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[ { "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" } ]

[ { "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 Arab girl 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 Arab woman had 39 lesions, some of which were associated with ulceration and bleeding. The Arab woman 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 72-year-old homeless man was referred for management of a recurrent cutaneous squamous cell carcinoma (SCC) of the right temple and brow. On review of history, maxillofacial magnetic resonance imaging (MRI) with and without contrast done 5 months prior to presentation showed a 5.9[thin space][multiplication sign][thin space]5.3[thin space][multiplication sign][thin space]3.7-cm mass centered at the right temple that tracked along the right lateral orbital wall as well as an enhancing right intraparotid lymph node. The patient was lost to follow-up and re-presented 5 months later with an enlarged crusting and ulcerating lesion of the right temple/brow (Figure 1A). On ocular examination, best-corrected visual acuity was 20/100 OD and 20/125 OS due to cataracts, pupils reacted normally without afferent pupillary defect, and ocular motility was full. He had mild proptosis in the right eye and right lower eyelid retraction. Orbicularis strength was intact and symmetric in both eyes. MRI of the orbits, face, and neck with and without contrast showed a 6.1[thin space][multiplication sign][thin space]5.7[thin space][multiplication sign][thin space]4.0-cm mass with erosion through the right sphenoid wing, involvement of the lacrimal gland, and abutment of the lateral rectus (Figure 1B). In discussing treatment strategies for the orbital component of the disease, the patient was strongly against an orbital exenteration.A, External photograph showing a large right brow mass with overlying crust after the patient was lost to follow-up and re-presented 5 months later. B, Coronal magnetic resonance imaging (MRI) demonstrating a soft tissue mass centered at the right temple with invasion through the right sphenoid wing, involvement of the lacrimal gland, and abutment of the lateral rectus.Partial debulking of the temple mass followed by cetuximab treatmentNeoadjuvant cemiplimab immunotherapy (anti[en dash]PD-L1 antibody), globe sparing orbitotomy, and surgical excision of the mass\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Platinum-based chemotherapy\nB. Partial debulking of the temple mass followed by cetuximab treatment\nC. Palliative radiotherapy\nD. Neoadjuvant cemiplimab immunotherapy (anti[en dash]PD-L1 antibody), globe sparing orbitotomy, and surgical excision of the mass\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 72-year-old homeless Asian man was referred for management of a recurrent cutaneous squamous cell carcinoma (SCC) of the right temple and brow. On review of history, maxillofacial magnetic resonance imaging (MRI) with and without contrast done 5 months prior to presentation showed a 5.9[thin space][multiplication sign][thin space]5.3[thin space][multiplication sign][thin space]3.7-cm mass centered at the right temple that tracked along the right lateral orbital wall as well as an enhancing right intraparotid lymph node. The Asian patient was lost to follow-up and re-presented 5 months later with an enlarged crusting and ulcerating lesion of the right temple/brow (Figure 1A). On ocular examination, best-corrected visual acuity was 20/100 OD and 20/125 OS due to cataracts, pupils reacted normally without afferent pupillary defect, and ocular motility was full. He had mild proptosis in the right eye and right lower eyelid retraction. Orbicularis strength was intact and symmetric in both eyes. MRI of the orbits, face, and neck with and without contrast showed a 6.1[thin space][multiplication sign][thin space]5.7[thin space][multiplication sign][thin space]4.0-cm mass with erosion through the right sphenoid wing, involvement of the lacrimal gland, and abutment of the lateral rectus (Figure 1B). In discussing treatment strategies for the orbital component of the disease, the Asian patient was strongly against an orbital exenteration.A, External photograph showing a large right brow mass with overlying crust after the Asian patient was lost to follow-up and re-presented 5 months later. B, Coronal magnetic resonance imaging (MRI) demonstrating a soft tissue mass centered at the right temple with invasion through the right sphenoid wing, involvement of the lacrimal gland, and abutment of the lateral rectus.Partial debulking of the temple mass followed by cetuximab treatmentNeoadjuvant cemiplimab immunotherapy (anti[en dash]PD-L1 antibody), globe sparing orbitotomy, and surgical excision of the mass\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Platinum-based chemotherapy\nB. Partial debulking of the temple mass followed by cetuximab treatment\nC. Palliative radiotherapy\nD. Neoadjuvant cemiplimab immunotherapy (anti[en dash]PD-L1 antibody), globe sparing orbitotomy, and surgical excision of the mass\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 72-year-old homeless Black woman was referred for management of a recurrent cutaneous squamous cell carcinoma (SCC) of the right temple and brow. On review of history, maxillofacial magnetic resonance imaging (MRI) with and without contrast done 5 months prior to presentation showed a 5.9[thin space][multiplication sign][thin space]5.3[thin space][multiplication sign][thin space]3.7-cm mass centered at the right temple that tracked along the right lateral orbital wall as well as an enhancing right intraparotid lymph node. The Black woman was lost to follow-up and re-presented 5 months later with an enlarged crusting and ulcerating lesion of the right temple/brow (Figure 1A). On ocular examination, best-corrected visual acuity was 20/100 OD and 20/125 OS due to cataracts, pupils reacted normally without afferent pupillary defect, and ocular motility was full. She had mild proptosis in the right eye and right lower eyelid retraction. Orbicularis strength was intact and symmetric in both eyes. MRI of the orbits, face, and neck with and without contrast showed a 6.1[thin space][multiplication sign][thin space]5.7[thin space][multiplication sign][thin space]4.0-cm mass with erosion through the right sphenoid wing, involvement of the lacrimal gland, and abutment of the lateral rectus (Figure 1B). In discussing treatment strategies for the orbital component of the disease, the Black woman was strongly against an orbital exenteration.A, External photograph showing a large right brow mass with overlying crust after the Black woman was lost to follow-up and re-presented 5 months later. B, Coronal magnetic resonance imaging (MRI) demonstrating a soft tissue mass centered at the right temple with invasion through the right sphenoid wing, involvement of the lacrimal gland, and abutment of the lateral rectus.Partial debulking of the temple mass followed by cetuximab treatmentNeoadjuvant cemiplimab immunotherapy (anti[en dash]PD-L1 antibody), globe sparing orbitotomy, and surgical excision of the mass\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Platinum-based chemotherapy\nB. Partial debulking of the temple mass followed by cetuximab treatment\nC. Palliative radiotherapy\nD. Neoadjuvant cemiplimab immunotherapy (anti[en dash]PD-L1 antibody), globe sparing orbitotomy, and surgical excision of the mass\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 72-year-old homeless Hispanic patient was referred for management of a recurrent cutaneous squamous cell carcinoma (SCC) of the right temple and brow. On review of history, maxillofacial magnetic resonance imaging (MRI) with and without contrast done 5 months prior to presentation showed a 5.9[thin space][multiplication sign][thin space]5.3[thin space][multiplication sign][thin space]3.7-cm mass centered at the right temple that tracked along the right lateral orbital wall as well as an enhancing right intraparotid lymph node. The Hispanic patient was lost to follow-up and re-presented 5 months later with an enlarged crusting and