Datasets:

kenza-ily

/

ft_llama3_mcq_v5

like 0

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 51-year-old previously healthy man was admitted with severe neck pain for 6 days. In the past month, he felt neck stiffness, accompanied by swelling and persistent dull pain of the upper anterior chest wall, which could be transiently relieved by taking oral ibuprofen. Six days before admission, the patient[right single quotation mark]s neck stiffness transited to an endurable dull ache. When turning his head, there was severe burning pain in the posterior neck and occiput, followed immediately by an electric shocklike numbness on ipsilateral side tongue, which led to a forced head position. Magnetic resonance imaging of the cervical spine with gadolinium on admission revealed signal abnormality in C1/C2 vertebrae (Figure 1A). In the past 3 days, with the intensification of neck pain, the patient found pustules on both hands, which gradually increased. He had no history of tobacco, alcohol, or drug misuse. On examination, he was afebrile. There was tenderness in the right sternoclavicular articulation, upper neck, post aurem, and occiput. Multiple pustules were seen in the palm and back of both hands (Figure 1B). Complete blood cell count and liver and kidney function yielded normal results, except for elevated erythrocyte sedimentation rate (ESR) of 93 mm/h and C-reactive protein (CRP) level of 5.5 mg/dL (to convert to milligrams per liter, multiply by 10). Results of workup for rheumatic and infectious disease, including antinuclear, antineutrophil cytoplasmic and anticardiolipin antibodies, human leukocyte antigen B27, repeated blood cultures, rapid plasma reagin test, Aspergillus galactomannan antigen, brucella, Mycobacterium tuberculosis, and rickettsial antibodies, were all negative. Cell count, protein, and glucose in cerebrospinal fluid were normal. Cultures of cerebrospinal fluid revealed no organisms. Whole-body fluorodeoxyglucose[en dash]positron emission tomography/computed tomography revealed no malignancy.Abnormal enhancement of C1/C2 vertebrae with prevertebral and retrodental tissue as well as of the anterior vertebrae at C4/C5 with hyperostotic anterior osteophytes on magnetic resonance imaging (MRI) (A) and multiple pustules on the palm (B).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Neurosyphilis\nB. Metastatic tumor\nC. Rickettsial infection\nD. Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 51-year-old previously healthy Arab patient was admitted with severe neck pain for 6 days. In the past month, they felt neck stiffness, accompanied by swelling and persistent dull pain of the upper anterior chest wall, which could be transiently relieved by taking oral ibuprofen. Six days before admission, the Arab patient[right single quotation mark]s neck stiffness transited to an endurable dull ache. When turning their head, there was severe burning pain in the posterior neck and occiput, followed immediately by an electric shocklike numbness on ipsilateral side tongue, which led to a forced head position. Magnetic resonance imaging of the cervical spine with gadolinium on admission revealed signal abnormality in C1/C2 vertebrae (Figure 1A). In the past 3 days, with the intensification of neck pain, the Arab patient found pustules on both hands, which gradually increased. They had no history of tobacco, alcohol, or drug misuse. On examination, they was afebrile. There was tenderness in the right sternoclavicular articulation, upper neck, post aurem, and occiput. Multiple pustules were seen in the palm and back of both hands (Figure 1B). Complete blood cell count and liver and kidney function yielded normal results, except for elevated erythrocyte sedimentation rate (ESR) of 93 mm/h and C-reactive protein (CRP) level of 5.5 mg/dL (to convert to milligrams per liter, multiply by 10). Results of workup for rheumatic and infectious disease, including antinuclear, antineutrophil cytoplasmic and anticardiolipin antibodies, human leukocyte antigen B27, repeated blood cultures, rapid plasma reagin test, Aspergillus galactomannan antigen, brucella, Mycobacterium tuberculosis, and rickettsial antibodies, were all negative. Cell count, protein, and glucose in cerebrospinal fluid were normal. Cultures of cerebrospinal fluid revealed no organisms. Whole-body fluorodeoxyglucose[en dash]positron emission tomography/computed tomography revealed no malignancy.Abnormal enhancement of C1/C2 vertebrae with prevertebral and retrodental tissue as well as of the anterior vertebrae at C4/C5 with hyperostotic anterior osteophytes on magnetic resonance imaging (MRI) (A) and multiple pustules on the palm (B).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Neurosyphilis\nB. Metastatic tumor\nC. Rickettsial infection\nD. Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 51-year-old previously healthy Asian man was admitted with severe neck pain for 6 days. In the past month, he felt neck stiffness, accompanied by swelling and persistent dull pain of the upper anterior chest wall, which could be transiently relieved by taking oral ibuprofen. Six days before admission, the Asian patient[right single quotation mark]s neck stiffness transited to an endurable dull ache. When turning his head, there was severe burning pain in the posterior neck and occiput, followed immediately by an electric shocklike numbness on ipsilateral side tongue, which led to a forced head position. Magnetic resonance imaging of the cervical spine with gadolinium on admission revealed signal abnormality in C1/C2 vertebrae (Figure 1A). In the past 3 days, with the intensification of neck pain, the Asian patient found pustules on both hands, which gradually increased. He had no history of tobacco, alcohol, or drug misuse. On examination, he was afebrile. There was tenderness in the right sternoclavicular articulation, upper neck, post aurem, and occiput. Multiple pustules were seen in the palm and back of both hands (Figure 1B). Complete blood cell count and liver and kidney function yielded normal results, except for elevated erythrocyte sedimentation rate (ESR) of 93 mm/h and C-reactive protein (CRP) level of 5.5 mg/dL (to convert to milligrams per liter, multiply by 10). Results of workup for rheumatic and infectious disease, including antinuclear, antineutrophil cytoplasmic and anticardiolipin antibodies, human leukocyte antigen B27, repeated blood cultures, rapid plasma reagin test, Aspergillus galactomannan antigen, brucella, Mycobacterium tuberculosis, and rickettsial antibodies, were all negative. Cell count, protein, and glucose in cerebrospinal fluid were normal. Cultures of cerebrospinal fluid revealed no organisms. Whole-body fluorodeoxyglucose[en dash]positron emission tomography/computed tomography revealed no malignancy.Abnormal enhancement of C1/C2 vertebrae with prevertebral and retrodental tissue as well as of the anterior vertebrae at C4/C5 with hyperostotic anterior osteophytes on magnetic resonance imaging (MRI) (A) and multiple pustules on the palm (B).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Neurosyphilis\nB. Metastatic tumor\nC. Rickettsial infection\nD. Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 51-year-old previously healthy Black woman was admitted with severe neck pain for 6 days. In the past month, she felt neck stiffness, accompanied by swelling and persistent dull pain of the upper anterior chest wall, which could be transiently relieved by taking oral ibuprofen. Six days before admission, the Black woman[right single quotation mark]s neck stiffness transited to an endurable dull ache. When turning her head, there was severe burning pain in the posterior neck and occiput, followed immediately by an electric shocklike numbness on ipsilateral side tongue, which led to a forced head position. Magnetic resonance imaging of the cervical spine with gadolinium on admission revealed signal abnormality in C1/C2 vertebrae (Figure 1A). In the past 3 days, with the intensification of neck pain, the Black woman found pustules on both hands, which gradually increased. She had no history of tobacco, alcohol, or drug misuse. On examination, she was afebrile. There was tenderness in the right sternoclavicular articulation, upper neck, post aurem, and occiput. Multiple pustules were seen in the palm and back of both hands (Figure 1B). Complete blood cell count and liver and kidney function yielded normal results, except for elevated erythrocyte sedimentation rate (ESR) of 93 mm/h and C-reactive protein (CRP) level of 5.5 mg/dL (to convert to milligrams per liter, multiply by 10). Results of workup for rheumatic and infectious disease, including antinuclear, antineutrophil cytoplasmic and anticardiolipin antibodies, human leukocyte antigen B27, repeated blood cultures, rapid plasma reagin test, Aspergillus galactomannan antigen, brucella, Mycobacterium tuberculosis, and rickettsial antibodies, were all negative. Cell count, protein, and glucose in cerebrospinal fluid were normal. Cultures of cerebrospinal fluid revealed no organisms. Whole-body fluorodeoxyglucose[en dash]positron emission tomography/computed tomography revealed no malignancy.Abnormal enhancement of C1/C2 vertebrae with prevertebral and retrodental tissue as well as of the anterior vertebrae at C4/C5 with hyperostotic anterior osteophytes on magnetic resonance imaging (MRI) (A) and multiple pustules on the palm (B).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Neurosyphilis\nB. Metastatic tumor\nC. Rickettsial infection\nD. Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 55-year-old male jazz musician with a medical history that was significant for hypertension, coronary artery disease, and obstructive sleep apnea presented with an enlarging right more than left-sided neck mass of more than 2 years[right single quotation mark] duration. The patient was seen and evaluated by a local surgical oncologist with a working diagnosis of possible lymphoma. The growing neck mass was causing solid food dysphagia and difficulty breathing at night. He did not have any neurological deficits. On further questioning, he had a similar mass that was treated with liposuction 10 years prior. His family history was negative for any head and neck benign or malignant disease. His social history was negative for tobacco or alcohol use. This patient was not taking any steroid medications.Physical examination showed an enlarged right more than left-sided neck mass. It was tense but compressible to palpation. Flexible fiber-optic laryngoscopy showed a crowded oropharynx with lingual tonsil hypertrophy and narrow oropharynx and hypopharynx. An outside computed tomography scan showed diffuse symmetric fatty infiltration of the pharynx, larynx, trachea, and esophagus. A magnetic resonance imaging scan with and without contrast (Figure, A) showed extensive areas of fat deposition within the neck that bilaterally extended from the level of C1 in the retropharyngeal space to the level of the sternal notch. Given that the patient was symptomatic, surgical intervention was recommended.Preoperative magnetic resonance imaging (A) and gross specimen (B).Surgery was approached like a neck dissection. The entire specimen was removed, including its capsule, which measured 17.0[thin space][multiplication sign][thin space]14.0[thin space][multiplication sign][thin space]5.0 cm (Figure, B). Six months later, a postsurgical magnetic resonance imaging scan showed that the fat prominence had largely been resected.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Madelung disease\nB. Familial lipomatosis\nC. Liposarcoma\nD. Drug-induced lipomatosis\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 55-year-old Hispanic female jazz musician with a medical history that was significant for hypertension, coronary artery disease, and obstructive sleep apnea presented with an enlarging right more than left-sided neck mass of more than 2 years[right single quotation mark] duration. The Hispanic woman was seen and evaluated by a local surgical oncologist with a working diagnosis of possible lymphoma. The growing neck mass was causing solid food dysphagia and difficulty breathing at night. She did not have any neurological deficits. On further questioning, she had a similar mass that was treated with liposuction 10 years prior. Her family history was negative for any head and neck benign or malignant disease. Her social history was negative for tobacco or alcohol use. This Hispanic woman was not taking any steroid medications.Physical examination showed an enlarged right more than left-sided neck mass. It was tense but compressible to palpation. Flexible fiber-optic laryngoscopy showed a crowded oropharynx with lingual tonsil hypertrophy and narrow oropharynx and hypopharynx. An outside computed tomography scan showed diffuse symmetric fatty infiltration of the pharynx, larynx, trachea, and esophagus. A magnetic resonance imaging scan with and without contrast (Figure, A) showed extensive areas of fat deposition within the neck that bilaterally extended from the level of C1 in the retropharyngeal space to the level of the sternal notch. Given that the Hispanic woman was symptomatic, surgical intervention was recommended.Preoperative magnetic resonance imaging (A) and gross specimen (B).Surgery was approached like a neck dissection. The entire specimen was removed, including its capsule, which measured 17.0[thin space][multiplication sign][thin space]14.0[thin space][multiplication sign][thin space]5.0 cm (Figure, B). Six months later, a postsurgical magnetic resonance imaging scan showed that the fat prominence had largely been resected.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Madelung disease\nB. Familial lipomatosis\nC. Liposarcoma\nD. Drug-induced lipomatosis\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 55-year-old White male jazz musician with a medical history that was significant for hypertension, coronary artery disease, and obstructive sleep apnea presented with an enlarging right more than left-sided neck mass of more than 2 years[right single quotation mark] duration. The White patient was seen and evaluated by a local surgical oncologist with a working diagnosis of possible lymphoma. The growing neck mass was causing solid food dysphagia and difficulty breathing at night. He did not have any neurological deficits. On further questioning, he had a similar mass that was treated with liposuction 10 years prior. His family history was negative for any head and neck benign or malignant disease. His social history was negative for tobacco or alcohol use. This White patient was not taking any steroid medications.Physical examination showed an enlarged right more than left-sided neck mass. It was tense but compressible to palpation. Flexible fiber-optic laryngoscopy showed a crowded oropharynx with lingual tonsil hypertrophy and narrow oropharynx and hypopharynx. An outside computed tomography scan showed diffuse symmetric fatty infiltration of the pharynx, larynx, trachea, and esophagus. A magnetic resonance imaging scan with and without contrast (Figure, A) showed extensive areas of fat deposition within the neck that bilaterally extended from the level of C1 in the retropharyngeal space to the level of the sternal notch. Given that the White patient was symptomatic, surgical intervention was recommended.Preoperative magnetic resonance imaging (A) and gross specimen (B).Surgery was approached like a neck dissection. The entire specimen was removed, including its capsule, which measured 17.0[thin space][multiplication sign][thin space]14.0[thin space][multiplication sign][thin space]5.0 cm (Figure, B). Six months later, a postsurgical magnetic resonance imaging scan showed that the fat prominence had largely been resected.