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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 67-year-old Black woman with dyslipidemia, obesity (body mass index, 34), past tobacco use, anxiety, and borderline hypertension presented to the emergency department (ED) after 3 days of shortness of breath on exertion. She described increased anxiety and a pleuritic chest pain that began a few hours prior to her ED visit, but no hemoptysis. She had no personal history of cancer, venous thrombosis, recent surgery, trauma, or admission to hospital. Her medications included fluoxetine, atorvastatin, vitamin D, magnesium, and niacin.On examination, her blood pressure was 164/82 mm Hg; pulse rate, 104/min; and respiratory rate, 18/min. Oxygen saturation level was 96% in room air. Her lungs were clear to auscultation bilaterally. No extra heart sounds or murmurs were noted. Examination of her extremities were unremarkable with no leg symptoms or swelling or pain at calf palpation. Laboratory test results showed a hemoglobin level of 160 g/dL (reference range, 14.0-17.5 g/dL), a platelet count of 129[thin space][multiplication sign][thin space]103/[greek small letter mu]L (reference range, 150-350[thin space][multiplication sign][thin space]103/[greek small letter mu]L), and a serum creatinine level of 1.26 mg/dL (reference range, 0.6-1.2 mg.dL) (111 [greek small letter mu]mol/L; reference range, 13-106 [greek small letter mu]mol/L). Her chest film was normal. The attending physician[right single quotation mark]s presumptive diagnosis was pulmonary embolism (PE). Her pretest clinical probability of PE according to the 2-level Wells score1 was likely (1.5 points for heart rate >100, and 3.0 for other diagnoses less likely than PE). Therefore, D-dimer measurement was not performed. Her computed tomographic pulmonary angiography (CTPA) result is reported in the Table.Rule out PE and perform a work up for alternative diagnoses.Obtain a bilateral lower limb veins compression ultrasonography.Obtain a lung ventilation-perfusion (V[combining dot above]/Q[combining dot above]) scan or pulmonary angiogram.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a bilateral lower limb veins compression ultrasonography.\nB. Obtain a lung ventilation-perfusion (V[combining dot above]/Q[combining dot above]) scan or pulmonary angiogram.\nC. Test for D-dimer.\nD. Rule out PE and perform a work up for alternative diagnoses.\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 67-year-old Hispanic man with dyslipidemia, obesity (body mass index, 34), past tobacco use, anxiety, and borderline hypertension presented to the emergency department (ED) after 3 days of shortness of breath on exertion. He described increased anxiety and a pleuritic chest pain that began a few hours prior to his ED visit, but no hemoptysis. He had no personal history of cancer, venous thrombosis, recent surgery, trauma, or admission to hospital. His medications included fluoxetine, atorvastatin, vitamin D, magnesium, and niacin.On examination, his blood pressure was 164/82 mm Hg; pulse rate, 104/min; and respiratory rate, 18/min. Oxygen saturation level was 96% in room air. His lungs were clear to auscultation bilaterally. No extra heart sounds or murmurs were noted. Examination of his extremities were unremarkable with no leg symptoms or swelling or pain at calf palpation. Laboratory test results showed a hemoglobin level of 160 g/dL (reference range, 14.0-17.5 g/dL), a platelet count of 129[thin space][multiplication sign][thin space]103/[greek small letter mu]L (reference range, 150-350[thin space][multiplication sign][thin space]103/[greek small letter mu]L), and a serum creatinine level of 1.26 mg/dL (reference range, 0.6-1.2 mg.dL) (111 [greek small letter mu]mol/L; reference range, 13-106 [greek small letter mu]mol/L). His chest film was normal. The attending physician[right single quotation mark]s presumptive diagnosis was pulmonary embolism (PE). His pretest clinical probability of PE according to the 2-level Wells score1 was likely (1.5 points for heart rate >100, and 3.0 for other diagnoses less likely than PE). Therefore, D-dimer measurement was not performed. His computed tomographic pulmonary angiography (CTPA) result is reported in the Table.Rule out PE and perform a work up for alternative diagnoses.Obtain a bilateral lower limb veins compression ultrasonography.Obtain a lung ventilation-perfusion (V[combining dot above]/Q[combining dot above]) scan or pulmonary angiogram.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a bilateral lower limb veins compression ultrasonography.\nB. Obtain a lung ventilation-perfusion (V[combining dot above]/Q[combining dot above]) scan or pulmonary angiogram.\nC. Test for D-dimer.\nD. Rule out PE and perform a work up for alternative diagnoses.