ulcerating lesion of the right temple/brow (Figure 1A). On ocular examination, best-corrected visual acuity was 20/100 OD and 20/125 OS due to cataracts, pupils reacted normally without afferent pupillary defect, and ocular motility was full. They had mild proptosis in the right eye and right lower eyelid retraction. Orbicularis strength was intact and symmetric in both eyes. MRI of the orbits, face, and neck with and without contrast showed a 6.1[thin space][multiplication sign][thin space]5.7[thin space][multiplication sign][thin space]4.0-cm mass with erosion through the right sphenoid wing, involvement of the lacrimal gland, and abutment of the lateral rectus (Figure 1B). In discussing treatment strategies for the orbital component of the disease, the Hispanic patient was strongly against an orbital exenteration.A, External photograph showing a large right brow mass with overlying crust after the Hispanic patient was lost to follow-up and re-presented 5 months later. B, Coronal magnetic resonance imaging (MRI) demonstrating a soft tissue mass centered at the right temple with invasion through the right sphenoid wing, involvement of the lacrimal gland, and abutment of the lateral rectus.Partial debulking of the temple mass followed by cetuximab treatmentNeoadjuvant cemiplimab immunotherapy (anti[en dash]PD-L1 antibody), globe sparing orbitotomy, and surgical excision of the mass\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Platinum-based chemotherapy\nB. Partial debulking of the temple mass followed by cetuximab treatment\nC. Palliative radiotherapy\nD. Neoadjuvant cemiplimab immunotherapy (anti[en dash]PD-L1 antibody), globe sparing orbitotomy, and surgical excision of the mass\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>\nAn otherwise healthy man in his 60s presented to our department with an 8-month history of widespread pruritic papulonodular skin lesions on his extremities and trunk. The patient had been initially diagnosed with nodular prurigo at a local hospital and treated with various topical steroids and oral antihistamines for 2 months, without significant improvement. The skin lesions continued to progress and worsened after scratching. Physical examinations revealed disseminated erythematous papules, hypertrophic plaques approximately 1 to 2 cm in diameter, and dome-shaped nodules with excoriated whitish or pink centers on the scalp, chest, abdomen, back, waist, and extremities (Figure, A and B). Subsequent examinations of the mucosal membranes appeared normal. Other physical examinations as well as his medical and family histories were unremarkable. Peripheral eosinophils, serum total immunoglobulin E level, enzyme-linked immunosorbent assay (ELISA) test for HIV, and results of other routine laboratory tests were within normal ranges or negative. A biopsy specimen was taken from one of the skin lesions on his right forearm for histopathological examination and direct immunofluorescence (DIF) testing (Figure, C and D).A and B, Clinical images showed disseminated erythematous papules, hypertrophic plaques approximately 1 to 2 cm in diameter, and dome-shaped nodules with excoriated whitish or pink centers on the back, waist, and extremities. C, A biopsy specimen taken from the right forearm showed marked hyperkeratosis, acanthosis with irregular elongation of the rete ridges, fibrotic dermis, and perivascular lymphocytic infiltrate (hematoxylin-eosin). D, Direct immunofluorescence revealed linear deposition of immunoglobulin G along the basement membrane zone.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Epidermolysis bullosa pruriginosa\nB. Prurigo nodularis\nC. Pemphigoid nodularis\nD. Acquired perforating dermatosis\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>\nAn otherwise healthy White man in his 60s presented to our department with an 8-month history of widespread pruritic papulonodular skin lesions on his extremities and trunk. The White patient had been initially diagnosed with nodular prurigo at a local hospital and treated with various topical steroids and oral antihistamines for 2 months, without significant improvement. The skin lesions continued to progress and worsened after scratching. Physical examinations revealed disseminated erythematous papules, hypertrophic plaques approximately 1 to 2 cm in diameter, and dome-shaped nodules with excoriated whitish or pink centers on the scalp, chest, abdomen, back, waist, and extremities (Figure, A and B). Subsequent examinations of the mucosal membranes appeared normal. Other physical examinations as well as his medical and family histories were unremarkable. Peripheral eosinophils, serum total immunoglobulin E level, enzyme-linked immunosorbent assay (ELISA) test for HIV, and results of other routine laboratory tests were within normal ranges or negative. A biopsy specimen was taken from one of the skin lesions on his right forearm for histopathological examination and direct immunofluorescence (DIF) testing (Figure, C and D).A and B, Clinical images showed disseminated erythematous papules, hypertrophic plaques approximately 1 to 2 cm in diameter, and dome-shaped nodules with excoriated whitish or pink centers on the back, waist, and extremities. C, A biopsy specimen taken from the right forearm showed marked hyperkeratosis, acanthosis with irregular elongation of the rete ridges, fibrotic dermis, and perivascular lymphocytic infiltrate (hematoxylin-eosin). D, Direct immunofluorescence revealed linear deposition of immunoglobulin G along the basement membrane zone.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Epidermolysis bullosa pruriginosa\nB. Prurigo nodularis\nC. Pemphigoid nodularis\nD. Acquired perforating dermatosis\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>\nAn otherwise healthy Arab woman in her 60s presented to our department with an 8-month history of widespread pruritic papulonodular skin lesions on her extremities and trunk. The Arab woman had been initially diagnosed with nodular prurigo at a local hospital and treated with various topical steroids and oral antihistamines for 2 months, without significant improvement. The skin lesions continued to progress and worsened after scratching. Physical examinations revealed disseminated erythematous papules, hypertrophic plaques approximately 1 to 2 cm in diameter, and dome-shaped nodules with excoriated whitish or pink centers on the scalp, chest, abdomen, back, waist, and extremities (Figure, A and B). Subsequent examinations of the mucosal membranes appeared normal. Other physical examinations as well as her medical and family histories were unremarkable. Peripheral eosinophils, serum total immunoglobulin E level, enzyme-linked immunosorbent assay (ELISA) test for HIV, and results of other routine laboratory tests were within normal ranges or negative. A biopsy specimen was taken from one of the skin lesions on her right forearm for histopathological examination and direct immunofluorescence (DIF) testing (Figure, C and D).A and B, Clinical images showed disseminated erythematous papules, hypertrophic plaques approximately 1 to 2 cm in diameter, and dome-shaped nodules with excoriated whitish or pink centers on the back, waist, and extremities. C, A biopsy specimen taken from the right forearm showed marked hyperkeratosis, acanthosis with irregular elongation of the rete ridges, fibrotic dermis, and perivascular lymphocytic infiltrate (hematoxylin-eosin). D, Direct immunofluorescence revealed linear deposition of immunoglobulin G along the basement membrane zone.