 47-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 27, "age": 42, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["benign_condition"], "escalation_required": true, "vignette": "A 42-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 27, "age": 42, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["benign_condition"], "escalation_required": true, "vignette": "A 42-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 27, "age": 42, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["benign_condition"], "escalation_required": true, "vignette": "A 42-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 27, "age": 42, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["benign_condition"], "escalation_required": true, "vignette": "A 42-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 30, "age": 35, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 35-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 30, "age": 35, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 35-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 30, "age": 35, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 35-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 30, "age": 35, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 35-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 32, "age": 18, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 18-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 32, "age": 18, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 18-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 32, "age": 18, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 18-year-old female presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 32, "age": 18, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 18-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 44, "age": 29, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 29-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 44, "age": 29, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 29-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 44, "age": 29, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 29-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 44, "age": 29, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 29-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 46, "age": 36, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["copd", "environmental_lung_disease", "chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 36-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 46, "age": 36, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["copd", "environmental_lung_disease", "chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 36-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 46, "age": 36, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["copd", "environmental_lung_disease", "chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 36-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 46, "age": 36, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["copd", "environmental_lung_disease", "chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 36-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Shortness of breath is progressively worsening. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 57, "age": 35, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 35-year-old male presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 57, "age": 35, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 35-year-old male presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 57, "age": 35, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 35-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 57, "age": 35, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 35-year-old male presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 67, "age": 48, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 48-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 67, "age": 48, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 48-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 67, "age": 48, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 48-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 67, "age": 48, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 48-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 71, "age": 37, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 37-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "original"}
{"case_id": 71, "age": 37, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 37-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "lexical_rephrase"}
{"case_id": 71, "age": 37, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 37-year-old female presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "symptom_removed"}
{"case_id": 71, "age": 37, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 37-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 73, "age": 44, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 44-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 73, "age": 44, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 44-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 73, "age": 44, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 44-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 73, "age": 44, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 44-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 80, "age": 46, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 46-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 80, "age": 46, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 46-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 80, "age": 46, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 46-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 80, "age": 46, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 46-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 81, "age": 44, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 44-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 81, "age": 44, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 44-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 81, "age": 44, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 44-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 81, "age": 44, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 44-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 89, "age": 39, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 39-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 89, "age": 39, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 39-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 89, "age": 39, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 39-year-old female presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 89, "age": 39, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 39-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 94, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 94, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 94, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 94, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 95, "age": 29, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 29-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 95, "age": 29, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 29-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 95, "age": 29, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 29-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 95, "age": 29, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 29-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 99, "age": 53, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 53-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 99, "age": 53, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 53-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 99, "age": 53, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 53-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 99, "age": 53, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 53-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 103, "age": 28, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 28-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 103, "age": 28, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 28-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 103, "age": 28, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 28-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 103, "age": 28, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 28-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 104, "age": 45, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 45-year-old male presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 104, "age": 45, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 45-year-old male presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 104, "age": 45, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 45-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 104, "age": 45, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 45-year-old male presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 114, "age": 39, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 39-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 114, "age": 39, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 39-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 114, "age": 39, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 39-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 114, "age": 39, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 39-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 127, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "original"}
{"case_id": 127, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "lexical_rephrase"}
{"case_id": 127, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "symptom_removed"}