\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 man in his 50s was referred to the dermatology clinic for a chronic, painful nonhealing ulcer on the right forearm following a ground-level fall 3 months previously. He reported subjective fevers, as well as increasing erythema and tenderness immediately around the right forearm lesion. He stated that he did not have a history of poor wound healing or painful skin ulcers. He had a history of type 2 diabetes and an allogenic bone marrow transplant 1 year prior for myelodysplastic syndrome complicated by pancytopenia and chronic graft-vs-host disease. Physical examination revealed an isolated slightly erythematous, edematous plaque with a prominent central eschar on the right forearm (Figure, A). An incisional biopsy at the edge of the eschar was performed, and a specimen was sent for pathological evaluation (Figure, B-D).A, Clinical photograph of a nonhealing ulcer with central eschar on the right forearm. B-D, Histopathologic images. B, Necrotic debris and fat necrosis with saponification (hematoxylin-eosin, original magnification [multiplication sign]40). C, Saponification and needle-like clefts within necrotic adipocytes (hematoxylin-eosin, original magnification [multiplication sign]200). D, Numerous nonseptate, thick-walled fungal hyphae in the dermis (hematoxylin-eosin, original magnification [multiplication sign]400).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Cutaneous aspergillosis\nB. Pyoderma gangrenosum\nC. Squamous cell carcinoma\nD. Cutaneous mucormycosis\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 man in his 50s was referred to the dermatology clinic for a chronic, painful nonhealing ulcer on the right forearm following a ground-level fall 3 months previously. He reported subjective fevers, as well as increasing erythema and tenderness immediately around the right forearm lesion. He stated that he did not have a history of poor wound healing or painful skin ulcers. He had a history of type 2 diabetes and an allogenic bone marrow transplant 1 year prior for myelodysplastic syndrome complicated by pancytopenia and chronic graft-vs-host disease. Physical examination revealed an isolated slightly erythematous, edematous plaque with a prominent central eschar on the right forearm (Figure, A). An incisional biopsy at the edge of the eschar was performed, and a specimen was sent for pathological evaluation (Figure, B-D).A, Clinical photograph of a nonhealing ulcer with central eschar on the right forearm. B-D, Histopathologic images. B, Necrotic debris and fat necrosis with saponification (hematoxylin-eosin, original magnification [multiplication sign]40). C, Saponification and needle-like clefts within necrotic adipocytes (hematoxylin-eosin, original magnification [multiplication sign]200). D, Numerous nonseptate, thick-walled fungal hyphae in the dermis (hematoxylin-eosin, original magnification [multiplication sign]400).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Cutaneous aspergillosis\nB. Pyoderma gangrenosum\nC. Squamous cell carcinoma\nD. Cutaneous mucormycosis\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 Arab woman in her 50s was referred to the dermatology clinic for a chronic, painful nonhealing ulcer on the right forearm following a ground-level fall 3 months previously. She reported subjective fevers, as well as increasing erythema and tenderness immediately around the right forearm lesion. She stated that she did not have a history of poor wound healing or painful skin ulcers. She had a history of type 2 diabetes and an allogenic bone marrow transplant 1 year prior for myelodysplastic syndrome complicated by pancytopenia and chronic graft-vs-host disease. Physical examination revealed an isolated slightly erythematous, edematous plaque with a prominent central eschar on the right forearm (Figure, A). An incisional biopsy at the edge of the eschar was performed, and a specimen was sent for pathological evaluation (Figure, B-D).A, Clinical photograph of a nonhealing ulcer with central eschar on the right forearm. B-D, Histopathologic images. B, Necrotic debris and fat necrosis with saponification (hematoxylin-eosin, original magnification [multiplication sign]40). C, Saponification and needle-like clefts within necrotic adipocytes (hematoxylin-eosin, original magnification [multiplication sign]200). D, Numerous nonseptate, thick-walled fungal hyphae in the dermis (hematoxylin-eosin, original magnification [multiplication sign]400).