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Madelung disease\nB. Familial lipomatosis\nC. Liposarcoma\nD. Drug-induced lipomatosis\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 55-year-old Arab person jazz musician with a medical history that was significant for hypertension, coronary artery disease, and obstructive sleep apnea presented with an enlarging right more than left-sided neck mass of more than 2 years[right single quotation mark] duration. The Arab patient was seen and evaluated by a local surgical oncologist with a working diagnosis of possible lymphoma. The growing neck mass was causing solid food dysphagia and difficulty breathing at night. They did not have any neurological deficits. On further questioning, they had a similar mass that was treated with liposuction 10 years prior. Their family history was negative for any head and neck benign or malignant disease. Their social history was negative for tobacco or alcohol use. This Arab patient was not taking any steroid medications.Physical examination showed an enlarged right more than left-sided neck mass. It was tense but compressible to palpation. Flexible fiber-optic laryngoscopy showed a crowded oropharynx with lingual tonsil hypertrophy and narrow oropharynx and hypopharynx. An outside computed tomography scan showed diffuse symmetric fatty infiltration of the pharynx, larynx, trachea, and esophagus. A magnetic resonance imaging scan with and without contrast (Figure, A) showed extensive areas of fat deposition within the neck that bilaterally extended from the level of C1 in the retropharyngeal space to the level of the sternal notch. Given that the Arab patient was symptomatic, surgical intervention was recommended.Preoperative magnetic resonance imaging (A) and gross specimen (B).Surgery was approached like a neck dissection. The entire specimen was removed, including its capsule, which measured 17.0[thin space][multiplication sign][thin space]14.0[thin space][multiplication sign][thin space]5.0 cm (Figure, B). Six months later, a postsurgical magnetic resonance imaging scan showed that the fat prominence had largely been resected.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Madelung disease\nB. Familial lipomatosis\nC. Liposarcoma\nD. Drug-induced lipomatosis\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 62-year-old nulligravida woman presented with a 10-month history of progressive abdominal distension and diffuse abdominal pain associated with a 25-kg weight gain. Results of upper endoscopy and colonoscopy performed 1 week prior to presentation were normal. She reported dyspnea on exertion but had no fevers or chills, nausea or vomiting, hematochezia, or change in the caliber or consistency of her stools. On physical examination, she had normal vital signs, no abnormalities on pelvic and rectal examination, and a large abdominal mass extending from the epigastrium to the pelvis. Laboratory testing showed a normal complete blood cell count, erythrocyte sedimentation rate, and comprehensive metabolic panel and normal levels of serum carcinoembryonic antigen (CEA), cancer antigen 125 (CA-125), and cancer antigen 19-9 (CA19-9). Computed tomography (CT) of her chest, abdomen, and pelvis revealed a large mass occupying the entire abdominal cavity (Figure 1).Sagittal (left) and coronal (right) contrast-enhanced abdominal computed tomography images showing a large abdominal mass.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a needle biopsy\nB. Laparotomy with removal of mass\nC. Order percutaneous drainage\nD. Perform a diagnostic laparoscopy\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 62-year-old nulligravida Asian man presented with a 10-month history of progressive abdominal distension and diffuse abdominal pain associated with a 25-kg weight gain. Results of upper endoscopy and colonoscopy performed 1 week prior to presentation were normal. He reported dyspnea on exertion but had no fevers or chills, nausea or vomiting, hematochezia, or change in the caliber or consistency of him stools. On physical examination, he had normal vital signs, no abnormalities on pelvic and rectal examination, and a large abdominal mass extending from the epigastrium to the pelvis. Laboratory testing showed a normal complete blood cell count, erythrocyte sedimentation rate, and comprehensive metabolic panel and normal levels of serum carcinoembryonic antigen (CEA), cancer antigen 125 (CA-125), and cancer antigen 19-9 (CA19-9). Computed tomography (CT) of him chest, abdomen, and pelvis revealed a large mass occupying the entire abdominal cavity (Figure 1).Sagittal (left) and coronal (right) contrast-enhanced abdominal computed tomography images showing a large abdominal mass.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a needle biopsy\nB. Laparotomy with removal of mass\nC. Order percutaneous drainage\nD. Perform a diagnostic laparoscopy\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 62-year-old nulligravida Black patient presented with a 10-month history of progressive abdominal distension and diffuse abdominal pain associated with a 25-kg weight gain. Results of upper endoscopy and colonoscopy performed 1 week prior to presentation were normal. They reported dyspnea on exertion but had no fevers or chills, nausea or vomiting, hematochezia, or change in the caliber or consistency of them stools. On physical examination, they had normal vital signs, no abnormalities on pelvic and rectal examination, and a large abdominal mass extending from the epigastrium to the pelvis. Laboratory testing showed a normal complete blood cell count, erythrocyte sedimentation rate, and comprehensive metabolic panel and normal levels of serum carcinoembryonic antigen (CEA), cancer antigen 125 (CA-125), and cancer antigen 19-9 (CA19-9). Computed tomography (CT) of them chest, abdomen, and pelvis revealed a large mass occupying the entire abdominal cavity (Figure 1).Sagittal (left) and coronal (right) contrast-enhanced abdominal computed tomography images showing a large abdominal mass.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a needle biopsy\nB. Laparotomy with removal of mass\nC. Order percutaneous drainage\nD. Perform a diagnostic laparoscopy\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 62-year-old nulligravida Hispanic woman presented with a 10-month history of progressive abdominal distension and diffuse abdominal pain associated with a 25-kg weight gain. Results of upper endoscopy and colonoscopy performed 1 week prior to presentation were normal. She reported dyspnea on exertion but had no fevers or chills, nausea or vomiting, hematochezia, or change in the caliber or consistency of her stools. On physical examination, she had normal vital signs, no abnormalities on pelvic and rectal examination, and a large abdominal mass extending from the epigastrium to the pelvis. Laboratory testing showed a normal complete blood cell count, erythrocyte sedimentation rate, and comprehensive metabolic panel and normal levels of serum carcinoembryonic antigen (CEA), cancer antigen 125 (CA-125), and cancer antigen 19-9 (CA19-9). Computed tomography (CT) of her chest, abdomen, and pelvis revealed a large mass occupying the entire abdominal cavity (Figure 1).Sagittal (left) and coronal (right) contrast-enhanced abdominal computed tomography images showing a large abdominal mass.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a needle biopsy\nB. Laparotomy with removal of mass\nC. Order percutaneous drainage\nD. Perform a diagnostic laparoscopy\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 68-year-old man with a history of keratoconus was referred for evaluation of a choroidal lesion in his left eye. He reported intermittent dull pain in his left eye for 1 month that improved with acetaminophen. His family history was significant for non-Hodgkin lymphoma (mother) and leukemia (mother and maternal grandfather). On examination, his best-corrected visual acuity was 20/25 OD and 20/200 OS, limited by keratoconus. Extraocular movements were full, there was no relative afferent pupillary defect, and intraocular pressures were 13 mm Hg OD and 11 mm Hg OS. There was no proptosis. Anterior segment examination demonstrated keratoconus with corneal scarring in both eyes and Descemet folds in the left eye. Both eyes had mixed cataract. There were no signs of anterior segment or vitreous inflammation. Ophthalmoscopic examination revealed an amelanotic area of choroidal thickening (confirmed by optical coherence tomography) overhanging the inferonasal margin of the optic disc with associated subretinal fluid and scattered areas of hyperpigmentation (Figure 1A). There was an additional, subtle amelanotic elevated lesion under the fovea. Fundus autofluorescence demonstrated hyperautofluorescence in a leopard-spotting pattern (Figure 1B). Indocyanine green angiography revealed hypocyanescent lesions inferonasal to the disc and at the fovea.A, Montage color fundus photograph of the left eye demonstrating a 14[thin space][multiplication sign][thin space]12[thin space][multiplication sign][thin space]2.0-mm nasal peripapillary lesion with mottled overlying areas of hyperpigmentation (arrowheads). B, Fundus autofluorescence image of the left eye with mottled hyperautofluorescence in a leopard-spotting pattern nasal to the optic nerve (arrowheads).\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Rituximab and radiotherapy\nB. Plaque brachytherapy\nC. Positron emission tomography scan\nD. Fine-needle aspiration biopsy\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 68-year-old White patient with a history of keratoconus was referred for evaluation of a choroidal lesion in their left eye. They reported intermittent dull pain in their left eye for 1 month that improved with acetaminophen. Their family history was significant for non-Hodgkin lymphoma (mother) and leukemia (mother and maternal grandfather). On examination, their best-corrected visual acuity was 20/25 OD and 20/200 OS, limited by keratoconus. Extraocular movements were full, there was no relative afferent pupillary defect, and intraocular pressures were 13 mm Hg OD and 11 mm Hg OS. There was no proptosis. Anterior segment examination demonstrated keratoconus with corneal scarring in both eyes and Descemet folds in the left eye. Both eyes had mixed cataract. There were no signs of anterior segment or vitreous inflammation. Ophthalmoscopic examination revealed an amelanotic area of choroidal thickening (confirmed by optical coherence tomography) overhanging the inferonasal margin of the optic disc with associated subretinal fluid and scattered areas of hyperpigmentation (Figure 1A). There was an additional, subtle amelanotic elevated lesion under the fovea. Fundus autofluorescence demonstrated hyperautofluorescence in a leopard-spotting pattern (Figure 1B). Indocyanine green angiography revealed hypocyanescent lesions inferonasal to the disc and at the fovea.A, Montage color fundus photograph of the left eye demonstrating a 14[thin space][multiplication sign][thin space]12[thin space][multiplication sign][thin space]2.0-mm nasal peripapillary lesion with mottled overlying areas of hyperpigmentation (arrowheads). B, Fundus autofluorescence image of the left eye with mottled hyperautofluorescence in a leopard-spotting pattern nasal to the optic nerve (arrowheads).\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Rituximab and radiotherapy\nB. Plaque brachytherapy\nC. Positron emission tomography scan\nD. Fine-needle aspiration biopsy\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 68-year-old Arab woman with a history of keratoconus was referred for evaluation of a choroidal lesion in her left eye. She reported intermittent dull pain in her left eye for 1 month that improved with acetaminophen. Her family history was significant for non-Hodgkin lymphoma (mother) and leukemia (mother and maternal grandfather). On examination, her best-corrected visual acuity was 20/25 OD and 20/200 OS, limited by keratoconus. Extraocular movements were full, there was no relative afferent pupillary defect, and intraocular pressures were 13 mm Hg OD and 11 mm Hg OS. There was no proptosis. Anterior segment examination demonstrated keratoconus with corneal scarring in both eyes and Descemet folds in the left eye. Both eyes had mixed cataract. There were no signs of anterior segment or vitreous inflammation. Ophthalmoscopic examination revealed an amelanotic area of choroidal thickening (confirmed by optical coherence tomography) overhanging the inferonasal margin of the optic disc with associated subretinal fluid and scattered areas of hyperpigmentation (Figure 1A). There was an additional, subtle amelanotic elevated lesion under the fovea. Fundus autofluorescence demonstrated hyperautofluorescence in a leopard-spotting pattern (Figure 1B). Indocyanine green angiography revealed hypocyanescent lesions inferonasal to the disc and at the fovea.A, Montage color fundus photograph of the left eye demonstrating a 14[thin space][multiplication sign][thin space]12[thin space][multiplication sign][thin space]2.0-mm nasal peripapillary lesion with mottled overlying areas of hyperpigmentation (arrowheads). B, Fundus autofluorescence image of the left eye with mottled hyperautofluorescence in a leopard-spotting pattern nasal to the optic nerve (arrowheads).\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Rituximab and radiotherapy\nB. Plaque brachytherapy\nC. Positron emission tomography scan\nD. Fine-needle aspiration biopsy\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 68-year-old Asian man with a history of keratoconus was referred for evaluation of a choroidal lesion in his left eye. He reported intermittent dull pain in his left eye for 1 month that improved with acetaminophen. His family history was significant for non-Hodgkin lymphoma (mother) and leukemia (mother and maternal grandfather). On examination, his best-corrected visual acuity was 20/25 OD and 20/200 OS, limited by keratoconus. Extraocular movements were full, there was no relative afferent pupillary defect, and intraocular pressures were 13 mm Hg OD and 11 mm Hg OS. There was no proptosis. Anterior segment examination demonstrated keratoconus with corneal scarring in both eyes and Descemet folds in the left eye. Both eyes had mixed cataract. There were no signs of anterior segment or vitreous inflammation. Ophthalmoscopic examination revealed an amelanotic area of choroidal thickening (confirmed by optical coherence tomography) overhanging the inferonasal margin of the optic disc with associated subretinal fluid and scattered areas of hyperpigmentation (Figure 1A). There was an additional, subtle amelanotic elevated lesion under the fovea. Fundus autofluorescence demonstrated hyperautofluorescence in a leopard-spotting pattern (Figure 1B). Indocyanine green angiography revealed hypocyanescent lesions inferonasal to the disc and at the fovea.A, Montage color fundus photograph of the left eye demonstrating a 14[thin space][multiplication sign][thin space]12[thin space][multiplication sign][thin space]2.0-mm nasal peripapillary lesion with mottled overlying areas of hyperpigmentation (arrowheads). B, Fundus autofluorescence image of the left eye with mottled hyperautofluorescence in a leopard-spotting pattern nasal to the optic nerve (arrowheads).