{"case_id": 127, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 142, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 142, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 142, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 142, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 146, "age": 53, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 53-year-old male presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 146, "age": 53, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 53-year-old male presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 146, "age": 53, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 53-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 146, "age": 53, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 53-year-old male presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 159, "age": 28, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 28-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 159, "age": 28, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 28-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 159, "age": 28, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 28-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 159, "age": 28, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 28-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 163, "age": 62, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 62-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 163, "age": 62, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 62-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 163, "age": 62, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 62-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 163, "age": 62, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 62-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 166, "age": 64, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 64-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "original"}
{"case_id": 166, "age": 64, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 64-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "lexical_rephrase"}
{"case_id": 166, "age": 64, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 64-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "symptom_removed"}
{"case_id": 166, "age": 64, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 64-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 167, "age": 39, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 39-year-old male presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 167, "age": 39, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 39-year-old male presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 167, "age": 39, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 39-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 167, "age": 39, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 39-year-old male presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 175, "age": 35, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 35-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 175, "age": 35, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 35-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 175, "age": 35, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 35-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 175, "age": 35, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 35-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 196, "age": 37, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 37-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "original"}
{"case_id": 196, "age": 37, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 37-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "lexical_rephrase"}
{"case_id": 196, "age": 37, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 37-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "symptom_removed"}
{"case_id": 196, "age": 37, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 37-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 203, "age": 29, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["lung_cancer", "copd", "environmental_lung_disease"], "escalation_required": true, "vignette": "A 29-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 203, "age": 29, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["lung_cancer", "copd", "environmental_lung_disease"], "escalation_required": true, "vignette": "A 29-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 203, "age": 29, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["lung_cancer", "copd", "environmental_lung_disease"], "escalation_required": true, "vignette": "A 29-year-old female presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 203, "age": 29, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["lung_cancer", "copd", "environmental_lung_disease"], "escalation_required": true, "vignette": "A 29-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 214, "age": 28, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 28-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 214, "age": 28, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 28-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 214, "age": 28, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 28-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 214, "age": 28, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 28-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 216, "age": 39, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 39-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 216, "age": 39, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 39-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 216, "age": 39, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 39-year-old female presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 216, "age": 39, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 39-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 217, "age": 35, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["benign_condition"], "escalation_required": true, "vignette": "A 35-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 217, "age": 35, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["benign_condition"], "escalation_required": true, "vignette": "A 35-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 217, "age": 35, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["benign_condition"], "escalation_required": true, "vignette": "A 35-year-old female presents for pulmonary evaluation. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 217, "age": 35, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["benign_condition"], "escalation_required": true, "vignette": "A 35-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 220, "age": 26, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 26-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 220, "age": 26, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 26-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 220, "age": 26, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 26-year-old female presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 220, "age": 26, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 26-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 223, "age": 37, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 37-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "original"}
{"case_id": 223, "age": 37, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 37-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "lexical_rephrase"}
{"case_id": 223, "age": 37, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 37-year-old female presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "symptom_removed"}
{"case_id": 223, "age": 37, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 37-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 224, "age": 37, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease", "chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 37-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 224, "age": 37, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease", "chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 37-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 224, "age": 37, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease", "chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 37-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 224, "age": 37, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease", "chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 37-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 225, "age": 49, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 49-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 225, "age": 49, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 49-year-old male presents for pulmonary evaluation. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 225, "age": 49, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 49-year-old male presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 225, "age": 49, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 49-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 228, "age": 29, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["lung_cancer", "copd", "environmental_lung_disease"], "escalation_required": true, "vignette": "A 29-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 228, "age": 29, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["lung_cancer", "copd", "environmental_lung_disease"], "escalation_required": true, "vignette": "A 29-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 228, "age": 29, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["lung_cancer", "copd", "environmental_lung_disease"], "escalation_required": true, "vignette": "A 29-year-old female presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 228, "age": 29, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["lung_cancer", "copd", "environmental_lung_disease"], "escalation_required": true, "vignette": "A 29-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 233, "age": 36, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["copd", "environmental_lung_disease", "chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 36-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 233, "age": 36, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["copd", "environmental_lung_disease", "chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 36-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 233, "age": 36, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["copd", "environmental_lung_disease", "chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 36-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 233, "age": 36, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["copd", "environmental_lung_disease", "chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 36-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Shortness of breath is progressively worsening. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 234, "age": 36, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["lung_cancer", "copd", "environmental_lung_disease"], "escalation_required": true, "vignette": "A 36-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 234, "age": 36, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["lung_cancer", "copd", "environmental_lung_disease"], "escalation_required": true, "vignette": "A 36-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 234, "age": 36, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["lung_cancer", "copd", "environmental_lung_disease"], "escalation_required": true, "vignette": "A 36-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 234, "age": 36, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["lung_cancer", "copd", "environmental_lung_disease"], "escalation_required": true, "vignette": "A 36-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 238, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["copd", "environmental_lung_disease", "chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 238, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["copd", "environmental_lung_disease", "chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 238, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["copd", "environmental_lung_disease", "chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 238, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["copd", "environmental_lung_disease", "chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Shortness of breath is progressively worsening. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 250, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "original"}
{"case_id": 250, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "lexical_rephrase"}
{"case_id": 250, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "symptom_removed"}
{"case_id": 250, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 252, "age": 26, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["lung_cancer", "copd", "environmental_lung_disease"], "escalation_required": true, "vignette": "A 26-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 252, "age": 26, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["lung_cancer", "copd", "environmental_lung_disease"], "escalation_required": true, "vignette": "A 26-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 252, "age": 26, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["lung_cancer", "copd", "environmental_lung_disease"], "escalation_required": true, "vignette": "A 26-year-old female presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 252, "age": 26, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["lung_cancer", "copd", "environmental_lung_disease"], "escalation_required": true, "vignette": "A 26-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 270, "age": 48, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 48-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 270, "age": 48, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 48-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 270, "age": 48, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 48-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 270, "age": 48, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 48-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 271, "age": 26, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 26-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 271, "age": 26, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 26-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 271, "age": 26, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 26-year-old female presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 271, "age": 26, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 26-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 273, "age": 53, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 53-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 273, "age": 53, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 53-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 273, "age": 53, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 53-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 273, "age": 53, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": true, "vignette": "A 53-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Unintentional weight loss is noted. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 274, "age": 37, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 37-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "original"}
{"case_id": 274, "age": 37, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 37-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "lexical_rephrase"}
{"case_id": 274, "age": 37, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 37-year-old female presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "symptom_removed"}
{"case_id": 274, "age": 37, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 37-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 276, "age": 48, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 48-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 276, "age": 48, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 48-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 276, "age": 48, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 48-year-old female presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 276, "age": 48, "sex": "female", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 48-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 281, "age": 24, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 24-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 281, "age": 24, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 24-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 281, "age": 24, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 24-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 281, "age": 24, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 24-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 284, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 284, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 284, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 284, "age": 33, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 33-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 296, "age": 44, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 44-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 296, "age": 44, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 44-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 296, "age": 44, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 44-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 296, "age": 44, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 44-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 300, "age": 64, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 64-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "original"}
{"case_id": 300, "age": 64, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 64-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "lexical_rephrase"}
{"case_id": 300, "age": 64, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 64-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted.", "perturbation_type": "symptom_removed"}
{"case_id": 300, "age": 64, "sex": "male", "risk_tier": "High", "risk_score": 2, "urgency": "urgent_ct_scan", "gold_differential": ["environmental_lung_disease"], "escalation_required": true, "vignette": "A 64-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Unintentional weight loss is noted. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 322, "age": 27, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old male presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 322, "age": 27, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old male presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 322, "age": 27, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old male presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 322, "age": 27, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old male presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 323, "age": 33, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 33-year-old male presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 323, "age": 33, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 33-year-old male presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 323, "age": 33, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 33-year-old male presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 323, "age": 33, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 33-year-old male presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 332, "age": 18, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 18-year-old female presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 332, "age": 18, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 18-year-old female presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 332, "age": 18, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 18-year-old female presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 332, "age": 18, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 18-year-old female presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 344, "age": 32, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 32-year-old male presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 344, "age": 32, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 32-year-old male presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 344, "age": 32, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 32-year-old male presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 344, "age": 32, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 32-year-old male presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 348, "age": 48, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "original"}
{"case_id": 348, "age": 48, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "lexical_rephrase"}
{"case_id": 348, "age": 48, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "symptom_removed"}