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Epidermolysis bullosa pruriginosa\nB. Prurigo nodularis\nC. Pemphigoid nodularis\nD. Acquired perforating dermatosis\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>\nAn otherwise healthy Asian patient in their 60s presented to our department with an 8-month history of widespread pruritic papulonodular skin lesions on their extremities and trunk. The Asian patient had been initially diagnosed with nodular prurigo at a local hospital and treated with various topical steroids and oral antihistamines for 2 months, without significant improvement. The skin lesions continued to progress and worsened after scratching. Physical examinations revealed disseminated erythematous papules, hypertrophic plaques approximately 1 to 2 cm in diameter, and dome-shaped nodules with excoriated whitish or pink centers on the scalp, chest, abdomen, back, waist, and extremities (Figure, A and B). Subsequent examinations of the mucosal membranes appeared normal. Other physical examinations as well as their medical and family histories were unremarkable. Peripheral eosinophils, serum total immunoglobulin E level, enzyme-linked immunosorbent assay (ELISA) test for HIV, and results of other routine laboratory tests were within normal ranges or negative. A biopsy specimen was taken from one of the skin lesions on their right forearm for histopathological examination and direct immunofluorescence (DIF) testing (Figure, C and D).A and B, Clinical images showed disseminated erythematous papules, hypertrophic plaques approximately 1 to 2 cm in diameter, and dome-shaped nodules with excoriated whitish or pink centers on the back, waist, and extremities. C, A biopsy specimen taken from the right forearm showed marked hyperkeratosis, acanthosis with irregular elongation of the rete ridges, fibrotic dermis, and perivascular lymphocytic infiltrate (hematoxylin-eosin). D, Direct immunofluorescence revealed linear deposition of immunoglobulin G along the basement membrane zone.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Epidermolysis bullosa pruriginosa\nB. Prurigo nodularis\nC. Pemphigoid nodularis\nD. Acquired perforating dermatosis\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 15-year-old girl presented to the otorhinolaryngologic department for a right-side postauricular mass. The mass had been present since birth but had slowly grown larger in the previous 2 years. On physical examination, a 2.5[thin space][multiplication sign][thin space]1.5-cm, nontender, blue, soft, cystic mass was observed in the right postauricular area. There were no fistular openings around the auricle or in the external auditory canal (EAC), and there were no additional cysts, sinuses, or fistulas at the right neck from the hyoid bone and chin to the EAC. On temporal bone computed tomography, a 2.5[thin space][multiplication sign][thin space]1.5-cm, hypodense, oval-shaped cystic mass was revealed at the subcutaneous fat layer superoposterior to the right auricle. On temporal magnetic resonance imaging (MRI), an oval cystic mass was revealed at the same location, with high signal intensity on both T1-weighted and T2-weighted images and low signal intensity on enhanced T1-weighted fat suppression and T2-weighted short T1 inversion recovery images (Figure, A-D). In surgery, the well-demarcated cystic mass was completely excised. Yellowish fluid leaked out of the cyst during excision. On histopathologic examination, the cyst was lined by keratinizing stratified squamous epithelium with hair follicles and sebaceous glands. The cyst contained keratinous debris (Figure, E). There was no recurrence 6 months after surgery.A-D, Magnetic resonance imaging showed a 2.5[thin space][multiplication sign][thin space]1.5-cm, oval cystic mass at the subcutaneous fat layer superoposterior to the right auricle with high signal intensity on both T1-weighted and T2-weighted images and low signal intensity on enhanced T1-weighted fat suppression and T2-weighted short T1 inversion recovery images (in order from the left). E, Hematoxylin-eosin staining showed a cyst composed of keratinizing stratified squamous epithelium, hair follicles, and sebaceous glands.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Hemangioma\nB. Type 1 first branchial cleft cyst\nC. Pilomatricoma\nD. Epidermoid cyst\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 15-year-old Black child presented to the otorhinolaryngologic department for a right-side postauricular mass. The mass had been present since birth but had slowly grown larger in the previous 2 years. On physical examination, a 2.5[thin space][multiplication sign][thin space]1.5-cm, nontender, blue, soft, cystic mass was observed in the right postauricular area. There were no fistular openings around the auricle or in the external auditory canal (EAC), and there were no additional cysts, sinuses, or fistulas at the right neck from the hyoid bone and chin to the EAC. On temporal bone computed tomography, a 2.5[thin space][multiplication sign][thin space]1.5-cm, hypodense, oval-shaped cystic mass was revealed at the subcutaneous fat layer superoposterior to the right auricle. On temporal magnetic resonance imaging (MRI), an oval cystic mass was revealed at the same location, with high signal intensity on both T1-weighted and T2-weighted images and low signal intensity on enhanced T1-weighted fat suppression and T2-weighted short T1 inversion recovery images (Figure, A-D). In surgery, the well-demarcated cystic mass was completely excised. Yellowish fluid leaked out of the cyst during excision. On histopathologic examination, the cyst was lined by keratinizing stratified squamous epithelium with hair follicles and sebaceous glands. The cyst contained keratinous debris (Figure, E). There was no recurrence 6 months after surgery.A-D, Magnetic resonance imaging showed a 2.5[thin space][multiplication sign][thin space]1.5-cm, oval cystic mass at the subcutaneous fat layer superoposterior to the right auricle with high signal intensity on both T1-weighted and T2-weighted images and low signal intensity on enhanced T1-weighted fat suppression and T2-weighted short T1 inversion recovery images (in order from the left). E, Hematoxylin-eosin staining showed a cyst composed of keratinizing stratified squamous epithelium, hair follicles, and sebaceous glands.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Hemangioma\nB. Type 1 first branchial cleft cyst\nC. Pilomatricoma\nD. Epidermoid cyst\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 15-year-old Hispanic boy presented to the otorhinolaryngologic department for a right-side postauricular mass. The mass had been present since birth but had slowly grown larger in the previous 2 years. On physical examination, a 2.5[thin space][multiplication sign][thin space]1.5-cm, nontender, blue, soft, cystic mass was observed in the right postauricular area. There were no fistular openings around the auricle or in the external auditory canal (EAC), and there were no additional cysts, sinuses, or fistulas at the right neck from the hyoid bone and chin to the EAC. On temporal bone computed tomography, a 2.5[thin space][multiplication sign][thin space]1.5-cm, hypodense, oval-shaped cystic mass was revealed at the subcutaneous fat layer superoposterior to the right auricle. On temporal magnetic resonance imaging (MRI), an oval cystic mass was revealed at the same location, with high signal intensity on both T1-weighted and T2-weighted images and low signal intensity on enhanced T1-weighted fat suppression and T2-weighted short T1 inversion recovery images (Figure, A-D). In surgery, the well-demarcated cystic mass was completely excised. Yellowish fluid leaked out of the cyst during excision. On histopathologic examination, the cyst was lined by keratinizing stratified squamous epithelium with hair follicles and sebaceous glands. The cyst contained keratinous debris (Figure, E). There was no recurrence 6 months after surgery.A-D, Magnetic resonance imaging showed a 2.5[thin space][multiplication sign][thin space]1.5-cm, oval cystic mass at the subcutaneous fat layer superoposterior to the right auricle with high signal intensity on both T1-weighted and T2-weighted images and low signal intensity on enhanced T1-weighted fat suppression and T2-weighted short T1 inversion recovery images (in order from the left). E, Hematoxylin-eosin staining showed a cyst composed of keratinizing stratified squamous epithelium, hair follicles, and sebaceous glands.