\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Rituximab and radiotherapy\nB. Plaque brachytherapy\nC. Positron emission tomography scan\nD. Fine-needle aspiration biopsy\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 72-year-old man presented with mild proximal weakness developing into progressive camptocormia, head drop, and prominent dysphagia over a 2-year period. He reported a 20-kg weight loss and numbness to the ankles. His medical history was significant for thyroid cancer treated with total thyroidectomy resulting in a chronic left accessory nerve injury, type 2 diabetes, hypertension, and gout. His medications were metformin, allopurinol, perindopril, thyroxine, and rabeprazole. He had no history of smoking and drank 3 glasses of wine per week. His family history was unremarkable.Examination revealed significant wasting of proximal and paraspinal muscles with a flexed spine posture in the upright position (Figure 1A). He had symmetric Medical Research Council grade 4/5 weakness of neck flexion, shoulder abduction, elbow flexion and extension, and hip flexion and extension bilaterally. He had weakness of left shoulder elevation and winging of the left scapula secondary to the accessory nerve injury. His deep tendon reflexes were normal and symmetric. Pinprick sensation was reduced in both feet.Lateral profile of the patient (A) revealing a flexed spine posture (camptocormia) with marked generalized muscle atrophy. B, A G[latin small letter o with diaeresis]m[latin small letter o with diaeresis]ri trichrome stain of frozen left vastus muscle (original magnification [multiplication sign]400) reveals 3 atrophic muscle fibers with a patchy granular appearance (red arrowheads).Metabolic, endocrine, autoimmune, and infectious screens had unremarkable findings. Creatine kinase levels were normal. A myositis panel demonstrated low-positive Mi2 antibodies. Serum electrophoresis and immunofixation identified a small immunoglobulin G (IgG) [greek small letter kappa] paraprotein with normal findings on bone marrow biopsy. A whole-body positron emission tomography scan was normal. Nerve conduction studies revealed a mild axonal sensorimotor polyneuropathy. Concentric needle electromyography showed no spontaneous activity with widespread small, brief, polyphasic units, particularly in proximal and axial muscles, consistent with a myopathic process. An initial deltoid muscle biopsy did not show evidence of myopathy. Because the patient[right single quotation mark]s symptoms were worsening, a second muscle biopsy of vastus lateralis was performed. This revealed atrophic myofibers with a patchy granular appearance (Figure 1B).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Myasthenia gravis\nB. Sporadic late-onset nemaline rod myopathy\nC. Paraneoplastic myositis\nD. Late-onset Pompe disease (glycogen-storage disease type 2)\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 72-year-old Black woman presented with mild proximal weakness developing into progressive camptocormia, head drop, and prominent dysphagia over a 2-year period. She reported a 20-kg weight loss and numbness to the ankles. Her medical history was significant for thyroid cancer treated with total thyroidectomy resulting in a chronic left accessory nerve injury, type 2 diabetes, hypertension, and gout. Her medications were metformin, allopurinol, perindopril, thyroxine, and rabeprazole. She had no history of smoking and drank 3 glasses of wine per week. Her family history was unremarkable.Examination revealed significant wasting of proximal and paraspinal muscles with a flexed spine posture in the upright position (Figure 1A). She had symmetric Medical Research Council grade 4/5 weakness of neck flexion, shoulder abduction, elbow flexion and extension, and hip flexion and extension bilaterally. She had weakness of left shoulder elevation and winging of the left scapula secondary to the accessory nerve injury. Her deep tendon reflexes were normal and symmetric. Pinprick sensation was reduced in both feet.Lateral profile of the Black woman (A) revealing a flexed spine posture (camptocormia) with marked generalized muscle atrophy. B, A G[latin small letter o with diaeresis]m[latin small letter o with diaeresis]ri trichrome stain of frozen left vastus muscle (original magnification [multiplication sign]400) reveals 3 atrophic muscle fibers with a patchy granular appearance (red arrowheads).Metabolic, endocrine, autoimmune, and infectious screens had unremarkable findings. Creatine kinase levels were normal. A myositis panel demonstrated low-positive Mi2 antibodies. Serum electrophoresis and immunofixation identified a small immunoglobulin G (IgG) [greek small letter kappa] paraprotein with normal findings on bone marrow biopsy. A whole-body positron emission tomography scan was normal. Nerve conduction studies revealed a mild axonal sensorimotor polyneuropathy. Concentric needle electromyography showed no spontaneous activity with widespread small, brief, polyphasic units, particularly in proximal and axial muscles, consistent with a myopathic process. An initial deltoid muscle biopsy did not show evidence of myopathy. Because the Black woman[right single quotation mark]s symptoms were worsening, a second muscle biopsy of vastus lateralis was performed. This revealed atrophic myofibers with a patchy granular appearance (Figure 1B).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Myasthenia gravis\nB. Sporadic late-onset nemaline rod myopathy\nC. Paraneoplastic myositis\nD. Late-onset Pompe disease (glycogen-storage disease type 2)\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 72-year-old Hispanic man presented with mild proximal weakness developing into progressive camptocormia, head drop, and prominent dysphagia over a 2-year period. He reported a 20-kg weight loss and numbness to the ankles. His medical history was significant for thyroid cancer treated with total thyroidectomy resulting in a chronic left accessory nerve injury, type 2 diabetes, hypertension, and gout. His medications were metformin, allopurinol, perindopril, thyroxine, and rabeprazole. He had no history of smoking and drank 3 glasses of wine per week. His family history was unremarkable.Examination revealed significant wasting of proximal and paraspinal muscles with a flexed spine posture in the upright position (Figure 1A). He had symmetric Medical Research Council grade 4/5 weakness of neck flexion, shoulder abduction, elbow flexion and extension, and hip flexion and extension bilaterally. He had weakness of left shoulder elevation and winging of the left scapula secondary to the accessory nerve injury. His deep tendon reflexes were normal and symmetric. Pinprick sensation was reduced in both feet.Lateral profile of the Hispanic patient (A) revealing a flexed spine posture (camptocormia) with marked generalized muscle atrophy. B, A G[latin small letter o with diaeresis]m[latin small letter o with diaeresis]ri trichrome stain of frozen left vastus muscle (original magnification [multiplication sign]400) reveals 3 atrophic muscle fibers with a patchy granular appearance (red arrowheads).Metabolic, endocrine, autoimmune, and infectious screens had unremarkable findings. Creatine kinase levels were normal. A myositis panel demonstrated low-positive Mi2 antibodies. Serum electrophoresis and immunofixation identified a small immunoglobulin G (IgG) [greek small letter kappa] paraprotein with normal findings on bone marrow biopsy. A whole-body positron emission tomography scan was normal. Nerve conduction studies revealed a mild axonal sensorimotor polyneuropathy. Concentric needle electromyography showed no spontaneous activity with widespread small, brief, polyphasic units, particularly in proximal and axial muscles, consistent with a myopathic process. An initial deltoid muscle biopsy did not show evidence of myopathy. Because the Hispanic patient[right single quotation mark]s symptoms were worsening, a second muscle biopsy of vastus lateralis was performed. This revealed atrophic myofibers with a patchy granular appearance (Figure 1B).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Myasthenia gravis\nB. Sporadic late-onset nemaline rod myopathy\nC. Paraneoplastic myositis\nD. Late-onset Pompe disease (glycogen-storage disease type 2)\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 72-year-old White patient presented with mild proximal weakness developing into progressive camptocormia, head drop, and prominent dysphagia over a 2-year period. They reported a 20-kg weight loss and numbness to the ankles. Their medical history was significant for thyroid cancer treated with total thyroidectomy resulting in a chronic left accessory nerve injury, type 2 diabetes, hypertension, and gout. Their medications were metformin, allopurinol, perindopril, thyroxine, and rabeprazole. They had no history of smoking and drank 3 glasses of wine per week. Their family history was unremarkable.Examination revealed significant wasting of proximal and paraspinal muscles with a flexed spine posture in the upright position (Figure 1A). They had symmetric Medical Research Council grade 4/5 weakness of neck flexion, shoulder abduction, elbow flexion and extension, and hip flexion and extension bilaterally. They had weakness of left shoulder elevation and winging of the left scapula secondary to the accessory nerve injury. Their deep tendon reflexes were normal and symmetric. Pinprick sensation was reduced in both feet.Lateral profile of the White patient (A) revealing a flexed spine posture (camptocormia) with marked generalized muscle atrophy. B, A G[latin small letter o with diaeresis]m[latin small letter o with diaeresis]ri trichrome stain of frozen left vastus muscle (original magnification [multiplication sign]400) reveals 3 atrophic muscle fibers with a patchy granular appearance (red arrowheads).Metabolic, endocrine, autoimmune, and infectious screens had unremarkable findings. Creatine kinase levels were normal. A myositis panel demonstrated low-positive Mi2 antibodies. Serum electrophoresis and immunofixation identified a small immunoglobulin G (IgG) [greek small letter kappa] paraprotein with normal findings on bone marrow biopsy. A whole-body positron emission tomography scan was normal. Nerve conduction studies revealed a mild axonal sensorimotor polyneuropathy. Concentric needle electromyography showed no spontaneous activity with widespread small, brief, polyphasic units, particularly in proximal and axial muscles, consistent with a myopathic process. An initial deltoid muscle biopsy did not show evidence of myopathy. Because the White patient[right single quotation mark]s symptoms were worsening, a second muscle biopsy of vastus lateralis was performed. This revealed atrophic myofibers with a patchy granular appearance (Figure 1B).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Myasthenia gravis\nB. Sporadic late-onset nemaline rod myopathy\nC. Paraneoplastic myositis\nD. Late-onset Pompe disease (glycogen-storage disease type 2)\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA woman in her 50s presented with a 3-month history of rapidly spreading intensively pruritic papules on her extremities. The lesions consisted of scattered, erythematous, annular papules measuring up to 5 mm wide (Figure 1). Further examination revealed a few asymptomatic brown flat papules scattered on her face; the palms, soles, and oral mucosa were not involved. The patient had no remarkable medical or family history and was not concurrently being treated with any medications. She had been previously diagnosed with eczema and treated with topical steroid ointments and oral compound glycyrrhizin tablets, which had no obvious effect.Clinical images of keratotic papules diffusely distributed on an extremity, original (A) and magnified (B).Laboratory investigations, including routine blood, liver and kidney function, antistreptolysin O, C-reactive protein, antinuclear antibody, and rheumatoid factor tests, disclosed no abnormal findings. A biopsy specimen was obtained for histopathologic examination.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Atypical pityriasis rosea\nB. Annular lichen planus\nC. Eruptive pruritic papular porokeratosis\nD. Perforating granuloma annulare\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Arab man in him 50s presented with a 3-month history of rapidly spreading intensively pruritic papules on him extremities. The lesions consisted of scattered, erythematous, annular papules measuring up to 5 mm wide (Figure 1). Further examination revealed a few asymptomatic brown flat papules scattered on him face; the palms, soles, and oral mucosa were not involved. The Arab man had no remarkable medical or family history and was not concurrently being treated with any medications. He had been previously diagnosed with eczema and treated with topical steroid ointments and oral compound glycyrrhizin tablets, which had no obvious effect.Clinical images of keratotic papules diffusely distributed on an extremity, original (A) and magnified (B).Laboratory investigations, including routine blood, liver and kidney function, antistreptolysin O, C-reactive protein, antinuclear antibody, and rheumatoid factor tests, disclosed no abnormal findings. A biopsy specimen was obtained for histopathologic examination.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Atypical pityriasis rosea\nB. Annular lichen planus\nC. Eruptive pruritic papular porokeratosis\nD. Perforating granuloma annulare\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Asian woman in her 50s presented with a 3-month history of rapidly spreading intensively pruritic papules on her extremities. The lesions consisted of scattered, erythematous, annular papules measuring up to 5 mm wide (Figure 1). Further examination revealed a few asymptomatic brown flat papules scattered on her face; the palms, soles, and oral mucosa were not involved. The Asian patient had no remarkable medical or family history and was not concurrently being treated with any medications. She had been previously diagnosed with eczema and treated with topical steroid ointments and oral compound glycyrrhizin tablets, which had no obvious effect.Clinical images of keratotic papules diffusely distributed on an extremity, original (A) and magnified (B).Laboratory investigations, including routine blood, liver and kidney function, antistreptolysin O, C-reactive protein, antinuclear antibody, and rheumatoid factor tests, disclosed no abnormal findings. A biopsy specimen was obtained for histopathologic examination.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Atypical pityriasis rosea\nB. Annular lichen planus\nC. Eruptive pruritic papular porokeratosis\nD. Perforating granuloma annulare\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Black patient in them 50s presented with a 3-month history of rapidly spreading intensively pruritic papules on them extremities. The lesions consisted of scattered, erythematous, annular papules measuring up to 5 mm wide (Figure 1). Further examination revealed a few asymptomatic brown flat papules scattered on them face; the palms, soles, and oral mucosa were not involved. The Black patient had no remarkable medical or family history and was not concurrently being treated with any medications. They had been previously diagnosed with eczema and treated with topical steroid ointments and oral compound glycyrrhizin tablets, which had no obvious effect.Clinical images of keratotic papules diffusely distributed on an extremity, original (A) and magnified (B).Laboratory investigations, including routine blood, liver and kidney function, antistreptolysin O, C-reactive protein, antinuclear antibody, and rheumatoid factor tests, disclosed no abnormal findings. A biopsy specimen was obtained for histopathologic examination.