{"case_id": 348, "age": 48, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 352, "age": 47, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 47-year-old female presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 352, "age": 47, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 47-year-old female presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 352, "age": 47, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 47-year-old female presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 352, "age": 47, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 47-year-old female presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 363, "age": 27, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old female presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 363, "age": 27, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old female presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 363, "age": 27, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old female presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 363, "age": 27, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old female presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 367, "age": 27, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old female presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 367, "age": 27, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old female presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 367, "age": 27, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old female presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 367, "age": 27, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old female presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 370, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 370, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 370, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 370, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 373, "age": 55, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 55-year-old male presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 373, "age": 55, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 55-year-old male presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 373, "age": 55, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 55-year-old male presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 373, "age": 55, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 55-year-old male presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 379, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 379, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 379, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 379, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 387, "age": 25, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 25-year-old female presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 387, "age": 25, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 25-year-old female presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 387, "age": 25, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 25-year-old female presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 387, "age": 25, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 25-year-old female presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 388, "age": 18, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 18-year-old female presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 388, "age": 18, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 18-year-old female presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 388, "age": 18, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 18-year-old female presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 388, "age": 18, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 18-year-old female presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 389, "age": 26, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 26-year-old male presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 389, "age": 26, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 26-year-old male presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 389, "age": 26, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 26-year-old male presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 389, "age": 26, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 26-year-old male presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 405, "age": 35, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 405, "age": 35, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 405, "age": 35, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 405, "age": 35, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 410, "age": 45, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 410, "age": 45, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 410, "age": 45, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 410, "age": 45, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. Unintentional weight loss is noted. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 429, "age": 47, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 47-year-old female presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 429, "age": 47, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 47-year-old female presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 429, "age": 47, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 47-year-old female presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 429, "age": 47, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 47-year-old female presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 432, "age": 25, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 25-year-old female presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 432, "age": 25, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 25-year-old female presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 432, "age": 25, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 25-year-old female presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 432, "age": 25, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 25-year-old female presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 459, "age": 45, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 459, "age": 45, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 459, "age": 45, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 459, "age": 45, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. Unintentional weight loss is noted. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 464, "age": 28, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 28-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 464, "age": 28, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 28-year-old male presents for pulmonary evaluation. This individual reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 464, "age": 28, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 28-year-old male presents for pulmonary evaluation. Hemoptysis has been observed. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 464, "age": 28, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 28-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Hemoptysis has been observed. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 469, "age": 48, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "original"}
{"case_id": 469, "age": 48, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "lexical_rephrase"}
{"case_id": 469, "age": 48, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "symptom_removed"}
{"case_id": 469, "age": 48, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 470, "age": 33, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 33-year-old male presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 470, "age": 33, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 33-year-old male presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 470, "age": 33, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 33-year-old male presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 470, "age": 33, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 33-year-old male presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 473, "age": 24, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 24-year-old female presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 473, "age": 24, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 24-year-old female presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 473, "age": 24, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 24-year-old female presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 473, "age": 24, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 24-year-old female presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 511, "age": 33, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 33-year-old male presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 511, "age": 33, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 33-year-old male presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 511, "age": 33, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 33-year-old male presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 511, "age": 33, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 33-year-old male presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 517, "age": 52, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 52-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure.", "perturbation_type": "original"}
{"case_id": 517, "age": 52, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 52-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure.", "perturbation_type": "lexical_rephrase"}
{"case_id": 517, "age": 52, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 52-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure.", "perturbation_type": "symptom_removed"}