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Hemangioma\nB. Type 1 first branchial cleft cyst\nC. Pilomatricoma\nD. Epidermoid cyst\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 15-year-old White girl presented to the otorhinolaryngologic department for a right-side postauricular mass. The mass had been present since birth but had slowly grown larger in the previous 2 years. On physical examination, a 2.5[thin space][multiplication sign][thin space]1.5-cm, nontender, blue, soft, cystic mass was observed in the right postauricular area. There were no fistular openings around the auricle or in the external auditory canal (EAC), and there were no additional cysts, sinuses, or fistulas at the right neck from the hyoid bone and chin to the EAC. On temporal bone computed tomography, a 2.5[thin space][multiplication sign][thin space]1.5-cm, hypodense, oval-shaped cystic mass was revealed at the subcutaneous fat layer superoposterior to the right auricle. On temporal magnetic resonance imaging (MRI), an oval cystic mass was revealed at the same location, with high signal intensity on both T1-weighted and T2-weighted images and low signal intensity on enhanced T1-weighted fat suppression and T2-weighted short T1 inversion recovery images (Figure, A-D). In surgery, the well-demarcated cystic mass was completely excised. Yellowish fluid leaked out of the cyst during excision. On histopathologic examination, the cyst was lined by keratinizing stratified squamous epithelium with hair follicles and sebaceous glands. The cyst contained keratinous debris (Figure, E). There was no recurrence 6 months after surgery.A-D, Magnetic resonance imaging showed a 2.5[thin space][multiplication sign][thin space]1.5-cm, oval cystic mass at the subcutaneous fat layer superoposterior to the right auricle with high signal intensity on both T1-weighted and T2-weighted images and low signal intensity on enhanced T1-weighted fat suppression and T2-weighted short T1 inversion recovery images (in order from the left). E, Hematoxylin-eosin staining showed a cyst composed of keratinizing stratified squamous epithelium, hair follicles, and sebaceous glands.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Hemangioma\nB. Type 1 first branchial cleft cyst\nC. Pilomatricoma\nD. Epidermoid cyst\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 66-year-old woman with chronic hepatitis B infection and hepatocellular carcinoma (HCC) presented with subacute epigastric pain. Three years prior, she was diagnosed with a solitary HCC and underwent surgical resection with curative intent. Pathology revealed poorly differentiated HCC, 16 cm in largest dimension, with large vein involvement (T3bNXM0, R0 resection). The patient underwent expectant observation. One and a half years prior to the current presentation, laboratory results revealed an elevated [greek small letter alpha]-fetoprotein (AFP), and cross-sectional imaging revealed multiple lung nodules consistent with metastases. She was treated with nivolumab every other week and attained a biochemical (baseline, 212.2 ng/dL; best response, 3.3 ng/dL) and radiographic complete response.In the current presentation, the patient reported nonradiating epigastric pain of moderate intensity for 1 month. Associated symptoms included nausea, anorexia, and water brash without emesis. Review of systems was positive for unchanged chronic abdominal bloating and negative for other constitutional or gastrointestinal symptoms. Laboratory results, including liver function tests, amylase, lipase, and AFP, were within normal limits, and hepatitis B virus polymerase chain reaction was undetectable. Computed tomography with multiphasic liver protocol showed new enlarged mesenteric nodes and diffuse thickening of the gastric body (Figure, A). Esophagogastroduodenoscopy (EGD) identified diffuse inflammation and ulcerations in the gastric body and antrum (Figure, B). Biopsy specimens showed chronic and active mixed inflammatory infiltrate, including intraepithelial lymphocytosis (Figure, C). No overt viral cytopathic effects were observed, and immunostaining results for Helicobacter pylori, cytomegalovirus, and adenovirus were negative.A, Coronal view of restaging computed tomography of chest, abdomen, and pelvis with contrast. The yellow circle notes borderline enlarged mesenteric nodes inferior to the stomach, and the yellow arrowheads show thickened gastric body wall. B, Gross appearance of the gastric mucosa visualized via upper endoscopy, which showed diffuse inflammation and ulceration in the gastric body and antrum. C, Biopsy of the gastric mucosa showed marked chronic and active intraepithelial infiltration of lymphocytes (blue arrowheads) and neutrophils (yellow arrowhead) and associated glandular epithelial injury with withered glands and gland dropout (red circle) (original magnification [multiplication sign]100).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Immunotherapy-related gastritis\nB. Liver cancer progression\nC. Infectious gastritis\nD. Portal hypertensive gastropathy\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 66-year-old Arab man with chronic hepatitis B infection and hepatocellular carcinoma (HCC) presented with subacute epigastric pain. Three years prior, he was diagnosed with a solitary HCC and underwent surgical resection with curative intent. Pathology revealed poorly differentiated HCC, 16 cm in largest dimension, with large vein involvement (T3bNXM0, R0 resection). The Arab man underwent expectant observation. One and a half years prior to the current presentation, laboratory results revealed an elevated [greek small letter alpha]-fetoprotein (AFP), and cross-sectional imaging revealed multiple lung nodules consistent with metastases. He was treated with nivolumab every other week and attained a biochemical (baseline, 212.2 ng/dL; best response, 3.3 ng/dL) and radiographic complete response.In the current presentation, the Arab man reported nonradiating epigastric pain of moderate intensity for 1 month. Associated symptoms included nausea, anorexia, and water brash without emesis. Review of systems was positive for unchanged chronic abdominal bloating and negative for other constitutional or gastrointestinal symptoms. Laboratory results, including liver function tests, amylase, lipase, and AFP, were within normal limits, and hepatitis B virus polymerase chain reaction was undetectable. Computed tomography with multiphasic liver protocol showed new enlarged mesenteric nodes and diffuse thickening of the gastric body (Figure, A). Esophagogastroduodenoscopy (EGD) identified diffuse inflammation and ulcerations in the gastric body and antrum (Figure, B). Biopsy specimens showed chronic and active mixed inflammatory infiltrate, including intraepithelial lymphocytosis (Figure, C). No overt viral cytopathic effects were observed, and immunostaining results for Helicobacter pylori, cytomegalovirus, and adenovirus were negative.A, Coronal view of restaging computed tomography of chest, abdomen, and pelvis with contrast. The yellow circle notes borderline enlarged mesenteric nodes inferior to the stomach, and the yellow arrowheads show thickened gastric body wall. B, Gross appearance of the gastric mucosa visualized via upper endoscopy, which showed diffuse inflammation and ulceration in the gastric body and antrum. C, Biopsy of the gastric mucosa showed marked chronic and active intraepithelial infiltration of lymphocytes (blue arrowheads) and neutrophils (yellow arrowhead) and associated glandular epithelial injury with withered glands and gland dropout (red circle) (original magnification [multiplication sign]100).