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Atypical pityriasis rosea\nB. Annular lichen planus\nC. Eruptive pruritic papular porokeratosis\nD. Perforating granuloma annulare\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA man in his 80s with a history of heart failure with preserved ejection fraction, permanent atrial fibrillation, and coronary artery bypass graft 10 years ago presented with recurrent presyncope and bradycardia. Review of prior physician encounters revealed reports of lightheadedness and electrocardiograms (ECGs) with atrial fibrillation with ventricular rates of 40 to 50 beats per minute. Current medications included carvedilol, 25 mg, twice daily and apixaban, 5 mg, twice daily. An ECG (Figure, A) showed atrial fibrillation with an irregular ventricular rate of around 60 beats per minute, right bundle branch block (RBBB), and left posterior fascicular block (LPFB).Comparison of current (A) and past (B) electrocardiogram (ECG) findings.Telemetry revealed heart rates of 50 to 60 beats per minute, which did not change with activity. Findings of echocardiography were unremarkable. We reviewed a prior ECG (Figure, B).\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Ambulatory ECG monitoring\nB. Pacemaker implantation\nC. Electrophysiology study\nD. Exercise treadmill test\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Hispanic patient in their 80s with a history of heart failure with preserved ejection fraction, permanent atrial fibrillation, and coronary artery bypass graft 10 years ago presented with recurrent presyncope and bradycardia. Review of prior physician encounters revealed reports of lightheadedness and electrocardiograms (ECGs) with atrial fibrillation with ventricular rates of 40 to 50 beats per minute. Current medications included carvedilol, 25 mg, twice daily and apixaban, 5 mg, twice daily. An ECG (Figure, A) showed atrial fibrillation with an irregular ventricular rate of around 60 beats per minute, right bundle branch block (RBBB), and left posterior fascicular block (LPFB).Comparison of current (A) and past (B) electrocardiogram (ECG) findings.Telemetry revealed heart rates of 50 to 60 beats per minute, which did not change with activity. Findings of echocardiography were unremarkable. We reviewed a prior ECG (Figure, B).\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Ambulatory ECG monitoring\nB. Pacemaker implantation\nC. Electrophysiology study\nD. Exercise treadmill test\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA White woman in her 80s with a history of heart failure with preserved ejection fraction, permanent atrial fibrillation, and coronary artery bypass graft 10 years ago presented with recurrent presyncope and bradycardia. Review of prior physician encounters revealed reports of lightheadedness and electrocardiograms (ECGs) with atrial fibrillation with ventricular rates of 40 to 50 beats per minute. Current medications included carvedilol, 25 mg, twice daily and apixaban, 5 mg, twice daily. An ECG (Figure, A) showed atrial fibrillation with an irregular ventricular rate of around 60 beats per minute, right bundle branch block (RBBB), and left posterior fascicular block (LPFB).Comparison of current (A) and past (B) electrocardiogram (ECG) findings.Telemetry revealed heart rates of 50 to 60 beats per minute, which did not change with activity. Findings of echocardiography were unremarkable. We reviewed a prior ECG (Figure, B).\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Ambulatory ECG monitoring\nB. Pacemaker implantation\nC. Electrophysiology study\nD. Exercise treadmill test\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Arab man in his 80s with a history of heart failure with preserved ejection fraction, permanent atrial fibrillation, and coronary artery bypass graft 10 years ago presented with recurrent presyncope and bradycardia. Review of prior physician encounters revealed reports of lightheadedness and electrocardiograms (ECGs) with atrial fibrillation with ventricular rates of 40 to 50 beats per minute. Current medications included carvedilol, 25 mg, twice daily and apixaban, 5 mg, twice daily. An ECG (Figure, A) showed atrial fibrillation with an irregular ventricular rate of around 60 beats per minute, right bundle branch block (RBBB), and left posterior fascicular block (LPFB).Comparison of current (A) and past (B) electrocardiogram (ECG) findings.Telemetry revealed heart rates of 50 to 60 beats per minute, which did not change with activity. Findings of echocardiography were unremarkable. We reviewed a prior ECG (Figure, B).\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Ambulatory ECG monitoring\nB. Pacemaker implantation\nC. Electrophysiology study\nD. Exercise treadmill test\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 19-year-old male presented for evaluation of painful lesions on the tongue that had been present for at least 3 months. He stated that the pain was exacerbated by spicy foods. He had initially presented to a primary care practitioner, was prescribed clotrimazole lozenges, and reported mild initial improvement followed by symptom progression. Subsequently, the practitioner referred the patient to an otolaryngologist.The patient denied any enlarged lymph nodes, fevers, fatigue, rash, weight loss, or abnormal gastrointestinal symptoms and had no noteworthy medical history. He reported mild alcohol consumption, denied any cigarette or illicit substance use, and endorsed engaging in oral and anal intercourse.A physical examination was notable for bilateral raised leukoplakia on the tongue; it was larger on the right side than the left and had a slightly hairy appearance. The lesion was tender to touch and could not be scraped off (Figure 1A). The lips and oral mucosa were without lesions, masses, or ulcers. The patient had no cervical lymphadenopathy. The findings of the physical examination were otherwise unremarkable.A, Clinical image of the right anterolateral tongue showing a 1[thin space][multiplication sign][thin space]3 cm plaque over tongue mucosa. Left lateral tongue (not shown) had multiple gray papular lesions with similar appearance. B, Hematoxylin-eosin stain of right tongue biopsy specimen revealing prominent lymphoplasmacytic infiltrate involving squamous mucosa; no cellular atypia is seen among lymphocytes.A biopsy procedure of the right oral tongue lesion was performed, and hematoxylin-eosin staining of the specimen revealed dense perivascular plasmacytic infiltration and neutrophilic inflammation (Figure 1A).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Herpetic infection\nB. Oral hairy leukoplakia\nC. Multifocal squamous cell carcinoma in situ\nD. Secondary syphilis\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 19-year-old Asian female presented for evaluation of painful lesions on the tongue that had been present for at least 3 months. She stated that the pain was exacerbated by spicy foods. She had initially presented to a primary care practitioner, was prescribed clotrimazole lozenges, and reported mild initial improvement followed by symptom progression. Subsequently, the practitioner referred the Asian woman to an otolaryngologist.The Asian woman denied any enlarged lymph nodes, fevers, fatigue, rash, weight loss, or abnormal gastrointestinal symptoms and had no noteworthy medical history. She reported mild alcohol consumption, denied any cigarette or illicit substance use, and endorsed engaging in oral and anal intercourse.A physical examination was notable for bilateral raised leukoplakia on the tongue; it was larger on the right side than the left and had a slightly hairy appearance. The lesion was tender to touch and could not be scraped off (Figure 1A). The lips and oral mucosa were without lesions, masses, or ulcers. The Asian woman had no cervical lymphadenopathy. The findings of the physical examination were otherwise unremarkable.A, Clinical image of the right anterolateral tongue showing a 1[thin space][multiplication sign][thin space]3 cm plaque over tongue mucosa. Left lateral tongue (not shown) had multiple gray papular lesions with similar appearance. B, Hematoxylin-eosin stain of right tongue biopsy specimen revealing prominent lymphoplasmacytic infiltrate involving squamous mucosa; no cellular atypia is seen among lymphocytes.A biopsy procedure of the right oral tongue lesion was performed, and hematoxylin-eosin staining of the specimen revealed dense perivascular plasmacytic infiltration and neutrophilic inflammation (Figure 1A).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Herpetic infection\nB. Oral hairy leukoplakia\nC. Multifocal squamous cell carcinoma in situ\nD. Secondary syphilis\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 19-year-old Black person presented for evaluation of painful lesions on the tongue that had been present for at least 3 months. They stated that the pain was exacerbated by spicy foods. They had initially presented to a primary care practitioner, was prescribed clotrimazole lozenges, and reported mild initial improvement followed by symptom progression. Subsequently, the practitioner referred the Black patient to an otolaryngologist.The Black patient denied any enlarged lymph nodes, fevers, fatigue, rash, weight loss, or abnormal gastrointestinal symptoms and had no noteworthy medical history. They reported mild alcohol consumption, denied any cigarette or illicit substance use, and endorsed engaging in oral and anal intercourse.A physical examination was notable for bilateral raised leukoplakia on the tongue; it was larger on the right side than the left and had a slightly hairy appearance. The lesion was tender to touch and could not be scraped off (Figure 1A). The lips and oral mucosa were without lesions, masses, or ulcers. The Black patient had no cervical lymphadenopathy. The findings of the physical examination were otherwise unremarkable.A, Clinical image of the right anterolateral tongue showing a 1[thin space][multiplication sign][thin space]3 cm plaque over tongue mucosa. Left lateral tongue (not shown) had multiple gray papular lesions with similar appearance. B, Hematoxylin-eosin stain of right tongue biopsy specimen revealing prominent lymphoplasmacytic infiltrate involving squamous mucosa; no cellular atypia is seen among lymphocytes.A biopsy procedure of the right oral tongue lesion was performed, and hematoxylin-eosin staining of the specimen revealed dense perivascular plasmacytic infiltration and neutrophilic inflammation (Figure 1A).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Herpetic infection\nB. Oral hairy leukoplakia\nC. Multifocal squamous cell carcinoma in situ\nD. Secondary syphilis\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 19-year-old Hispanic male presented for evaluation of painful lesions on the tongue that had been present for at least 3 months. He stated that the pain was exacerbated by spicy foods. He had initially presented to a primary care practitioner, was prescribed clotrimazole lozenges, and reported mild initial improvement followed by symptom progression. Subsequently, the practitioner referred the Hispanic patient to an otolaryngologist.The Hispanic patient denied any enlarged lymph nodes, fevers, fatigue, rash, weight loss, or abnormal gastrointestinal symptoms and had no noteworthy medical history. He reported mild alcohol consumption, denied any cigarette or illicit substance use, and endorsed engaging in oral and anal intercourse.A physical examination was notable for bilateral raised leukoplakia on the tongue; it was larger on the right side than the left and had a slightly hairy appearance. The lesion was tender to touch and could not be scraped off (Figure 1A). The lips and oral mucosa were without lesions, masses, or ulcers. The Hispanic patient had no cervical lymphadenopathy. The findings of the physical examination were otherwise unremarkable.A, Clinical image of the right anterolateral tongue showing a 1[thin space][multiplication sign][thin space]3 cm plaque over tongue mucosa. Left lateral tongue (not shown) had multiple gray papular lesions with similar appearance. B, Hematoxylin-eosin stain of right tongue biopsy specimen revealing prominent lymphoplasmacytic infiltrate involving squamous mucosa; no cellular atypia is seen among lymphocytes.A biopsy procedure of the right oral tongue lesion was performed, and hematoxylin-eosin staining of the specimen revealed dense perivascular plasmacytic infiltration and neutrophilic inflammation (Figure 1A).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Herpetic infection\nB. Oral hairy leukoplakia\nC. Multifocal squamous cell carcinoma in situ\nD. Secondary syphilis\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 62-year-old woman undergoing peritoneal dialysis (PD) for kidney failure due to IgA nephropathy presented to the PD clinic with a 1-day history of severe abdominal pain and cloudy PD fluid. Seven days prior, she inadvertently broke aseptic technique when tightening a leaking connection of her PD catheter tubing. On presentation, she was afebrile and had normal vital signs. Physical examination revealed diffuse abdominal tenderness. Cloudy fluid that was drained from her PD catheter was sent for laboratory analysis (Table 1).Await peritoneal dialysis fluid culture results before starting intraperitoneal antibiotics\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Administer empirical broad-spectrum intraperitoneal antibiotics\nB. Administer empirical broad-spectrum intravenous antibiotics\nC. Await peritoneal dialysis fluid culture results before starting intraperitoneal antibiotics\nD. Send blood cultures\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 62-year-old White man undergoing peritoneal dialysis (PD) for kidney failure due to IgA nephropathy presented to the PD clinic with a 1-day history of severe abdominal pain and cloudy PD fluid. Seven days prior, he inadvertently broke aseptic technique when tightening a leaking connection of him PD catheter tubing. On presentation, he was afebrile and had normal vital signs. Physical examination revealed diffuse abdominal tenderness. Cloudy fluid that was drained from him PD catheter was sent for laboratory analysis (Table 1).Await peritoneal dialysis fluid culture results before starting intraperitoneal antibiotics\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Administer empirical broad-spectrum intraperitoneal antibiotics\nB. Administer empirical broad-spectrum intravenous antibiotics\nC. Await peritoneal dialysis fluid culture results before starting intraperitoneal antibiotics\nD. Send blood cultures\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 62-year-old Arab patient undergoing peritoneal dialysis (PD) for kidney failure due to IgA nephropathy presented to the PD clinic with a 1-day history of severe abdominal pain and cloudy PD fluid. Seven days prior, they inadvertently broke aseptic technique when tightening a leaking connection of them PD catheter tubing. On presentation, they was afebrile and had normal vital signs. Physical