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Cutaneous aspergillosis\nB. Pyoderma gangrenosum\nC. Squamous cell carcinoma\nD. Cutaneous mucormycosis\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 Asian patient in their 50s was referred to the dermatology clinic for a chronic, painful nonhealing ulcer on the right forearm following a ground-level fall 3 months previously. They reported subjective fevers, as well as increasing erythema and tenderness immediately around the right forearm lesion. They stated that they did not have a history of poor wound healing or painful skin ulcers. They had a history of type 2 diabetes and an allogenic bone marrow transplant 1 year prior for myelodysplastic syndrome complicated by pancytopenia and chronic graft-vs-host disease. Physical examination revealed an isolated slightly erythematous, edematous plaque with a prominent central eschar on the right forearm (Figure, A). An incisional biopsy at the edge of the eschar was performed, and a specimen was sent for pathological evaluation (Figure, B-D).A, Clinical photograph of a nonhealing ulcer with central eschar on the right forearm. B-D, Histopathologic images. B, Necrotic debris and fat necrosis with saponification (hematoxylin-eosin, original magnification [multiplication sign]40). C, Saponification and needle-like clefts within necrotic adipocytes (hematoxylin-eosin, original magnification [multiplication sign]200). D, Numerous nonseptate, thick-walled fungal hyphae in the dermis (hematoxylin-eosin, original magnification [multiplication sign]400).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Cutaneous aspergillosis\nB. Pyoderma gangrenosum\nC. Squamous cell carcinoma\nD. Cutaneous mucormycosis\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 man in his 70s presented with erythematous ears associated with a burning sensation. He reported that the lesions had begun 6 months previously and that they were most bothersome at the end of the day or when he was exposed to the cold and damp environment while out on his boat. He applied ice to alleviate the burning, but this worsened the condition. A heating pad provided some measure of relief, as did a brief course of systemic corticosteroids.Physical examination revealed that some papular lesions were associated with slight purpura and hemorrhagic crust (Figure, A). Histologic findings from biopsy specimens were also obtained by routine histologic analysis (Figure, B) and direct immunofluorescence examination (Figure, C).A, Clinically, the left ear demonstrates erythema, edema, and focal crusting. B, Biopsy specimen from the left ear reveals thrombi within engorged blood vessels but fails to reveal significant inflammation of blood vessel walls (hematoxylin-eosin, original magnification [multiplication sign]200). C, Biopsy specimen from the left ear under direct immunofluorescence and stained for anti-IgM highlights thrombi within vessels (original magnification [multiplication sign]200).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Relapsing polychondritis\nB. Granulomatosis with polyangiitis (Wegener granulomatosis)\nC. Chilblain\nD. Cold agglutinin disease\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 70s presented with erythematous ears associated with a burning sensation. He reported that the lesions had begun 6 months previously and that they were most bothersome at the end of the day or when he was exposed to the cold and damp environment while out on his boat. He applied ice to alleviate the burning, but this worsened the condition. A heating pad provided some measure of relief, as did a brief course of systemic corticosteroids.Physical examination revealed that some papular lesions were associated with slight purpura and hemorrhagic crust (Figure, A). Histologic findings from biopsy specimens were also obtained by routine histologic analysis (Figure, B) and direct immunofluorescence examination (Figure, C).A, Clinically, the left ear demonstrates erythema, edema, and focal crusting. B, Biopsy specimen from the left ear reveals thrombi within engorged blood vessels but fails to reveal significant inflammation of blood vessel walls (hematoxylin-eosin, original magnification [multiplication sign]200). C, Biopsy specimen from the left ear under direct immunofluorescence and stained for anti-IgM highlights thrombi within vessels (original magnification [multiplication sign]200).