{"case_id": 517, "age": 52, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 52-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 546, "age": 38, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old male presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 546, "age": 38, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old male presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 546, "age": 38, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old male presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 546, "age": 38, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old male presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 549, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 549, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 549, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 549, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 558, "age": 24, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 24-year-old female presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 558, "age": 24, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 24-year-old female presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 558, "age": 24, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 24-year-old female presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 558, "age": 24, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 24-year-old female presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 565, "age": 24, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 24-year-old female presents for pulmonary evaluation. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 565, "age": 24, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 24-year-old female presents for pulmonary evaluation. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 565, "age": 24, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 24-year-old female presents for pulmonary evaluation. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 565, "age": 24, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 24-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 570, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 570, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 570, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 570, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 574, "age": 24, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 24-year-old female presents for pulmonary evaluation. Hemoptysis has been observed.", "perturbation_type": "original"}
{"case_id": 574, "age": 24, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 24-year-old female presents for pulmonary evaluation. Hemoptysis has been observed.", "perturbation_type": "lexical_rephrase"}
{"case_id": 574, "age": 24, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 24-year-old female presents for pulmonary evaluation. Hemoptysis has been observed.", "perturbation_type": "symptom_removed"}
{"case_id": 574, "age": 24, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 24-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 580, "age": 45, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old male presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 580, "age": 45, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old male presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 580, "age": 45, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old male presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 580, "age": 45, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old male presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 591, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 591, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 591, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 591, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 603, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 603, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 603, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 603, "age": 38, "sex": "female", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 604, "age": 33, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 33-year-old male presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 604, "age": 33, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 33-year-old male presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 604, "age": 33, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 33-year-old male presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 604, "age": 33, "sex": "male", "risk_tier": "Low", "risk_score": 0, "urgency": "routine_followup", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 33-year-old male presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 616, "age": 27, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old male presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 616, "age": 27, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old male presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 616, "age": 27, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old male presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 616, "age": 27, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old male presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 618, "age": 22, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 22-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 618, "age": 22, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 22-year-old male presents for pulmonary evaluation. This individual reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 618, "age": 22, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 22-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 618, "age": 22, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 22-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 623, "age": 24, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["sleep_apnea"], "escalation_required": false, "vignette": "A 24-year-old male presents for pulmonary evaluation. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 623, "age": 24, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["sleep_apnea"], "escalation_required": false, "vignette": "A 24-year-old male presents for pulmonary evaluation. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 623, "age": 24, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["sleep_apnea"], "escalation_required": false, "vignette": "A 24-year-old male presents for pulmonary evaluation. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 623, "age": 24, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["sleep_apnea"], "escalation_required": false, "vignette": "A 24-year-old male presents for pulmonary evaluation. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 633, "age": 46, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": false, "vignette": "A 46-year-old female presents for pulmonary evaluation. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 633, "age": 46, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": false, "vignette": "A 46-year-old female presents for pulmonary evaluation. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 633, "age": 46, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": false, "vignette": "A 46-year-old female presents for pulmonary evaluation. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 633, "age": 46, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": false, "vignette": "A 46-year-old female presents for pulmonary evaluation. Shortness of breath is progressively worsening. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 643, "age": 48, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 643, "age": 48, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 643, "age": 48, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old female presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 643, "age": 48, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 650, "age": 14, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["sleep_apnea"], "escalation_required": false, "vignette": "A 14-year-old male presents for pulmonary evaluation. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 650, "age": 14, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["sleep_apnea"], "escalation_required": false, "vignette": "A 14-year-old male presents for pulmonary evaluation. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 650, "age": 14, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["sleep_apnea"], "escalation_required": false, "vignette": "A 14-year-old male presents for pulmonary evaluation. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 650, "age": 14, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["sleep_apnea"], "escalation_required": false, "vignette": "A 14-year-old male presents for pulmonary evaluation. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 654, "age": 52, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 52-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 654, "age": 52, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 52-year-old male presents for pulmonary evaluation. This individual reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 654, "age": 52, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 52-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 654, "age": 52, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 52-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 655, "age": 45, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 655, "age": 45, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 655, "age": 45, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 655, "age": 45, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 658, "age": 48, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 658, "age": 48, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 658, "age": 48, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old female presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 658, "age": 48, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 663, "age": 33, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 33-year-old male presents for pulmonary evaluation. Hemoptysis has been observed. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 663, "age": 33, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 33-year-old male presents for pulmonary evaluation. Hemoptysis has been observed. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 663, "age": 33, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 33-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 663, "age": 33, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 33-year-old male presents for pulmonary evaluation. Hemoptysis has been observed. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 665, "age": 52, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 52-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 665, "age": 52, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 52-year-old male presents for pulmonary evaluation. This individual reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 665, "age": 52, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 52-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 665, "age": 52, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 52-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 671, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 671, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. This individual reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 671, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 671, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 677, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "original"}