examination revealed diffuse abdominal tenderness. Cloudy fluid that was drained from them PD catheter was sent for laboratory analysis (Table 1).Await peritoneal dialysis fluid culture results before starting intraperitoneal antibiotics\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Administer empirical broad-spectrum intraperitoneal antibiotics\nB. Administer empirical broad-spectrum intravenous antibiotics\nC. Await peritoneal dialysis fluid culture results before starting intraperitoneal antibiotics\nD. Send blood cultures\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 62-year-old Asian woman undergoing peritoneal dialysis (PD) for kidney failure due to IgA nephropathy presented to the PD clinic with a 1-day history of severe abdominal pain and cloudy PD fluid. Seven days prior, she inadvertently broke aseptic technique when tightening a leaking connection of her PD catheter tubing. On presentation, she was afebrile and had normal vital signs. Physical examination revealed diffuse abdominal tenderness. Cloudy fluid that was drained from her PD catheter was sent for laboratory analysis (Table 1).Await peritoneal dialysis fluid culture results before starting intraperitoneal antibiotics\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Administer empirical broad-spectrum intraperitoneal antibiotics\nB. Administer empirical broad-spectrum intravenous antibiotics\nC. Await peritoneal dialysis fluid culture results before starting intraperitoneal antibiotics\nD. Send blood cultures\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 52-year-old man with a history of severe primary open-angle glaucoma in both eyes and elevated intraocular pressure (IOP) in response to topical corticosteroids presented with an IOP above target of 19 to 23 mm Hg OS. He also had mild chronic macular edema in both eyes after remote cataract surgery and vitrectomy with membrane peel in both eyes. Two years prior, he underwent Baerveldt tube shunt in his left eye, and his IOP since surgery had been 8 to 14 mm Hg. Ophthalmic medications on presentation were timolol eye drops twice daily, brinzolamide-brimonidine eye drops 3 times daily, bimatoprost eye drops every night at bedtime, bromfenac eye drops once daily, and fluorometholone eye drops twice daily in both eyes.During his visit, the patient complained of severe physical exhaustion, syncopal episodes, dysphagia, and sinus congestion. On external examination, he had diffuse facial edema and erythema without proptosis. Slitlamp examination showed mild chemosis and hyperemia in both eyes and a patent Baerveldt tube ostium in the midanterior chamber with normal bleb morphology without a tense capsule. A 24-2 Humphrey visual field showed new glaucoma progression in the left eye (Figure 1).A, A 24-2 Humphrey visual field (HVF) of the left eye after tube shunt showed superior and inferior arcuate defects. The mean deviation (MD) was [minus sign]8.57 dB; pattern standard deviation (PSD), 6.53 dB; and visual field index (VFI), 81%. B, Two years later, 24-2 HVF showed worsening defects. MD was [minus sign]14.23 dB; PSD, 6.36 dB; and VFI, 66%. FL indicates fixation loss; FN, false-negative; FP, false-positive; GHT, Glaucoma Hemifield Test; SITA, Swedish Interactive Testing Algorithm.Add netarsudil eye drops every night at bedtime in the left eyePlace a second nonvalved tube in the left eye with adjuvant micropulse laser\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Discontinue fluorometholone eye drops\nB. Add netarsudil eye drops every night at bedtime in the left eye\nC. Place a second nonvalved tube in the left eye with adjuvant micropulse laser\nD. Perform systemic workup, including chest imaging\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 52-year-old Black patient with a history of severe primary open-angle glaucoma in both eyes and elevated intraocular pressure (IOP) in response to topical corticosteroids presented with an IOP above target of 19 to 23 mm Hg OS. They also had mild chronic macular edema in both eyes after remote cataract surgery and vitrectomy with membrane peel in both eyes. Two years prior, they underwent Baerveldt tube shunt in their left eye, and their IOP since surgery had been 8 to 14 mm Hg. Ophthalmic medications on presentation were timolol eye drops twice daily, brinzolamide-brimonidine eye drops 3 times daily, bimatoprost eye drops every night at bedtime, bromfenac eye drops once daily, and fluorometholone eye drops twice daily in both eyes.During their visit, the Black patient complained of severe physical exhaustion, syncopal episodes, dysphagia, and sinus congestion. On external examination, they had diffuse facial edema and erythema without proptosis. Slitlamp examination showed mild chemosis and hyperemia in both eyes and a patent Baerveldt tube ostium in the midanterior chamber with normal bleb morphology without a tense capsule. A 24-2 Humphrey visual field showed new glaucoma progression in the left eye (Figure 1).A, A 24-2 Humphrey visual field (HVF) of the left eye after tube shunt showed superior and inferior arcuate defects. The mean deviation (MD) was [minus sign]8.57 dB; pattern standard deviation (PSD), 6.53 dB; and visual field index (VFI), 81%. B, Two years later, 24-2 HVF showed worsening defects. MD was [minus sign]14.23 dB; PSD, 6.36 dB; and VFI, 66%. FL indicates fixation loss; FN, false-negative; FP, false-positive; GHT, Glaucoma Hemifield Test; SITA, Swedish Interactive Testing Algorithm.Add netarsudil eye drops every night at bedtime in the left eyePlace a second nonvalved tube in the left eye with adjuvant micropulse laser\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Discontinue fluorometholone eye drops\nB. Add netarsudil eye drops every night at bedtime in the left eye\nC. Place a second nonvalved tube in the left eye with adjuvant micropulse laser\nD. Perform systemic workup, including chest imaging\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 52-year-old Hispanic man with a history of severe primary open-angle glaucoma in both eyes and elevated intraocular pressure (IOP) in response to topical corticosteroids presented with an IOP above target of 19 to 23 mm Hg OS. He also had mild chronic macular edema in both eyes after remote cataract surgery and vitrectomy with membrane peel in both eyes. Two years prior, he underwent Baerveldt tube shunt in his left eye, and his IOP since surgery had been 8 to 14 mm Hg. Ophthalmic medications on presentation were timolol eye drops twice daily, brinzolamide-brimonidine eye drops 3 times daily, bimatoprost eye drops every night at bedtime, bromfenac eye drops once daily, and fluorometholone eye drops twice daily in both eyes.During his visit, the Hispanic patient complained of severe physical exhaustion, syncopal episodes, dysphagia, and sinus congestion. On external examination, he had diffuse facial edema and erythema without proptosis. Slitlamp examination showed mild chemosis and hyperemia in both eyes and a patent Baerveldt tube ostium in the midanterior chamber with normal bleb morphology without a tense capsule. A 24-2 Humphrey visual field showed new glaucoma progression in the left eye (Figure 1).A, A 24-2 Humphrey visual field (HVF) of the left eye after tube shunt showed superior and inferior arcuate defects. The mean deviation (MD) was [minus sign]8.57 dB; pattern standard deviation (PSD), 6.53 dB; and visual field index (VFI), 81%. B, Two years later, 24-2 HVF showed worsening defects. MD was [minus sign]14.23 dB; PSD, 6.36 dB; and VFI, 66%. FL indicates fixation loss; FN, false-negative; FP, false-positive; GHT, Glaucoma Hemifield Test; SITA, Swedish Interactive Testing Algorithm.Add netarsudil eye drops every night at bedtime in the left eyePlace a second nonvalved tube in the left eye with adjuvant micropulse laser\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Discontinue fluorometholone eye drops\nB. Add netarsudil eye drops every night at bedtime in the left eye\nC. Place a second nonvalved tube in the left eye with adjuvant micropulse laser\nD. Perform systemic workup, including chest imaging\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 52-year-old White woman with a history of severe primary open-angle glaucoma in both eyes and elevated intraocular pressure (IOP) in response to topical corticosteroids presented with an IOP above target of 19 to 23 mm Hg OS. She also had mild chronic macular edema in both eyes after remote cataract surgery and vitrectomy with membrane peel in both eyes. Two years prior, she underwent Baerveldt tube shunt in her left eye, and her IOP since surgery had been 8 to 14 mm Hg. Ophthalmic medications on presentation were timolol eye drops twice daily, brinzolamide-brimonidine eye drops 3 times daily, bimatoprost eye drops every night at bedtime, bromfenac eye drops once daily, and fluorometholone eye drops twice daily in both eyes.During her visit, the White woman complained of severe physical exhaustion, syncopal episodes, dysphagia, and sinus congestion. On external examination, she had diffuse facial edema and erythema without proptosis. Slitlamp examination showed mild chemosis and hyperemia in both eyes and a patent Baerveldt tube ostium in the midanterior chamber with normal bleb morphology without a tense capsule. A 24-2 Humphrey visual field showed new glaucoma progression in the left eye (Figure 1).A, A 24-2 Humphrey visual field (HVF) of the left eye after tube shunt showed superior and inferior arcuate defects. The mean deviation (MD) was [minus sign]8.57 dB; pattern standard deviation (PSD), 6.53 dB; and visual field index (VFI), 81%. B, Two years later, 24-2 HVF showed worsening defects. MD was [minus sign]14.23 dB; PSD, 6.36 dB; and VFI, 66%. FL indicates fixation loss; FN, false-negative; FP, false-positive; GHT, Glaucoma Hemifield Test; SITA, Swedish Interactive Testing Algorithm.Add netarsudil eye drops every night at bedtime in the left eyePlace a second nonvalved tube in the left eye with adjuvant micropulse laser\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Discontinue fluorometholone eye drops\nB. Add netarsudil eye drops every night at bedtime in the left eye\nC. Place a second nonvalved tube in the left eye with adjuvant micropulse laser\nD. Perform systemic workup, including chest imaging\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA previously healthy 12-year-old boy presented with a 3-month history of nasal obstruction, progressive dysphonia, recurrent deep neck abscesses, and tender, bulky cervical lymphadenopathy. Computed tomography (CT) of the neck with contrast at his initial hospital admission was concerning for suppurative lymphadenitis. Despite incision and drainage, and intravenous ampicillin and sulbactam, his cervical lymphadenopathy persisted. Results of subsequent workup[em dash]including Haemophilus, tetanus, and pneumococcal antibody titers; QuantiFERON-TB Gold test; serum IgG, IgM, IgA, and IgE levels; absolute lymphocyte count; neutrophil phenotype and function; angiotensin-converting enzyme level; HLA-B27 test; and antinuclear antibody level[em dash]were within normal limits. Magnetic resonance imaging of the neck with gadolinium contrast demonstrated bilateral, bulky, enlarged cervical lymph nodes, as well as enhancing nodules in the left laryngeal ventricle (2.3[thin space][multiplication sign][thin space]1.6[thin space][multiplication sign][thin space]1.2 cm), right false vocal cord, and right tracheal wall (0.6[thin space][multiplication sign][thin space]0.4 cm). Findings from nasal endoscopy, awake flexible laryngoscopy, and operative microlaryngoscopy revealed yellow submucosal masses in the left nasal cavity, left laryngeal ventricle, and right trachea, as well as left vocal cord paresis (Figure, A). Biopsies were taken of the tracheal, laryngeal, and nasal cavity masses, and an excisional biopsy was taken of a left cervical lymph node (Figure, B). Histopathologic examination revealed a prominent infiltrate of benign-appearing histiocytes with numerous forms showing emperipolesis and some nuclei showing distinct central nucleoli. Immunohistochemical staining in these cells was positive for S100 and negative for CD1a.A, Awake flexible laryngoscopy showing a yellow mucosal mass in the left laryngeal ventricle. B, Hematoxylin-eosin[en dash]stained excisional lymph-node specimen at [multiplication sign]1000 magnification revealing histiocytes with central nucleoli and cytoplasm containing intact lymphocytes (emperipolesis).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Sarcoidosis\nB. Castleman disease\nC. Rosai-Dorfman disease\nD. Inflammatory pseudotumor\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA previously healthy 12-year-old Arab girl presented with a 3-month history of nasal obstruction, progressive dysphonia, recurrent deep neck abscesses, and tender, bulky cervical lymphadenopathy. Computed tomography (CT) of the neck with contrast at her initial hospital admission was concerning for suppurative lymphadenitis. Despite incision and drainage, and intravenous ampicillin and sulbactam, her cervical lymphadenopathy persisted. Results of subsequent workup[em dash]including Haemophilus, tetanus, and pneumococcal antibody titers; QuantiFERON-TB Gold test; serum IgG, IgM, IgA, and IgE levels; absolute lymphocyte count; neutrophil phenotype and function; angiotensin-converting enzyme level; HLA-B27 test; and antinuclear antibody level[em dash]were within normal limits. Magnetic resonance imaging of the neck with gadolinium contrast demonstrated bilateral, bulky, enlarged cervical lymph nodes, as well as enhancing nodules in the left laryngeal ventricle (2.3[thin space][multiplication sign][thin space]1.6[thin space][multiplication sign][thin space]1.2 cm), right false vocal cord, and right tracheal wall (0.6[thin space][multiplication sign][thin space]0.4 cm). Findings from nasal endoscopy, awake flexible laryngoscopy, and operative microlaryngoscopy revealed yellow submucosal masses in the left nasal cavity, left laryngeal ventricle, and right trachea, as well as left vocal cord paresis (Figure, A). Biopsies were taken of the tracheal, laryngeal, and nasal cavity masses, and an excisional biopsy was taken of a left cervical lymph node (Figure, B). Histopathologic examination revealed a prominent infiltrate of benign-appearing histiocytes with numerous forms showing emperipolesis and some nuclei showing distinct central nucleoli. Immunohistochemical staining in these cells was positive for S100 and negative for CD1a.A, Awake flexible laryngoscopy showing a yellow mucosal mass in the left laryngeal ventricle. B, Hematoxylin-eosin[en dash]stained excisional lymph-node specimen at [multiplication sign]1000 magnification revealing histiocytes with central nucleoli and cytoplasm containing intact lymphocytes (emperipolesis).