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Immunotherapy-related gastritis\nB. Liver cancer progression\nC. Infectious gastritis\nD. Portal hypertensive gastropathy\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 66-year-old Asian patient with chronic hepatitis B infection and hepatocellular carcinoma (HCC) presented with subacute epigastric pain. Three years prior, they was diagnosed with a solitary HCC and underwent surgical resection with curative intent. Pathology revealed poorly differentiated HCC, 16 cm in largest dimension, with large vein involvement (T3bNXM0, R0 resection). The Asian patient underwent expectant observation. One and a half years prior to the current presentation, laboratory results revealed an elevated [greek small letter alpha]-fetoprotein (AFP), and cross-sectional imaging revealed multiple lung nodules consistent with metastases. They was treated with nivolumab every other week and attained a biochemical (baseline, 212.2 ng/dL; best response, 3.3 ng/dL) and radiographic complete response.In the current presentation, the Asian patient reported nonradiating epigastric pain of moderate intensity for 1 month. Associated symptoms included nausea, anorexia, and water brash without emesis. Review of systems was positive for unchanged chronic abdominal bloating and negative for other constitutional or gastrointestinal symptoms. Laboratory results, including liver function tests, amylase, lipase, and AFP, were within normal limits, and hepatitis B virus polymerase chain reaction was undetectable. Computed tomography with multiphasic liver protocol showed new enlarged mesenteric nodes and diffuse thickening of the gastric body (Figure, A). Esophagogastroduodenoscopy (EGD) identified diffuse inflammation and ulcerations in the gastric body and antrum (Figure, B). Biopsy specimens showed chronic and active mixed inflammatory infiltrate, including intraepithelial lymphocytosis (Figure, C). No overt viral cytopathic effects were observed, and immunostaining results for Helicobacter pylori, cytomegalovirus, and adenovirus were negative.A, Coronal view of restaging computed tomography of chest, abdomen, and pelvis with contrast. The yellow circle notes borderline enlarged mesenteric nodes inferior to the stomach, and the yellow arrowheads show thickened gastric body wall. B, Gross appearance of the gastric mucosa visualized via upper endoscopy, which showed diffuse inflammation and ulceration in the gastric body and antrum. C, Biopsy of the gastric mucosa showed marked chronic and active intraepithelial infiltration of lymphocytes (blue arrowheads) and neutrophils (yellow arrowhead) and associated glandular epithelial injury with withered glands and gland dropout (red circle) (original magnification [multiplication sign]100).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Immunotherapy-related gastritis\nB. Liver cancer progression\nC. Infectious gastritis\nD. Portal hypertensive gastropathy\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 66-year-old Black woman with chronic hepatitis B infection and hepatocellular carcinoma (HCC) presented with subacute epigastric pain. Three years prior, she was diagnosed with a solitary HCC and underwent surgical resection with curative intent. Pathology revealed poorly differentiated HCC, 16 cm in largest dimension, with large vein involvement (T3bNXM0, R0 resection). The Black patient underwent expectant observation. One and a half years prior to the current presentation, laboratory results revealed an elevated [greek small letter alpha]-fetoprotein (AFP), and cross-sectional imaging revealed multiple lung nodules consistent with metastases. She was treated with nivolumab every other week and attained a biochemical (baseline, 212.2 ng/dL; best response, 3.3 ng/dL) and radiographic complete response.In the current presentation, the Black patient reported nonradiating epigastric pain of moderate intensity for 1 month. Associated symptoms included nausea, anorexia, and water brash without emesis. Review of systems was positive for unchanged chronic abdominal bloating and negative for other constitutional or gastrointestinal symptoms. Laboratory results, including liver function tests, amylase, lipase, and AFP, were within normal limits, and hepatitis B virus polymerase chain reaction was undetectable. Computed tomography with multiphasic liver protocol showed new enlarged mesenteric nodes and diffuse thickening of the gastric body (Figure, A). Esophagogastroduodenoscopy (EGD) identified diffuse inflammation and ulcerations in the gastric body and antrum (Figure, B). Biopsy specimens showed chronic and active mixed inflammatory infiltrate, including intraepithelial lymphocytosis (Figure, C). No overt viral cytopathic effects were observed, and immunostaining results for Helicobacter pylori, cytomegalovirus, and adenovirus were negative.A, Coronal view of restaging computed tomography of chest, abdomen, and pelvis with contrast. The yellow circle notes borderline enlarged mesenteric nodes inferior to the stomach, and the yellow arrowheads show thickened gastric body wall. B, Gross appearance of the gastric mucosa visualized via upper endoscopy, which showed diffuse inflammation and ulceration in the gastric body and antrum. C, Biopsy of the gastric mucosa showed marked chronic and active intraepithelial infiltration of lymphocytes (blue arrowheads) and neutrophils (yellow arrowhead) and associated glandular epithelial injury with withered glands and gland dropout (red circle) (original magnification [multiplication sign]100).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Immunotherapy-related gastritis\nB. Liver cancer progression\nC. Infectious gastritis\nD. Portal hypertensive gastropathy\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 65-year-old patient was referred to the ear, nose, and throat department with left-sided hearing loss during the past 6 months without evident cause. He had a medical history of myocardial infarction, sleep apnea, M[latin small letter e with acute]ni[latin small letter e with grave]re disease, and congenital cataract. Furthermore, he did not report otalgia, otorrhea, a recent episode of M[latin small letter e with acute]ni[latin small letter e with grave]re disease, or other ear, nose, and throat or systemic symptoms. The patient used atorvastatin and acetylsalicylic acid, did not smoke, and reported drinking 2 glasses of wine daily. Otoscopy of the left ear revealed a yellow-whitish calcareous lobular mass located in the mesotympanum anterior to the malleus with an intact tympanic membrane. The lesion was hard and painful during palpation (Figure 1A). Otoscopy results for the right side were normal.Conductive hearing loss of the left ear because of a middle ear mass, seen on otoscopy (A) and on computed tomography (CT) (B).Pure-tone audiometry results showed a left-sided mixed hearing loss with a pure tone average of 110 dB HL and bone conduction levels at approximately 60 dB HL. The tympanogram showed a normal A-type curve with a normal to low middle ear compliance of 0.5 mm on the left side. Computed tomography (CT) imaging of the middle ear showed a heterogeneous hyperdense round mass of 5.5 mm in the left middle ear with a close relation to the malleus, eardrum, and tegmen (Figure 1B). There were no other abnormalities in the mastoid, ossicular chain, facial nerve canal, or surrounding blood vessels.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Tympanosclerosis\nB. Tophaceous gout\nC. Cholesteatoma\nD. Osteoma\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 65-year-old Hispanic woman was referred to the ear, nose, and throat department with left-sided hearing loss during the past 6 months without evident cause. She had a medical history of myocardial infarction, sleep apnea, M[latin small letter e with acute]ni[latin small letter e with grave]re disease, and congenital cataract. Furthermore, she did not report otalgia, otorrhea, a recent episode of M[latin small letter e with acute]ni[latin small letter e with grave]re disease, or other ear, nose, and throat or systemic symptoms. The Hispanic woman used atorvastatin and acetylsalicylic acid, did not smoke, and reported drinking 2 glasses of wine daily. Otoscopy of the left ear revealed a yellow-whitish calcareous lobular mass located in the mesotympanum anterior to the malleus with an intact tympanic membrane. The lesion was hard and painful during palpation (Figure 1A). Otoscopy results for the right side were normal.Conductive hearing loss of the left ear because of a middle ear mass, seen on otoscopy (A) and on computed tomography (CT) (B).Pure-tone audiometry results showed a left-sided mixed hearing loss with a pure tone average of 110 dB HL and bone conduction levels at approximately 60 dB HL. The tympanogram showed a normal A-type curve with a normal to low middle ear compliance of 0.5 mm on the left side. Computed tomography (CT) imaging of the middle ear showed a heterogeneous hyperdense round mass of 5.5 mm in the left middle ear with a close relation to the malleus, eardrum, and tegmen (Figure 1B). There were no other abnormalities in the mastoid, ossicular chain, facial nerve canal, or surrounding blood vessels.