{"case_id": 677, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "lexical_rephrase"}
{"case_id": 677, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "symptom_removed"}
{"case_id": 677, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 686, "age": 19, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 19-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 686, "age": 19, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 19-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 686, "age": 19, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 19-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 686, "age": 19, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 19-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 692, "age": 36, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 36-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "original"}
{"case_id": 692, "age": 36, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 36-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "lexical_rephrase"}
{"case_id": 692, "age": 36, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 36-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "symptom_removed"}
{"case_id": 692, "age": 36, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 36-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 699, "age": 38, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "original"}
{"case_id": 699, "age": 38, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "lexical_rephrase"}
{"case_id": 699, "age": 38, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "symptom_removed"}
{"case_id": 699, "age": 38, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 701, "age": 44, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 44-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "original"}
{"case_id": 701, "age": 44, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 44-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "lexical_rephrase"}
{"case_id": 701, "age": 44, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 44-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "symptom_removed"}
{"case_id": 701, "age": 44, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 44-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 704, "age": 38, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "original"}
{"case_id": 704, "age": 38, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "lexical_rephrase"}
{"case_id": 704, "age": 38, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "symptom_removed"}
{"case_id": 704, "age": 38, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 714, "age": 38, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "original"}
{"case_id": 714, "age": 38, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "lexical_rephrase"}
{"case_id": 714, "age": 38, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "symptom_removed"}
{"case_id": 714, "age": 38, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 718, "age": 31, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 31-year-old female presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 718, "age": 31, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 31-year-old female presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 718, "age": 31, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 31-year-old female presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 718, "age": 31, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 31-year-old female presents for pulmonary evaluation. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 721, "age": 45, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 721, "age": 45, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 721, "age": 45, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 721, "age": 45, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 733, "age": 14, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["sleep_apnea"], "escalation_required": false, "vignette": "A 14-year-old male presents for pulmonary evaluation. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 733, "age": 14, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["sleep_apnea"], "escalation_required": false, "vignette": "A 14-year-old male presents for pulmonary evaluation. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 733, "age": 14, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["sleep_apnea"], "escalation_required": false, "vignette": "A 14-year-old male presents for pulmonary evaluation. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 733, "age": 14, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["sleep_apnea"], "escalation_required": false, "vignette": "A 14-year-old male presents for pulmonary evaluation. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 735, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "original"}
{"case_id": 735, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "lexical_rephrase"}
{"case_id": 735, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "symptom_removed"}
{"case_id": 735, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 746, "age": 44, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 44-year-old male presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 746, "age": 44, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 44-year-old male presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 746, "age": 44, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 44-year-old male presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 746, "age": 44, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 44-year-old male presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 747, "age": 52, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 52-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 747, "age": 52, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 52-year-old male presents for pulmonary evaluation. This individual reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 747, "age": 52, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 52-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 747, "age": 52, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 52-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 754, "age": 45, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old female presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 754, "age": 45, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old female presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 754, "age": 45, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old female presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 754, "age": 45, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old female presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 758, "age": 32, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 32-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 758, "age": 32, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 32-year-old male presents for pulmonary evaluation. This individual reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 758, "age": 32, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 32-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 758, "age": 32, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 32-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 759, "age": 35, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 759, "age": 35, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 759, "age": 35, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old female presents for pulmonary evaluation. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 759, "age": 35, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 762, "age": 38, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "original"}
{"case_id": 762, "age": 38, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "lexical_rephrase"}
{"case_id": 762, "age": 38, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "symptom_removed"}
{"case_id": 762, "age": 38, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 777, "age": 14, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["sleep_apnea"], "escalation_required": false, "vignette": "A 14-year-old male presents for pulmonary evaluation. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 777, "age": 14, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["sleep_apnea"], "escalation_required": false, "vignette": "A 14-year-old male presents for pulmonary evaluation. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 777, "age": 14, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["sleep_apnea"], "escalation_required": false, "vignette": "A 14-year-old male presents for pulmonary evaluation. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 777, "age": 14, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["sleep_apnea"], "escalation_required": false, "vignette": "A 14-year-old male presents for pulmonary evaluation. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 781, "age": 48, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "original"}
{"case_id": 781, "age": 48, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "lexical_rephrase"}
{"case_id": 781, "age": 48, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "symptom_removed"}