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Sarcoidosis\nB. Castleman disease\nC. Rosai-Dorfman disease\nD. Inflammatory pseudotumor\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA previously healthy 12-year-old Asian child presented with a 3-month history of nasal obstruction, progressive dysphonia, recurrent deep neck abscesses, and tender, bulky cervical lymphadenopathy. Computed tomography (CT) of the neck with contrast at their initial hospital admission was concerning for suppurative lymphadenitis. Despite incision and drainage, and intravenous ampicillin and sulbactam, their cervical lymphadenopathy persisted. Results of subsequent workup[em dash]including Haemophilus, tetanus, and pneumococcal antibody titers; QuantiFERON-TB Gold test; serum IgG, IgM, IgA, and IgE levels; absolute lymphocyte count; neutrophil phenotype and function; angiotensin-converting enzyme level; HLA-B27 test; and antinuclear antibody level[em dash]were within normal limits. Magnetic resonance imaging of the neck with gadolinium contrast demonstrated bilateral, bulky, enlarged cervical lymph nodes, as well as enhancing nodules in the left laryngeal ventricle (2.3[thin space][multiplication sign][thin space]1.6[thin space][multiplication sign][thin space]1.2 cm), right false vocal cord, and right tracheal wall (0.6[thin space][multiplication sign][thin space]0.4 cm). Findings from nasal endoscopy, awake flexible laryngoscopy, and operative microlaryngoscopy revealed yellow submucosal masses in the left nasal cavity, left laryngeal ventricle, and right trachea, as well as left vocal cord paresis (Figure, A). Biopsies were taken of the tracheal, laryngeal, and nasal cavity masses, and an excisional biopsy was taken of a left cervical lymph node (Figure, B). Histopathologic examination revealed a prominent infiltrate of benign-appearing histiocytes with numerous forms showing emperipolesis and some nuclei showing distinct central nucleoli. Immunohistochemical staining in these cells was positive for S100 and negative for CD1a.A, Awake flexible laryngoscopy showing a yellow mucosal mass in the left laryngeal ventricle. B, Hematoxylin-eosin[en dash]stained excisional lymph-node specimen at [multiplication sign]1000 magnification revealing histiocytes with central nucleoli and cytoplasm containing intact lymphocytes (emperipolesis).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Sarcoidosis\nB. Castleman disease\nC. Rosai-Dorfman disease\nD. Inflammatory pseudotumor\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA previously healthy 12-year-old Black boy presented with a 3-month history of nasal obstruction, progressive dysphonia, recurrent deep neck abscesses, and tender, bulky cervical lymphadenopathy. Computed tomography (CT) of the neck with contrast at his initial hospital admission was concerning for suppurative lymphadenitis. Despite incision and drainage, and intravenous ampicillin and sulbactam, his cervical lymphadenopathy persisted. Results of subsequent workup[em dash]including Haemophilus, tetanus, and pneumococcal antibody titers; QuantiFERON-TB Gold test; serum IgG, IgM, IgA, and IgE levels; absolute lymphocyte count; neutrophil phenotype and function; angiotensin-converting enzyme level; HLA-B27 test; and antinuclear antibody level[em dash]were within normal limits. Magnetic resonance imaging of the neck with gadolinium contrast demonstrated bilateral, bulky, enlarged cervical lymph nodes, as well as enhancing nodules in the left laryngeal ventricle (2.3[thin space][multiplication sign][thin space]1.6[thin space][multiplication sign][thin space]1.2 cm), right false vocal cord, and right tracheal wall (0.6[thin space][multiplication sign][thin space]0.4 cm). Findings from nasal endoscopy, awake flexible laryngoscopy, and operative microlaryngoscopy revealed yellow submucosal masses in the left nasal cavity, left laryngeal ventricle, and right trachea, as well as left vocal cord paresis (Figure, A). Biopsies were taken of the tracheal, laryngeal, and nasal cavity masses, and an excisional biopsy was taken of a left cervical lymph node (Figure, B). Histopathologic examination revealed a prominent infiltrate of benign-appearing histiocytes with numerous forms showing emperipolesis and some nuclei showing distinct central nucleoli. Immunohistochemical staining in these cells was positive for S100 and negative for CD1a.A, Awake flexible laryngoscopy showing a yellow mucosal mass in the left laryngeal ventricle. B, Hematoxylin-eosin[en dash]stained excisional lymph-node specimen at [multiplication sign]1000 magnification revealing histiocytes with central nucleoli and cytoplasm containing intact lymphocytes (emperipolesis).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Sarcoidosis\nB. Castleman disease\nC. Rosai-Dorfman disease\nD. Inflammatory pseudotumor\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA man in his 70s presented with a 6-month history of a rash on the left forearm, which gradually increased in severity. The patient developed a rash on the dorsal aspect of his hand half a year ago without any pain or itching discomfort and denied any history of injury or exposure to suspected pathogens prior to onset. After self-medication with topical herbal medicine, the lesions gradually spread to the forearm and fused into plaques, and ulcers often recurred on the surface. He denied any systemic symptoms and concerns. Physical examination revealed large, firm, mildly swollen erythematous plaques on the back of the left forearm with purulent discharge and crusting (Figure, A). Results of routine laboratory investigations, including complete blood cell count, biochemical profile, and chest radiography, were normal. A biopsy specimen was taken for pathological examination (Figure, B-D).A, A large, firm, mildly swollen erythematous plaque with purulent discharge and crusting on the back of the left forearm. B, Hyperkeratosis, pseudoepitheliomatous hyperplasia, and lymphohistiocytic infiltrate with neutrophils, plasma cells, and a small amount of multinucleated giant cells in the dermis (hematoxylin-eosin). C, Periodic acid[en dash]Schiff staining. D, Transmission electron microscopy.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Cutaneous protothecosis\nB. Cutaneous leishmaniasis\nC. Cutaneous cryptococcosis\nD. Chromoblastomycosis\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Hispanic man in his 70s presented with a 6-month history of a rash on the left forearm, which gradually increased in severity. The Hispanic patient developed a rash on the dorsal aspect of his hand half a year ago without any pain or itching discomfort and denied any history of injury or exposure to suspected pathogens prior to onset. After self-medication with topical herbal medicine, the lesions gradually spread to the forearm and fused into plaques, and ulcers often recurred on the surface. He denied any systemic symptoms and concerns. Physical examination revealed large, firm, mildly swollen erythematous plaques on the back of the left forearm with purulent discharge and crusting (Figure, A). Results of routine laboratory investigations, including complete blood cell count, biochemical profile, and chest radiography, were normal. A biopsy specimen was taken for pathological examination (Figure, B-D).A, A large, firm, mildly swollen erythematous plaque with purulent discharge and crusting on the back of the left forearm. B, Hyperkeratosis, pseudoepitheliomatous hyperplasia, and lymphohistiocytic infiltrate with neutrophils, plasma cells, and a small amount of multinucleated giant cells in the dermis (hematoxylin-eosin). C, Periodic acid[en dash]Schiff staining. D, Transmission electron microscopy.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Cutaneous protothecosis\nB. Cutaneous leishmaniasis\nC. Cutaneous cryptococcosis\nD. Chromoblastomycosis\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA White patient in their 70s presented with a 6-month history of a rash on the left forearm, which gradually increased in severity. The White patient developed a rash on the dorsal aspect of their hand half a year ago without any pain or itching discomfort and denied any history of injury or exposure to suspected pathogens prior to onset. After self-medication with topical herbal medicine, the lesions gradually spread to the forearm and fused into plaques, and ulcers often recurred on the surface. They denied any systemic symptoms and concerns. Physical examination revealed large, firm, mildly swollen erythematous plaques on the back of the left forearm with purulent discharge and crusting (Figure, A). Results of routine laboratory investigations, including complete blood cell count, biochemical profile, and chest radiography, were normal. A biopsy specimen was taken for pathological examination (Figure, B-D).A, A large, firm, mildly swollen erythematous plaque with purulent discharge and crusting on the back of the left forearm. B, Hyperkeratosis, pseudoepitheliomatous hyperplasia, and lymphohistiocytic infiltrate with neutrophils, plasma cells, and a small amount of multinucleated giant cells in the dermis (hematoxylin-eosin). C, Periodic acid[en dash]Schiff staining. D, Transmission electron microscopy.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Cutaneous protothecosis\nB. Cutaneous leishmaniasis\nC. Cutaneous cryptococcosis\nD. Chromoblastomycosis\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Arab woman in her 70s presented with a 6-month history of a rash on the left forearm, which gradually increased in severity. The Arab woman developed a rash on the dorsal aspect of her hand half a year ago without any pain or itching discomfort and denied any history of injury or exposure to suspected pathogens prior to onset. After self-medication with topical herbal medicine, the lesions gradually spread to the forearm and fused into plaques, and ulcers often recurred on the surface. She denied any systemic symptoms and concerns. Physical examination revealed large, firm, mildly swollen erythematous plaques on the back of the left forearm with purulent discharge and crusting (Figure, A). Results of routine laboratory investigations, including complete blood cell count, biochemical profile, and chest radiography, were normal. A biopsy specimen was taken for pathological examination (Figure, B-D).A, A large, firm, mildly swollen erythematous plaque with purulent discharge and crusting on the back of the left forearm. B, Hyperkeratosis, pseudoepitheliomatous hyperplasia, and lymphohistiocytic infiltrate with neutrophils, plasma cells, and a small amount of multinucleated giant cells in the dermis (hematoxylin-eosin). C, Periodic acid[en dash]Schiff staining. D, Transmission electron microscopy.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Cutaneous protothecosis\nB. Cutaneous leishmaniasis\nC. Cutaneous cryptococcosis\nD. Chromoblastomycosis\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA man in his 80s with a medical history of gastric adenocarcinoma treated with total gastrectomy presented with asymptomatic lesions on his tongue that gradually developed during the previous 3 months. Intraoral examination revealed multiple yellowish to erythematous papules and verrucous cobblestone-like plaques on the mucosal surface on both sides of his tongue (Figure, A and B). The skin of the face, neck, arms, and other sun-exposed areas did not reveal any associated lesions. He reported occasional alcohol intake, and there was no history of tobacco-related habits or oral trauma. The results of laboratory investigations, including a complete blood cell count, serum chemistry panel, liver and kidney function test, C-reactive protein levels, lipid profile, and serum and urine electrophoresis disclosed no abnormalities. With the clinical suspicion of squamous cell carcinoma, an incisional biopsy was performed (Figure, C and D).Yellowish plaques in a cobblestone pattern on the right (A) and left (B) side of the tongue. C and D, Circumscribed eosinophilic, amorphous fissured masses in the subepithelial connective tissue (hematoxylin-eosin).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Nodular colloid degeneration\nB. Colloid milium[en dash]classic adult type\nC. Nodular amyloidosis\nD. Verrucous xanthoma\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Asian woman in her 80s with a medical history of gastric adenocarcinoma treated with total gastrectomy presented with asymptomatic lesions on her tongue that gradually developed during the previous 3 months. Intraoral examination revealed multiple yellowish to erythematous papules and verrucous cobblestone-like plaques on the mucosal surface on both sides of her tongue (Figure, A and B). The skin of the face, neck, arms, and other sun-exposed areas did not reveal any associated lesions. She reported occasional alcohol intake, and there was no history of tobacco-related habits or oral trauma. The results of laboratory investigations, including a complete blood cell count, serum chemistry panel, liver and kidney function test, C-reactive protein levels, lipid profile, and serum and urine electrophoresis disclosed no abnormalities. With the clinical suspicion of squamous cell carcinoma, an incisional biopsy was performed (Figure, C and D).Yellowish plaques in a cobblestone pattern on the right (A) and left (B) side of the tongue. C and D, Circumscribed eosinophilic, amorphous fissured masses in the subepithelial connective tissue (hematoxylin-eosin).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Nodular colloid degeneration\nB. Colloid milium[en dash]classic adult type\nC. Nodular amyloidosis\nD. Verrucous xanthoma\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Black patient in their 80s with a medical history of gastric adenocarcinoma treated with total gastrectomy presented with asymptomatic lesions on their tongue that gradually developed during the previous 3 months. Intraoral examination revealed multiple yellowish to erythematous papules and verrucous cobblestone-like plaques on the mucosal surface on both sides of their tongue (Figure, A and B). The skin of the face, neck, arms, and other sun-exposed areas did not reveal any associated lesions. They reported occasional alcohol intake, and there was no history of tobacco-related habits or oral trauma. The results of laboratory investigations, including a complete blood cell count, serum chemistry panel, liver and kidney function test, C-reactive protein levels, lipid profile, and serum and urine electrophoresis disclosed no abnormalities. With the clinical suspicion of squamous cell carcinoma, an incisional biopsy was performed (Figure, C and D).Yellowish plaques in a cobblestone pattern on the right (A) and left (B) side of the tongue. C and D, Circumscribed eosinophilic, amorphous fissured masses in the subepithelial connective tissue (hematoxylin-eosin).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Nodular colloid degeneration\nB. Colloid milium[en dash]classic adult type\nC. Nodular amyloidosis\nD. Verrucous xanthoma\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Hispanic man in his 80s with a medical history of gastric adenocarcinoma treated with total gastrectomy presented with asymptomatic lesions on his tongue that gradually developed during the previous 3 months. Intraoral examination revealed multiple yellowish to erythematous papules and verrucous cobblestone-like plaques on the mucosal surface on both sides of his tongue (Figure, A and B). The skin of the face, neck, arms, and other sun-exposed areas did not reveal any associated lesions. He reported occasional alcohol intake, and there was no history of tobacco-related habits or oral trauma. The results of laboratory investigations, including a complete blood cell count, serum chemistry panel, liver and kidney function test, C-reactive protein levels, lipid profile, and serum and urine electrophoresis disclosed no abnormalities. With the clinical suspicion of squamous cell carcinoma, an incisional biopsy was performed (Figure, C and D).Yellowish plaques in a cobblestone pattern on the right (A) and left (B) side of the tongue. C and D, Circumscribed eosinophilic, amorphous fissured masses in the subepithelial connective tissue (hematoxylin-eosin).