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Tympanosclerosis\nB. Tophaceous gout\nC. Cholesteatoma\nD. Osteoma\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 65-year-old White patient was referred to the ear, nose, and throat department with left-sided hearing loss during the past 6 months without evident cause. They had a medical history of myocardial infarction, sleep apnea, M[latin small letter e with acute]ni[latin small letter e with grave]re disease, and congenital cataract. Furthermore, they did not report otalgia, otorrhea, a recent episode of M[latin small letter e with acute]ni[latin small letter e with grave]re disease, or other ear, nose, and throat or systemic symptoms. The White patient used atorvastatin and acetylsalicylic acid, did not smoke, and reported drinking 2 glasses of wine daily. Otoscopy of the left ear revealed a yellow-whitish calcareous lobular mass located in the mesotympanum anterior to the malleus with an intact tympanic membrane. The lesion was hard and painful during palpation (Figure 1A). Otoscopy results for the right side were normal.Conductive hearing loss of the left ear because of a middle ear mass, seen on otoscopy (A) and on computed tomography (CT) (B).Pure-tone audiometry results showed a left-sided mixed hearing loss with a pure tone average of 110 dB HL and bone conduction levels at approximately 60 dB HL. The tympanogram showed a normal A-type curve with a normal to low middle ear compliance of 0.5 mm on the left side. Computed tomography (CT) imaging of the middle ear showed a heterogeneous hyperdense round mass of 5.5 mm in the left middle ear with a close relation to the malleus, eardrum, and tegmen (Figure 1B). There were no other abnormalities in the mastoid, ossicular chain, facial nerve canal, or surrounding blood vessels.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Tympanosclerosis\nB. Tophaceous gout\nC. Cholesteatoma\nD. Osteoma\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 65-year-old Arab patient was referred to the ear, nose, and throat department with left-sided hearing loss during the past 6 months without evident cause. He had a medical history of myocardial infarction, sleep apnea, M[latin small letter e with acute]ni[latin small letter e with grave]re disease, and congenital cataract. Furthermore, he did not report otalgia, otorrhea, a recent episode of M[latin small letter e with acute]ni[latin small letter e with grave]re disease, or other ear, nose, and throat or systemic symptoms. The Arab patient used atorvastatin and acetylsalicylic acid, did not smoke, and reported drinking 2 glasses of wine daily. Otoscopy of the left ear revealed a yellow-whitish calcareous lobular mass located in the mesotympanum anterior to the malleus with an intact tympanic membrane. The lesion was hard and painful during palpation (Figure 1A). Otoscopy results for the right side were normal.Conductive hearing loss of the left ear because of a middle ear mass, seen on otoscopy (A) and on computed tomography (CT) (B).Pure-tone audiometry results showed a left-sided mixed hearing loss with a pure tone average of 110 dB HL and bone conduction levels at approximately 60 dB HL. The tympanogram showed a normal A-type curve with a normal to low middle ear compliance of 0.5 mm on the left side. Computed tomography (CT) imaging of the middle ear showed a heterogeneous hyperdense round mass of 5.5 mm in the left middle ear with a close relation to the malleus, eardrum, and tegmen (Figure 1B). There were no other abnormalities in the mastoid, ossicular chain, facial nerve canal, or surrounding blood vessels.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Tympanosclerosis\nB. Tophaceous gout\nC. Cholesteatoma\nD. Osteoma\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 59-year-old woman with a 5-year history of intermittent bilateral uveitis and scleritis presented with painful left uveitis and an episcleral nodule (Figure 1). Ultrasound biomicroscopy revealed an elevated and tender uveal-episcleral lesion. Visual acuity was 20/30 in the left eye and 20/25 in the right eye. She had been taking 60 mg of oral prednisone; topical prednisolone acetate, 1%; and oral ibuprofen for 10 days without relief. She was suspected of being a steroid responder due to elevated intraocular pressure bilaterally. Three years prior, sinus pressure symptoms led to magnetic resonance imaging that revealed a nasal sinus mass. Biopsy demonstrated a histiocytic infiltrate with emperipolesis, consistent with Rosai-Dorfman-Destombes (RDD) disease. Timolol-dorzolamide topical drops were initiated. Staging evaluations showed no other sites of RDD disease.Pretreatment. External photograph (A) and corresponding ultrasound biomicroscopy (B) demonstrating an elevated sclerouveal nodule.Initiate an alternative systemic therapy (ie, an immunomodulatory agent)Consider treating the left eye with intra-arterial melphalan\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Initiate an alternative systemic therapy (ie, an immunomodulatory agent)\nB. Consider treating the left eye with intra-arterial melphalan\nC. Administer subtenon triamcinolone to the left eye\nD. Switch oral ibuprofen to oral flurbiprofen\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 59-year-old Asian man with a 5-year history of intermittent bilateral uveitis and scleritis presented with painful left uveitis and an episcleral nodule (Figure 1). Ultrasound biomicroscopy revealed an elevated and tender uveal-episcleral lesion. Visual acuity was 20/30 in the left eye and 20/25 in the right eye. He had been taking 60 mg of oral prednisone; topical prednisolone acetate, 1%; and oral ibuprofen for 10 days without relief. He was suspected of being a steroid responder due to elevated intraocular pressure bilaterally. Three years prior, sinus pressure symptoms led to magnetic resonance imaging that revealed a nasal sinus mass. Biopsy demonstrated a histiocytic infiltrate with emperipolesis, consistent with Rosai-Dorfman-Destombes (RDD) disease. Timolol-dorzolamide topical drops were initiated. Staging evaluations showed no other sites of RDD disease.Pretreatment. External photograph (A) and corresponding ultrasound biomicroscopy (B) demonstrating an elevated sclerouveal nodule.Initiate an alternative systemic therapy (ie, an immunomodulatory agent)Consider treating the left eye with intra-arterial melphalan\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Initiate an alternative systemic therapy (ie, an immunomodulatory agent)\nB. Consider treating the left eye with intra-arterial melphalan\nC. Administer subtenon triamcinolone to the left eye\nD. Switch oral ibuprofen to oral flurbiprofen\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 59-year-old Black patient with a 5-year history of intermittent bilateral uveitis and scleritis presented with painful left uveitis and an episcleral nodule (Figure 1). Ultrasound biomicroscopy revealed an elevated and tender uveal-episcleral lesion. Visual acuity was 20/30 in the left eye and 20/25 in the right eye. They had been taking 60 mg of oral prednisone; topical prednisolone acetate, 1%; and oral ibuprofen for 10 days without relief. They was suspected of being a steroid responder due to elevated intraocular pressure bilaterally. Three years prior, sinus pressure symptoms led to magnetic resonance imaging that revealed a nasal sinus mass. Biopsy demonstrated a histiocytic infiltrate with emperipolesis, consistent with Rosai-Dorfman-Destombes (RDD) disease. Timolol-dorzolamide topical drops were initiated. Staging evaluations showed no other sites of RDD disease.Pretreatment. External photograph (A) and corresponding ultrasound biomicroscopy (B) demonstrating an elevated sclerouveal nodule.Initiate an