{"case_id": 781, "age": 48, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old female presents for pulmonary evaluation. Unintentional weight loss is noted. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 786, "age": 27, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old male presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 786, "age": 27, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old male presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 786, "age": 27, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old male presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 786, "age": 27, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old male presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 791, "age": 28, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": false, "vignette": "A 28-year-old female presents for pulmonary evaluation. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 791, "age": 28, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": false, "vignette": "A 28-year-old female presents for pulmonary evaluation. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 791, "age": 28, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": false, "vignette": "A 28-year-old female presents for pulmonary evaluation. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 791, "age": 28, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["chronic_respiratory_infection"], "escalation_required": false, "vignette": "A 28-year-old female presents for pulmonary evaluation. Shortness of breath is progressively worsening. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 794, "age": 38, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 794, "age": 38, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 794, "age": 38, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 794, "age": 38, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 38-year-old female presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 824, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "original"}
{"case_id": 824, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "lexical_rephrase"}
{"case_id": 824, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "symptom_removed"}
{"case_id": 824, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 825, "age": 14, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["sleep_apnea"], "escalation_required": false, "vignette": "A 14-year-old male presents for pulmonary evaluation. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 825, "age": 14, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["sleep_apnea"], "escalation_required": false, "vignette": "A 14-year-old male presents for pulmonary evaluation. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 825, "age": 14, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["sleep_apnea"], "escalation_required": false, "vignette": "A 14-year-old male presents for pulmonary evaluation. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 825, "age": 14, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["sleep_apnea"], "escalation_required": false, "vignette": "A 14-year-old male presents for pulmonary evaluation. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 826, "age": 52, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 52-year-old female presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 826, "age": 52, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 52-year-old female presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 826, "age": 52, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 52-year-old female presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 826, "age": 52, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 52-year-old female presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 828, "age": 23, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 23-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 828, "age": 23, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 23-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 828, "age": 23, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 23-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 828, "age": 23, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 23-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 858, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "original"}
{"case_id": 858, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "lexical_rephrase"}
{"case_id": 858, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted.", "perturbation_type": "symptom_removed"}
{"case_id": 858, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 865, "age": 38, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 38-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 865, "age": 38, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 38-year-old male presents for pulmonary evaluation. This individual reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 865, "age": 38, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 38-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 865, "age": 38, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 38-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 874, "age": 48, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 874, "age": 48, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 874, "age": 48, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old female presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 874, "age": 48, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 48-year-old female presents for pulmonary evaluation. Hemoptysis has been observed. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 880, "age": 45, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 880, "age": 45, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 880, "age": 45, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 880, "age": 45, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 884, "age": 65, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 65-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 884, "age": 65, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 65-year-old male presents for pulmonary evaluation. This individual reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 884, "age": 65, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 65-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 884, "age": 65, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 65-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 888, "age": 35, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 888, "age": 35, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 888, "age": 35, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old female presents for pulmonary evaluation. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 888, "age": 35, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old female presents for pulmonary evaluation. There is a significant history of tobacco exposure. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 892, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 892, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. This individual reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 892, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 892, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 893, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 893, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 893, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 893, "age": 35, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 35-year-old male presents for pulmonary evaluation. There is a significant history of tobacco exposure. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 896, "age": 27, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old male presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 896, "age": 27, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old male presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 896, "age": 27, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old male presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 896, "age": 27, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 27-year-old male presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 899, "age": 45, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "original"}
{"case_id": 899, "age": 45, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "lexical_rephrase"}
{"case_id": 899, "age": 45, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening.", "perturbation_type": "symptom_removed"}
{"case_id": 899, "age": 45, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 45-year-old male presents for pulmonary evaluation. Shortness of breath is progressively worsening. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 901, "age": 22, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 22-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "original"}
{"case_id": 901, "age": 22, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 22-year-old male presents for pulmonary evaluation. This individual reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "lexical_rephrase"}
{"case_id": 901, "age": 22, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 22-year-old male presents for pulmonary evaluation. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination.", "perturbation_type": "symptom_removed"}
{"case_id": 901, "age": 22, "sex": "male", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["environmental_lung_disease"], "escalation_required": false, "vignette": "A 22-year-old male presents for pulmonary evaluation. The patient reports chronic exposure to environmental pollutants. Unintentional weight loss is noted. Shortness of breath is progressively worsening. Digital clubbing is present on examination. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}
{"case_id": 903, "age": 52, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 52-year-old female presents for pulmonary evaluation.", "perturbation_type": "original"}
{"case_id": 903, "age": 52, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 52-year-old female presents for pulmonary evaluation.", "perturbation_type": "lexical_rephrase"}
{"case_id": 903, "age": 52, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 52-year-old female presents for pulmonary evaluation.", "perturbation_type": "symptom_removed"}
{"case_id": 903, "age": 52, "sex": "female", "risk_tier": "Medium", "risk_score": 1, "urgency": "specialist_consult", "gold_differential": ["benign_condition"], "escalation_required": false, "vignette": "A 52-year-old female presents for pulmonary evaluation. However, the patient denies severe respiratory distress.", "perturbation_type": "contradictory_signal"}