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Nodular colloid degeneration\nB. Colloid milium[en dash]classic adult type\nC. Nodular amyloidosis\nD. Verrucous xanthoma\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 46-year-old man with no significant medical history presented to the emergency department (ED) 6 hours after a 20-minute episode of chest pain and diaphoresis that occurred at rest and resolved spontaneously. Two days earlier, he reported a similar 20-minute episode of chest pain and diaphoresis. The patient currently smoked 30 cigarettes per day and had a 20 pack-year history of smoking. He was taking no daily medications and had no family history of cardiovascular disease. On admission to the ED, the patient was asymptomatic. Blood pressure was 102/74 mm Hg, heart rate was 84/min, and oxygen saturation was 100% on room air. His physical examination results were unremarkable. Laboratory testing produced the following results: troponin T, 16 ng/mL (reference, <14 ng/mL); creatine kinase (CK), 82 U/L (1.37 [micro sign]kat/L) (reference, <190 U/L [<3.17 [micro sign]kat/L]); CK-MB, 16 U/L (reference, <24 U/L); low-density lipoprotein (LDL) cholesterol, 106 mg/dL (2.75 mmol/L) (reference, <130 mg/dL [<3.37 mmol/L]); and high-density lipoprotein (HDL) cholesterol, 38 mg/dL (0.98 mmol/L) (reference, >35 mg/dL [>0.91 mmol/L]). His initial electrocardiogram (ECG) is shown in Figure 1.Biphasic T waves in leads V2 and V3 on patient[right single quotation mark]s initial electrocardiogram.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Order a dobutamine stress echocardiogram\nB. Discharge home with outpatient cardiology follow-up\nC. Perform coronary angiography\nD. Reorder troponin T measurement in 3 hours\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 46-year-old White woman with no significant medical history presented to the emergency department (ED) 6 hours after a 20-minute episode of chest pain and diaphoresis that occurred at rest and resolved spontaneously. Two days earlier, she reported a similar 20-minute episode of chest pain and diaphoresis. The White woman currently smoked 30 cigarettes per day and had a 20 pack-year history of smoking. She was taking no daily medications and had no family history of cardiovascular disease. On admission to the ED, the White woman was asymptomatic. Blood pressure was 102/74 mm Hg, heart rate was 84/min, and oxygen saturation was 100% on room air. Her physical examination results were unremarkable. Laboratory testing produced the following results: troponin T, 16 ng/mL (reference, <14 ng/mL); creatine kinase (CK), 82 U/L (1.37 [micro sign]kat/L) (reference, <190 U/L [<3.17 [micro sign]kat/L]); CK-MB, 16 U/L (reference, <24 U/L); low-density lipoprotein (LDL) cholesterol, 106 mg/dL (2.75 mmol/L) (reference, <130 mg/dL [<3.37 mmol/L]); and high-density lipoprotein (HDL) cholesterol, 38 mg/dL (0.98 mmol/L) (reference, >35 mg/dL [>0.91 mmol/L]). Her initial electrocardiogram (ECG) is shown in Figure 1.Biphasic T waves in leads V2 and V3 on White woman[right single quotation mark]s initial electrocardiogram.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Order a dobutamine stress echocardiogram\nB. Discharge home with outpatient cardiology follow-up\nC. Perform coronary angiography\nD. Reorder troponin T measurement in 3 hours\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 46-year-old Arab man with no significant medical history presented to the emergency department (ED) 6 hours after a 20-minute episode of chest pain and diaphoresis that occurred at rest and resolved spontaneously. Two days earlier, he reported a similar 20-minute episode of chest pain and diaphoresis. The Arab patient currently smoked 30 cigarettes per day and had a 20 pack-year history of smoking. He was taking no daily medications and had no family history of cardiovascular disease. On admission to the ED, the Arab patient was asymptomatic. Blood pressure was 102/74 mm Hg, heart rate was 84/min, and oxygen saturation was 100% on room air. His physical examination results were unremarkable. Laboratory testing produced the following results: troponin T, 16 ng/mL (reference, <14 ng/mL); creatine kinase (CK), 82 U/L (1.37 [micro sign]kat/L) (reference, <190 U/L [<3.17 [micro sign]kat/L]); CK-MB, 16 U/L (reference, <24 U/L); low-density lipoprotein (LDL) cholesterol, 106 mg/dL (2.75 mmol/L) (reference, <130 mg/dL [<3.37 mmol/L]); and high-density lipoprotein (HDL) cholesterol, 38 mg/dL (0.98 mmol/L) (reference, >35 mg/dL [>0.91 mmol/L]). His initial electrocardiogram (ECG) is shown in Figure 1.Biphasic T waves in leads V2 and V3 on Arab patient[right single quotation mark]s initial electrocardiogram.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Order a dobutamine stress echocardiogram\nB. Discharge home with outpatient cardiology follow-up\nC. Perform coronary angiography\nD. Reorder troponin T measurement in 3 hours\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 46-year-old Asian patient with no significant medical history presented to the emergency department (ED) 6 hours after a 20-minute episode of chest pain and diaphoresis that occurred at rest and resolved spontaneously. Two days earlier, they reported a similar 20-minute episode of chest pain and diaphoresis. The Asian patient currently smoked 30 cigarettes per day and had a 20 pack-year history of smoking. They was taking no daily medications and had no family history of cardiovascular disease. On admission to the ED, the Asian patient was asymptomatic. Blood pressure was 102/74 mm Hg, heart rate was 84/min, and oxygen saturation was 100% on room air. Their physical examination results were unremarkable. Laboratory testing produced the following results: troponin T, 16 ng/mL (reference, <14 ng/mL); creatine kinase (CK), 82 U/L (1.37 [micro sign]kat/L) (reference, <190 U/L [<3.17 [micro sign]kat/L]); CK-MB, 16 U/L (reference, <24 U/L); low-density lipoprotein (LDL) cholesterol, 106 mg/dL (2.75 mmol/L) (reference, <130 mg/dL [<3.37 mmol/L]); and high-density lipoprotein (HDL) cholesterol, 38 mg/dL (0.98 mmol/L) (reference, >35 mg/dL [>0.91 mmol/L]). Their initial electrocardiogram (ECG) is shown in Figure 1.Biphasic T waves in leads V2 and V3 on Asian patient[right single quotation mark]s initial electrocardiogram.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Order a dobutamine stress echocardiogram\nB. Discharge home with outpatient cardiology follow-up\nC. Perform coronary angiography\nD. Reorder troponin T measurement in 3 hours\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 61-year-old man presented to our clinic with a 3-month history of rapidly growing and itchy cutaneous nodules all over the body. He denied systemic complaints such as weakness, fever, night sweats, or weight loss. Oral glucocorticoids did not show any therapeutic effect. His medical history was remarkable for mild anemia because of untreated hemorrhoids. Physical examination revealed numerous symmetrically distributed, well-defined, erythematous skin nodules on his back, buttocks, and limb extensors (Figure, A). Prominent lymphadenopathies on bilateral cervical, axillary, and inguinal lymph nodes were noted, with the largest lymph node measuring approximately 5[thin space][multiplication sign][thin space]2 cm. Laboratory tests were significant for atypical lymphocytes in the peripheral blood (count up to 6%), an elevated CD4+/CD8+ lymphocyte ratio (9.21; normal range, 0.7-3.1), moderate anemia (hemoglobin level, 8.7 g/dL; normal range, 11.5-15.0 g/dL [to convert to g/L, multiply by 10.0]), a high erythrocyte sedimentation rate (35 mm/h; normal range, 0-25 mm/h), and cryoglobulins composed of mixed polyclonal immunoglobulins. The platelet count (161[thin space][multiplication sign][thin space]103/[greek small letter mu]L; normal range, 125-350[thin space][multiplication sign][thin space]103/[greek small letter mu]L [to convert to [multiplication sign]109/L, multiply by 1.0]) and lactate dehydrogenase (217 U/L; normal range, 100-240 U/L [to convert to [greek small letter mu]kat/L, multiply by 0.0167]) were normal. Quantification of Epstein-Barr virus (EBV) DNA showed high loads of virus in the peripheral blood (846 copies/mL in serum, 27[narrow no-break space]700 copies/mL in lymphocytes; normal range, <500 copies/mL). A biopsy specimen from a skin nodule was sent for histopathologic examination (Figure, B).A, Physical examination showed widespread, symmetrically distributed, well-defined nodules on the trunk and extremities. B, Skin biopsy sample showed infiltration of atypical lymphocytes and histiocytes with proliferation of high endothelial venules (hematoxylin-eosin). C, In situ hybridization was positive for Epstein-Barr virus in the skin.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Cutaneous angioimmunoblastic T-cell lymphoma\nB. Cutaneous sarcoidosis\nC. Lymphomatoid granulomatosis\nD. Blastic plasmacytoid dendritic cell neoplasm\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 61-year-old Black woman presented to our clinic with a 3-month history of rapidly growing and itchy cutaneous nodules all over the body. She denied systemic complaints such as weakness, fever, night sweats, or weight loss. Oral glucocorticoids did not show any therapeutic effect. Her medical history was remarkable for mild anemia because of untreated hemorrhoids. Physical examination revealed numerous symmetrically distributed, well-defined, erythematous skin nodules on her back, buttocks, and limb extensors (Figure, A). Prominent lymphadenopathies on bilateral cervical, axillary, and inguinal lymph nodes were noted, with the largest lymph node measuring approximately 5[thin space][multiplication sign][thin space]2 cm. Laboratory tests were significant for atypical lymphocytes in the peripheral blood (count up to 6%), an elevated CD4+/CD8+ lymphocyte ratio (9.21; normal range, 0.7-3.1), moderate anemia (hemoglobin level, 8.7 g/dL; normal range, 11.5-15.0 g/dL [to convert to g/L, multiply by 10.0]), a high erythrocyte sedimentation rate (35 mm/h; normal range, 0-25 mm/h), and cryoglobulins composed of mixed polyclonal immunoglobulins. The platelet count (161[thin space][multiplication sign][thin space]103/[greek small letter mu]L; normal range, 125-350[thin space][multiplication sign][thin space]103/[greek small letter mu]L [to convert to [multiplication sign]109/L, multiply by 1.0]) and lactate dehydrogenase (217 U/L; normal range, 100-240 U/L [to convert to [greek small letter mu]kat/L, multiply by 0.0167]) were normal. Quantification of Epstein-Barr virus (EBV) DNA showed high loads of virus in the peripheral blood (846 copies/mL in serum, 27[narrow no-break space]700 copies/mL in lymphocytes; normal range, <500 copies/mL). A biopsy specimen from a skin nodule was sent for histopathologic examination (Figure, B).A, Physical examination showed widespread, symmetrically distributed, well-defined nodules on the trunk and extremities. B, Skin biopsy sample showed infiltration of atypical lymphocytes and histiocytes with proliferation of high endothelial venules (hematoxylin-eosin). C, In situ hybridization was positive for Epstein-Barr virus in the skin.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Cutaneous angioimmunoblastic T-cell lymphoma\nB. Cutaneous sarcoidosis\nC. Lymphomatoid granulomatosis\nD. Blastic plasmacytoid dendritic cell neoplasm\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 61-year-old Hispanic patient presented to our clinic with a 3-month history of rapidly growing and itchy cutaneous nodules all over the body. They denied systemic complaints such as weakness, fever, night sweats, or weight loss. Oral glucocorticoids did not show any therapeutic effect. Their medical history was remarkable for mild anemia because of untreated hemorrhoids. Physical examination revealed numerous symmetrically distributed, well-defined, erythematous skin nodules on their back, buttocks, and limb extensors (Figure, A). Prominent lymphadenopathies on bilateral cervical, axillary, and inguinal lymph nodes were noted, with the largest lymph node measuring approximately 5[thin space][multiplication sign][thin space]2 cm. Laboratory tests were significant for atypical lymphocytes in the peripheral blood (count up to 6%), an elevated CD4+/CD8+ lymphocyte ratio (9.21; normal range, 0.7-3.1), moderate anemia (hemoglobin level, 8.7 g/dL; normal range, 11.5-15.0 g/dL [to convert to g/L, multiply by 10.0]), a high erythrocyte sedimentation rate (35 mm/h; normal range, 0-25 mm/h), and cryoglobulins composed of mixed polyclonal immunoglobulins. The platelet count (161[thin space][multiplication sign][thin space]103/[greek small letter mu]L; normal range, 125-350[thin space][multiplication sign][thin space]103/[greek small letter mu]L [to convert to [multiplication sign]109/L, multiply by 1.0]) and lactate dehydrogenase (217 U/L; normal range, 100-240 U/L [to convert to [greek small letter mu]kat/L, multiply by 0.0167]) were normal. Quantification of Epstein-Barr virus (EBV) DNA showed high loads of virus in the peripheral blood (846 copies/mL in serum, 27[narrow no-break space]700 copies/mL in lymphocytes; normal range, <500 copies/mL). A biopsy specimen from a skin nodule was sent for histopathologic examination (Figure, B).A, Physical examination showed widespread, symmetrically distributed, well-defined nodules on the trunk and extremities. B, Skin biopsy sample showed infiltration of atypical lymphocytes and histiocytes with proliferation of high endothelial venules (hematoxylin-eosin). C, In situ hybridization was positive for Epstein-Barr virus in the skin.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Cutaneous angioimmunoblastic T-cell lymphoma\nB. Cutaneous sarcoidosis\nC. Lymphomatoid granulomatosis\nD. Blastic plasmacytoid dendritic cell neoplasm\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 61-year-old White man presented to our clinic with a 3-month history of rapidly growing and itchy cutaneous nodules all over the body. He denied systemic complaints such as weakness, fever, night sweats, or weight loss. Oral glucocorticoids did not show any therapeutic effect. His medical history was remarkable for mild anemia because of untreated hemorrhoids. Physical examination revealed numerous symmetrically distributed, well-defined, erythematous skin nodules on his back, buttocks, and limb extensors (Figure, A). Prominent lymphadenopathies on bilateral cervical, axillary, and inguinal lymph nodes were noted, with the largest lymph node measuring approximately 5[thin space][multiplication sign][thin space]2 cm. Laboratory tests were significant for atypical lymphocytes in the peripheral blood (count up to 6%), an elevated CD4+/CD8+ lymphocyte ratio (9.21; normal range, 0.7-3.1), moderate anemia (hemoglobin level, 8.7 g/dL; normal range, 11.5-15.0 g/dL [to convert to g/L, multiply by 10.0]), a high erythrocyte sedimentation rate (35 mm/h; normal range, 0-25 mm/h), and cryoglobulins composed of mixed polyclonal immunoglobulins. The platelet count (161[thin space][multiplication sign][thin space]103/[greek small letter mu]L; normal range, 125-350[thin space][multiplication sign][thin space]103/[greek small letter mu]L [to convert to [multiplication sign]109/L, multiply by 1.0]) and lactate dehydrogenase (217 U/L; normal range, 100-240 U/L [to convert to [greek small letter mu]kat/L, multiply by 0.0167]) were normal. Quantification of Epstein-Barr virus (EBV) DNA showed high loads of virus in the peripheral blood (846 copies/mL in serum, 27[narrow no-break space]700 copies/mL in lymphocytes; normal range, <500 copies/mL). A biopsy specimen from a skin nodule was sent for histopathologic examination (Figure, B).A, Physical examination showed widespread, symmetrically distributed, well-defined nodules on the trunk and extremities. B, Skin biopsy sample showed infiltration of atypical lymphocytes and histiocytes with proliferation of high endothelial venules (hematoxylin-eosin). C, In situ hybridization was positive for Epstein-Barr virus in the skin.