alternative systemic therapy (ie, an immunomodulatory agent)Consider treating the left eye with intra-arterial melphalan\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Initiate an alternative systemic therapy (ie, an immunomodulatory agent)\nB. Consider treating the left eye with intra-arterial melphalan\nC. Administer subtenon triamcinolone to the left eye\nD. Switch oral ibuprofen to oral flurbiprofen\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 59-year-old Hispanic woman with a 5-year history of intermittent bilateral uveitis and scleritis presented with painful left uveitis and an episcleral nodule (Figure 1). Ultrasound biomicroscopy revealed an elevated and tender uveal-episcleral lesion. Visual acuity was 20/30 in the left eye and 20/25 in the right eye. She had been taking 60 mg of oral prednisone; topical prednisolone acetate, 1%; and oral ibuprofen for 10 days without relief. She was suspected of being a steroid responder due to elevated intraocular pressure bilaterally. Three years prior, sinus pressure symptoms led to magnetic resonance imaging that revealed a nasal sinus mass. Biopsy demonstrated a histiocytic infiltrate with emperipolesis, consistent with Rosai-Dorfman-Destombes (RDD) disease. Timolol-dorzolamide topical drops were initiated. Staging evaluations showed no other sites of RDD disease.Pretreatment. External photograph (A) and corresponding ultrasound biomicroscopy (B) demonstrating an elevated sclerouveal nodule.Initiate an alternative systemic therapy (ie, an immunomodulatory agent)Consider treating the left eye with intra-arterial melphalan\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Initiate an alternative systemic therapy (ie, an immunomodulatory agent)\nB. Consider treating the left eye with intra-arterial melphalan\nC. Administer subtenon triamcinolone to the left eye\nD. Switch oral ibuprofen to oral flurbiprofen\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 late 70s with a history of immunoglobulin A monoclonal gammopathy of unknown significance presented with a tender, draining lesion of the central face despite several courses of treatment with antibiotics (Figure, A). The patient lived in Southern California but had visited Kenya for an extended trip a few years prior. Review of systems was negative for fevers, night sweats, weight loss, headache, vision changes, respiratory distress, or arthralgias. On the left nasal dorsum and medial cheek, there was a 3[thin space][multiplication sign][thin space]4 cm violaceous plaque with focal purulent drainage. Within several weeks, the lesion rapidly expanded into a vegetative, freely draining plaque covering the cheeks and glabella and approaching the medial canthi (Figure, B). Computed tomography revealed findings consistent with abscess that did not involve the orbits, sinuses, or bone. Chest radiography results were unremarkable. Punch biopsy specimens were obtained for histopathological analysis and tissue cultures (Figure, C). Tissue culture results at 2 weeks remained negative, and a QuantiFERON-TB Gold test result was negative.A, Violaceous plaque on the nose and left cheek. B, Rapid progression of the lesion involved the cheeks and glabella, with substantially worsening drainage at 6-week follow-up. C, Punch biopsy of lesion showing suppurative and granulomatous dermatitis (hematoxylin-eosin). D, Posttreatment, there was improvement of the lesion from initial presentation, but substantial residual facial scarring remained.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Pyoderma gangrenosum\nB. Lupus vulgaris\nC. Granulomatosis with polyangiitis\nD. Coccidioidomycosis\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 woman in her late 70s with a history of immunoglobulin A monoclonal gammopathy of unknown significance presented with a tender, draining lesion of the central face despite several courses of treatment with antibiotics (Figure, A). The White patient lived in Southern California but had visited Kenya for an extended trip a few years prior. Review of systems was negative for fevers, night sweats, weight loss, headache, vision changes, respiratory distress, or arthralgias. On the left nasal dorsum and medial cheek, there was a 3[thin space][multiplication sign][thin space]4 cm violaceous plaque with focal purulent drainage. Within several weeks, the lesion rapidly expanded into a vegetative, freely draining plaque covering the cheeks and glabella and approaching the medial canthi (Figure, B). Computed tomography revealed findings consistent with abscess that did not involve the orbits, sinuses, or bone. Chest radiography results were unremarkable. Punch biopsy specimens were obtained for histopathological analysis and tissue cultures (Figure, C). Tissue culture results at 2 weeks remained negative, and a QuantiFERON-TB Gold test result was negative.A, Violaceous plaque on the nose and left cheek. B, Rapid progression of the lesion involved the cheeks and glabella, with substantially worsening drainage at 6-week follow-up. C, Punch biopsy of lesion showing suppurative and granulomatous dermatitis (hematoxylin-eosin). D, Posttreatment, there was improvement of the lesion from initial presentation, but substantial residual facial scarring remained.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Pyoderma gangrenosum\nB. Lupus vulgaris\nC. Granulomatosis with polyangiitis\nD. Coccidioidomycosis\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 man in him late 70s with a history of immunoglobulin A monoclonal gammopathy of unknown significance presented with a tender, draining lesion of the central face despite several courses of treatment with antibiotics (Figure, A). The Arab man lived in Southern California but had visited Kenya for an extended trip a few years prior. Review of systems was negative for fevers, night sweats, weight loss, headache, vision changes, respiratory distress, or arthralgias. On the left nasal dorsum and medial cheek, there was a 3[thin space][multiplication sign][thin space]4 cm violaceous plaque with focal purulent drainage. Within several weeks, the lesion rapidly expanded into a vegetative, freely draining plaque covering the cheeks and glabella and approaching the medial canthi (Figure, B). Computed tomography revealed findings consistent with abscess that did not involve the orbits, sinuses, or bone. Chest radiography results were unremarkable. Punch biopsy specimens were obtained for histopathological analysis and tissue cultures (Figure, C). Tissue culture results at 2 weeks remained negative, and a QuantiFERON-TB Gold test result was negative.A, Violaceous plaque on the nose and left cheek. B, Rapid progression of the lesion involved the cheeks and glabella, with substantially worsening drainage at 6-week follow-up. C, Punch biopsy of lesion showing suppurative and granulomatous dermatitis (hematoxylin-eosin). D, Posttreatment, there was improvement of the lesion from initial presentation, but substantial residual facial scarring remained.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Pyoderma gangrenosum\nB. Lupus vulgaris\nC. Granulomatosis with polyangiitis\nD. Coccidioidomycosis\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 patient in them late 70s with a history of immunoglobulin A monoclonal gammopathy of unknown significance presented with a tender, draining lesion of the central face despite several courses of treatment with antibiotics (Figure, A). The Asian patient lived in Southern California but had visited Kenya for an extended trip a few years prior. Review of systems was negative for fevers, night sweats, weight loss, headache, vision changes, respiratory distress, or arthralgias. On the left nasal dorsum and medial cheek, there was a 3[thin space][multiplication sign][thin space]4 cm violaceous plaque with focal purulent drainage. Within several weeks, the lesion rapidly expanded into a vegetative, freely draining plaque covering the cheeks and glabella and approaching the medial canthi (Figure, B). Computed tomography revealed findings consistent with abscess that did not involve the orbits, sinuses, or bone. Chest radiography results were unremarkable. Punch biopsy specimens were obtained for histopathological analysis and tissue cultures (Figure, C). Tissue culture results at 2 weeks remained negative, and a QuantiFERON-TB Gold test result was negative.A, Violaceous plaque on the nose and left cheek. B, Rapid progression of the lesion involved the cheeks and glabella, with substantially worsening drainage at 6-week follow-up. C, Punch biopsy of lesion showing suppurative and granulomatous dermatitis (hematoxylin-eosin). D, Posttreatment, there was improvement of the lesion from initial presentation, but substantial residual facial scarring remained.