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Cutaneous angioimmunoblastic T-cell lymphoma\nB. Cutaneous sarcoidosis\nC. Lymphomatoid granulomatosis\nD. Blastic plasmacytoid dendritic cell neoplasm\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 68-year-old man with a medical history of coronary artery disease, atrial fibrillation, and obesity had undergone C5 anterior corpectomy and fusion (C4-6) with expandable cage, autograft, and anterior instrumentation and posterior spinal decompression and fusion (C4-7) for cervical spondylotic myelopathy. Five months after surgery, he presented to the otolaryngology clinic with 3 weeks of mild odynophagia and dysphagia. It was noted that the patient had a prominent posterior pharyngeal wall, subtle asymmetry of vocal fold motion, and pooling of secretions in the left pyriform (Video 1). During the next 6 months, he gradually developed shortness of breath and stridor, and eventually presented to the emergency department in respiratory distress requiring intubation for 2 days. Shortly after extubation, laryngeal examination showed fullness of the posterior pharyngeal wall and severely limited vocal fold abduction bilaterally (Figure 1A; Video 1). A modified barium swallow study showed intermittent laryngeal penetration without aspiration (Video 2). Although the patient was unable to tolerate magnetic resonance imaging, a soft tissue computed tomography scan of the neck with contrast revealed a well-positioned plate with no evidence of fluid collection in the setting of a normal leukocyte count. One month later, a neuromuscular specialist investigated potential underlying neurological causes; however, results of nerve conduction, antiacetylcholine receptor, antimuscle-specific kinase, methylmalonic acid, HIV, rapid plasma reagin, vitamin B-12, thyroid stimulating hormone, thyroxine, copper, creatine kinase, and immunofixation studies were all unremarkable.Maximum abduction of vocal folds on laryngoscopic examination 11 months after placement of anterior cervical spinal plate (A) and 2 months after removal (B)\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Idiopathic bilateral vocal fold paralysis\nB. Spinal abscess causing laryngeal edema\nC. Arnold-Chiari malformation\nD. Delayed iatrogenic bilateral vocal fold paralysis\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 68-year-old Arab man with a medical history of coronary artery disease, atrial fibrillation, and obesity had undergone C5 anterior corpectomy and fusion (C4-6) with expandable cage, autograft, and anterior instrumentation and posterior spinal decompression and fusion (C4-7) for cervical spondylotic myelopathy. Five months after surgery, he presented to the otolaryngology clinic with 3 weeks of mild odynophagia and dysphagia. It was noted that the Arab patient had a prominent posterior pharyngeal wall, subtle asymmetry of vocal fold motion, and pooling of secretions in the left pyriform (Video 1). During the next 6 months, he gradually developed shortness of breath and stridor, and eventually presented to the emergency department in respiratory distress requiring intubation for 2 days. Shortly after extubation, laryngeal examination showed fullness of the posterior pharyngeal wall and severely limited vocal fold abduction bilaterally (Figure 1A; Video 1). A modified barium swallow study showed intermittent laryngeal penetration without aspiration (Video 2). Although the Arab patient was unable to tolerate magnetic resonance imaging, a soft tissue computed tomography scan of the neck with contrast revealed a well-positioned plate with no evidence of fluid collection in the setting of a normal leukocyte count. One month later, a neuromuscular specialist investigated potential underlying neurological causes; however, results of nerve conduction, antiacetylcholine receptor, antimuscle-specific kinase, methylmalonic acid, HIV, rapid plasma reagin, vitamin B-12, thyroid stimulating hormone, thyroxine, copper, creatine kinase, and immunofixation studies were all unremarkable.Maximum abduction of vocal folds on laryngoscopic examination 11 months after placement of anterior cervical spinal plate (A) and 2 months after removal (B)\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Idiopathic bilateral vocal fold paralysis\nB. Spinal abscess causing laryngeal edema\nC. Arnold-Chiari malformation\nD. Delayed iatrogenic bilateral vocal fold paralysis\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 68-year-old Asian woman with a medical history of coronary artery disease, atrial fibrillation, and obesity had undergone C5 anterior corpectomy and fusion (C4-6) with expandable cage, autograft, and anterior instrumentation and posterior spinal decompression and fusion (C4-7) for cervical spondylotic myelopathy. Five months after surgery, she presented to the otolaryngology clinic with 3 weeks of mild odynophagia and dysphagia. It was noted that the Asian woman had a prominent posterior pharyngeal wall, subtle asymmetry of vocal fold motion, and pooling of secretions in the left pyriform (Video 1). During the next 6 months, she gradually developed shortness of breath and stridor, and eventually presented to the emergency department in respiratory distress requiring intubation for 2 days. Shortly after extubation, laryngeal examination showed fullness of the posterior pharyngeal wall and severely limited vocal fold abduction bilaterally (Figure 1A; Video 1). A modified barium swallow study showed intermittent laryngeal penetration without aspiration (Video 2). Although the Asian woman was unable to tolerate magnetic resonance imaging, a soft tissue computed tomography scan of the neck with contrast revealed a well-positioned plate with no evidence of fluid collection in the setting of a normal leukocyte count. One month later, a neuromuscular specialist investigated potential underlying neurological causes; however, results of nerve conduction, antiacetylcholine receptor, antimuscle-specific kinase, methylmalonic acid, HIV, rapid plasma reagin, vitamin B-12, thyroid stimulating hormone, thyroxine, copper, creatine kinase, and immunofixation studies were all unremarkable.Maximum abduction of vocal folds on laryngoscopic examination 11 months after placement of anterior cervical spinal plate (A) and 2 months after removal (B)\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Idiopathic bilateral vocal fold paralysis\nB. Spinal abscess causing laryngeal edema\nC. Arnold-Chiari malformation\nD. Delayed iatrogenic bilateral vocal fold paralysis\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 68-year-old Black patient with a medical history of coronary artery disease, atrial fibrillation, and obesity had undergone C5 anterior corpectomy and fusion (C4-6) with expandable cage, autograft, and anterior instrumentation and posterior spinal decompression and fusion (C4-7) for cervical spondylotic myelopathy. Five months after surgery, they presented to the otolaryngology clinic with 3 weeks of mild odynophagia and dysphagia. It was noted that the Black patient had a prominent posterior pharyngeal wall, subtle asymmetry of vocal fold motion, and pooling of secretions in the left pyriform (Video 1). During the next 6 months, they gradually developed shortness of breath and stridor, and eventually presented to the emergency department in respiratory distress requiring intubation for 2 days. Shortly after extubation, laryngeal examination showed fullness of the posterior pharyngeal wall and severely limited vocal fold abduction bilaterally (Figure 1A; Video 1). A modified barium swallow study showed intermittent laryngeal penetration without aspiration (Video 2). Although the Black patient was unable to tolerate magnetic resonance imaging, a soft tissue computed tomography scan of the neck with contrast revealed a well-positioned plate with no evidence of fluid collection in the setting of a normal leukocyte count. One month later, a neuromuscular specialist investigated potential underlying neurological causes; however, results of nerve conduction, antiacetylcholine receptor, antimuscle-specific kinase, methylmalonic acid, HIV, rapid plasma reagin, vitamin B-12, thyroid stimulating hormone, thyroxine, copper, creatine kinase, and immunofixation studies were all unremarkable.Maximum abduction of vocal folds on laryngoscopic examination 11 months after placement of anterior cervical spinal plate (A) and 2 months after removal (B)\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Idiopathic bilateral vocal fold paralysis\nB. Spinal abscess causing laryngeal edema\nC. Arnold-Chiari malformation\nD. Delayed iatrogenic bilateral vocal fold paralysis\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 3-month-old boy was referred for evaluation of multiple cutaneous red papules. The guardian reported first noticing the papules at birth. During the following months, the papules grew in number and size, involving the head and neck, trunk, extremities, right palm, mons pubis, and buttocks. At the height of severity, the patient had 39 lesions, some of which were associated with ulceration and bleeding. The patient was born at full term via spontaneous vaginal delivery; the birth mother had not received prenatal care. Neither the birth mother nor the infant had any known history of environmental or occupational exposure to hazardous substances. The paternal family medical history was unremarkable; maternal family medical history was unknown.Physical examination revealed numerous bright red macules, papules, and plaques ranging in size from 1.0[thin space][multiplication sign][thin space]1.0 mm to 2.2[thin space][multiplication sign][thin space]2.3 cm, many of which had hemorrhagic crust and dark scale (Figure, A and B). Additional examination findings included retrognathia, thickened maxillary frenulum, and anterior ankyloglossia.A, Irregularly shaped red vascular plaque (2.2[thin space][multiplication sign][thin space]2.3 mm) with overlying scale, dark crusting, and a dark blue component with surrounding (1.0-3.0 mm) red papules. B, Numerous bright-red macules and papules (1[thin space][multiplication sign][thin space]1 mm-3[thin space][multiplication sign][thin space]3 mm) and 1 vascular red nodule (1.6[thin space][multiplication sign][thin space]1.1 cm) on the left lateral neck with dark overlying crusting. C, Low-power view of histopathology findings demonstrating epidermal hyperplasia and an upper dermal vascular proliferation (hematoxylin-eosin section).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Multifocal lymphangioendotheliomatosis with thrombocytopenia\nB. Congenital disseminated pyogenic granuloma\nC. Bacillary angiomatosis\nD. Multifocal infantile hemangioma\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 3-month-old Hispanic child was referred for evaluation of multiple cutaneous red papules. The guardian reported first noticing the papules at birth. During the following months, the papules grew in number and size, involving the head and neck, trunk, extremities, right palm, mons pubis, and buttocks. At the height of severity, the Hispanic patient had 39 lesions, some of which were associated with ulceration and bleeding. The Hispanic patient was born at full term via spontaneous vaginal delivery; the birth mother had not received prenatal care. Neither the birth mother nor the infant had any known history of environmental or occupational exposure to hazardous substances. The paternal family medical history was unremarkable; maternal family medical history was unknown.Physical examination revealed numerous bright red macules, papules, and plaques ranging in size from 1.0[thin space][multiplication sign][thin space]1.0 mm to 2.2[thin space][multiplication sign][thin space]2.3 cm, many of which had hemorrhagic crust and dark scale (Figure, A and B). Additional examination findings included retrognathia, thickened maxillary frenulum, and anterior ankyloglossia.A, Irregularly shaped red vascular plaque (2.2[thin space][multiplication sign][thin space]2.3 mm) with overlying scale, dark crusting, and a dark blue component with surrounding (1.0-3.0 mm) red papules. B, Numerous bright-red macules and papules (1[thin space][multiplication sign][thin space]1 mm-3[thin space][multiplication sign][thin space]3 mm) and 1 vascular red nodule (1.6[thin space][multiplication sign][thin space]1.1 cm) on the left lateral neck with dark overlying crusting. C, Low-power view of histopathology findings demonstrating epidermal hyperplasia and an upper dermal vascular proliferation (hematoxylin-eosin section).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Multifocal lymphangioendotheliomatosis with thrombocytopenia\nB. Congenital disseminated pyogenic granuloma\nC. Bacillary angiomatosis\nD. Multifocal infantile hemangioma\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 3-month-old White boy was referred for evaluation of multiple cutaneous red papules. The guardian reported first noticing the papules at birth. During the following months, the papules grew in number and size, involving the head and neck, trunk, extremities, right palm, mons pubis, and buttocks. At the height of severity, the White patient had 39 lesions, some of which were associated with ulceration and bleeding. The White patient was born at full term via spontaneous vaginal delivery; the birth mother had not received prenatal care. Neither the birth mother nor the infant had any known history of environmental or occupational exposure to hazardous substances. The paternal family medical history was unremarkable; maternal family medical history was unknown.Physical examination revealed numerous bright red macules, papules, and plaques ranging in size from 1.0[thin space][multiplication sign][thin space]1.0 mm to 2.2[thin space][multiplication sign][thin space]2.3 cm, many of which had hemorrhagic crust and dark scale (Figure, A and B). Additional examination findings included retrognathia, thickened maxillary frenulum, and anterior ankyloglossia.A, Irregularly shaped red vascular plaque (2.2[thin space][multiplication sign][thin space]2.3 mm) with overlying scale, dark crusting, and a dark blue component with surrounding (1.0-3.0 mm) red papules. B, Numerous bright-red macules and papules (1[thin space][multiplication sign][thin space]1 mm-3[thin space][multiplication sign][thin space]3 mm) and 1 vascular red nodule (1.6[thin space][multiplication sign][thin space]1.1 cm) on the left lateral neck with dark overlying crusting. C, Low-power view of histopathology findings demonstrating epidermal hyperplasia and an upper dermal vascular proliferation (hematoxylin-eosin section).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Multifocal lymphangioendotheliomatosis with thrombocytopenia\nB. Congenital disseminated pyogenic granuloma\nC. Bacillary angiomatosis\nD. Multifocal infantile hemangioma\n</options>" }, { "role": "assistant", "content": "B" } ]