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Pyoderma gangrenosum\nB. Lupus vulgaris\nC. Granulomatosis with polyangiitis\nD. Coccidioidomycosis\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 mid-50s with a history of mitral valve repair presented to the emergency department with complaints of recent-onset palpitation within the last hour. On physical examination, the patient showed a rhythmic tachycardia with a rate of 178 beats/min and blood pressure of 130/80 mm Hg. The 12-lead electrocardiogram (ECG) revealed a regular tachycardia with a rate of 178 beats/min; no obvious P waves were recognizable (Figure 1A). The QRS complexes displayed 2 different morphologies occurring with a definite allorhythmic distribution: pairs of beats exhibiting complete right bundle branch block (RBBB) and QRS duration of 140 milliseconds followed by a third beat with normal configuration and QRS duration of 70 milliseconds. This trigeminal variation in intraventricular conduction occurred without any change in cycle length and was maintained. Adenosine administration quickly slowed the ventricular rate allowing recognition of an atrial tachycardia with a rate of 178/min and a 2:1 atrioventricular (AV) ratio (Figure 1B).A, Regular supraventricular tachycardia with right bundle branch block aberration disappearing every third beat. B, Lead II. Numbers within the tracing indicate the R-R intervals (in milliseconds). The variability in ventricular cycle lengths results from small changes in both the P-P and P-R intervals. ECG indicates electrocardiogram.Place a temporary pacemaker and start treatment with low-molecular-weight heparin and amiodarone\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Order an urgent electrophysiologic investigation\nB. Perform urgent DC shock\nC. Place a temporary pacemaker and start treatment with low-molecular-weight heparin and amiodarone\nD. Start treatment with low-molecular-weight heparin and amiodarone\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 Black man in his mid-50s with a history of mitral valve repair presented to the emergency department with complaints of recent-onset palpitation within the last hour. On physical examination, the Black patient showed a rhythmic tachycardia with a rate of 178 beats/min and blood pressure of 130/80 mm Hg. The 12-lead electrocardiogram (ECG) revealed a regular tachycardia with a rate of 178 beats/min; no obvious P waves were recognizable (Figure 1A). The QRS complexes displayed 2 different morphologies occurring with a definite allorhythmic distribution: pairs of beats exhibiting complete right bundle branch block (RBBB) and QRS duration of 140 milliseconds followed by a third beat with normal configuration and QRS duration of 70 milliseconds. This trigeminal variation in intraventricular conduction occurred without any change in cycle length and was maintained. Adenosine administration quickly slowed the ventricular rate allowing recognition of an atrial tachycardia with a rate of 178/min and a 2:1 atrioventricular (AV) ratio (Figure 1B).A, Regular supraventricular tachycardia with right bundle branch block aberration disappearing every third beat. B, Lead II. Numbers within the tracing indicate the R-R intervals (in milliseconds). The variability in ventricular cycle lengths results from small changes in both the P-P and P-R intervals. ECG indicates electrocardiogram.Place a temporary pacemaker and start treatment with low-molecular-weight heparin and amiodarone\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Order an urgent electrophysiologic investigation\nB. Perform urgent DC shock\nC. Place a temporary pacemaker and start treatment with low-molecular-weight heparin and amiodarone\nD. Start treatment with low-molecular-weight heparin and amiodarone\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 Hispanic patient in their mid-50s with a history of mitral valve repair presented to the emergency department with complaints of recent-onset palpitation within the last hour. On physical examination, the Hispanic patient showed a rhythmic tachycardia with a rate of 178 beats/min and blood pressure of 130/80 mm Hg. The 12-lead electrocardiogram (ECG) revealed a regular tachycardia with a rate of 178 beats/min; no obvious P waves were recognizable (Figure 1A). The QRS complexes displayed 2 different morphologies occurring with a definite allorhythmic distribution: pairs of beats exhibiting complete right bundle branch block (RBBB) and QRS duration of 140 milliseconds followed by a third beat with normal configuration and QRS duration of 70 milliseconds. This trigeminal variation in intraventricular conduction occurred without any change in cycle length and was maintained. Adenosine administration quickly slowed the ventricular rate allowing recognition of an atrial tachycardia with a rate of 178/min and a 2:1 atrioventricular (AV) ratio (Figure 1B).A, Regular supraventricular tachycardia with right bundle branch block aberration disappearing every third beat. B, Lead II. Numbers within the tracing indicate the R-R intervals (in milliseconds). The variability in ventricular cycle lengths results from small changes in both the P-P and P-R intervals. ECG indicates electrocardiogram.Place a temporary pacemaker and start treatment with low-molecular-weight heparin and amiodarone\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Order an urgent electrophysiologic investigation\nB. Perform urgent DC shock\nC. Place a temporary pacemaker and start treatment with low-molecular-weight heparin and amiodarone\nD. Start treatment with low-molecular-weight heparin and amiodarone\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 White woman in her mid-50s with a history of mitral valve repair presented to the emergency department with complaints of recent-onset palpitation within the last hour. On physical examination, the White woman showed a rhythmic tachycardia with a rate of 178 beats/min and blood pressure of 130/80 mm Hg. The 12-lead electrocardiogram (ECG) revealed a regular tachycardia with a rate of 178 beats/min; no obvious P waves were recognizable (Figure 1A). The QRS complexes displayed 2 different morphologies occurring with a definite allorhythmic distribution: pairs of beats exhibiting complete right bundle branch block (RBBB) and QRS duration of 140 milliseconds followed by a third beat with normal configuration and QRS duration of 70 milliseconds. This trigeminal variation in intraventricular conduction occurred without any change in cycle length and was maintained. Adenosine administration quickly slowed the ventricular rate allowing recognition of an atrial tachycardia with a rate of 178/min and a 2:1 atrioventricular (AV) ratio (Figure 1B).A, Regular supraventricular tachycardia with right bundle branch block aberration disappearing every third beat. B, Lead II. Numbers within the tracing indicate the R-R intervals (in milliseconds). The variability in ventricular cycle lengths results from small changes in both the P-P and P-R intervals. ECG indicates electrocardiogram.Place a temporary pacemaker and start treatment with low-molecular-weight heparin and amiodarone\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Order an urgent electrophysiologic investigation\nB. Perform urgent DC shock\nC. Place a temporary pacemaker and start treatment with low-molecular-weight heparin and amiodarone\nD. Start treatment with low-molecular-weight heparin and amiodarone\n</options>" }, { "role": "assistant", "content": "D" } ]