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Relapsing polychondritis\nB. Granulomatosis with polyangiitis (Wegener granulomatosis)\nC. Chilblain\nD. Cold agglutinin disease\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 woman in her 70s presented with erythematous ears associated with a burning sensation. She reported that the lesions had begun 6 months previously and that they were most bothersome at the end of the day or when she was exposed to the cold and damp environment while out on her boat. She applied ice to alleviate the burning, but this worsened the condition. A heating pad provided some measure of relief, as did a brief course of systemic corticosteroids.Physical examination revealed that some papular lesions were associated with slight purpura and hemorrhagic crust (Figure, A). Histologic findings from biopsy specimens were also obtained by routine histologic analysis (Figure, B) and direct immunofluorescence examination (Figure, C).A, Clinically, the left ear demonstrates erythema, edema, and focal crusting. B, Biopsy specimen from the left ear reveals thrombi within engorged blood vessels but fails to reveal significant inflammation of blood vessel walls (hematoxylin-eosin, original magnification [multiplication sign]200). C, Biopsy specimen from the left ear under direct immunofluorescence and stained for anti-IgM highlights thrombi within vessels (original magnification [multiplication sign]200).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Relapsing polychondritis\nB. Granulomatosis with polyangiitis (Wegener granulomatosis)\nC. Chilblain\nD. Cold agglutinin disease\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 patient in their 70s presented with erythematous ears associated with a burning sensation. They reported that the lesions had begun 6 months previously and that they were most bothersome at the end of the day or when they was exposed to the cold and damp environment while out on their boat. They applied ice to alleviate the burning, but this worsened the condition. A heating pad provided some measure of relief, as did a brief course of systemic corticosteroids.Physical examination revealed that some papular lesions were associated with slight purpura and hemorrhagic crust (Figure, A). Histologic findings from biopsy specimens were also obtained by routine histologic analysis (Figure, B) and direct immunofluorescence examination (Figure, C).A, Clinically, the left ear demonstrates erythema, edema, and focal crusting. B, Biopsy specimen from the left ear reveals thrombi within engorged blood vessels but fails to reveal significant inflammation of blood vessel walls (hematoxylin-eosin, original magnification [multiplication sign]200). C, Biopsy specimen from the left ear under direct immunofluorescence and stained for anti-IgM highlights thrombi within vessels (original magnification [multiplication sign]200).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Relapsing polychondritis\nB. Granulomatosis with polyangiitis (Wegener granulomatosis)\nC. Chilblain\nD. Cold agglutinin disease\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 woman in her 50s developed severe trismus several months after treatment of a dental abscess. Approximately 10 years after onset of symptoms, she was seen by an oral surgeon who attempted mandibular release via a cervical incision. According to the patient, the surgeon was [left double quotation mark]unable to reach[right double quotation mark] the affected area, and the operation was unsuccessful. There was no other significant medical or surgical history. On physical examination, severe trismus was present with maximal interdental distance of 1 mm. The patient was brought to the operating room for excision. A maxillofacial computed tomographic (CT) examination was performed (Figure). A-C, Noncontrast computed tomographic images. A, Axial slice from an image of the facial bones. B, Coronal slice from an enhanced scan of the facial bones. C, Coronal image of the facial bones using a soft-tissue algorithm. Asterisk indicates left medial pterygoid artery. D, Three-dimensional reconstructed image of the facial bones.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Lymphoma\nB. Myositis ossificans traumatica\nC. Tumoral calcinosis\nD. Osteosarcoma\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 patient in them 50s developed severe trismus several months after treatment of a dental abscess. Approximately 10 years after onset of symptoms, they was seen by an oral surgeon who attempted mandibular release via a cervical incision. According to the Arab patient, the surgeon was [left double quotation mark]unable to reach[right double quotation mark] the affected area, and the operation was unsuccessful. There was no other significant medical or surgical history. On physical examination, severe trismus was present with maximal interdental distance of 1 mm. The Arab patient was brought to the operating room for excision. A maxillofacial computed tomographic (CT) examination was performed (Figure). A-C, Noncontrast computed tomographic images. A, Axial slice from an image of the facial bones. B, Coronal slice from an enhanced scan of the facial bones. C, Coronal image of the facial bones using a soft-tissue algorithm. Asterisk indicates left medial pterygoid artery. D, Three-dimensional reconstructed image of the facial bones.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Lymphoma\nB. Myositis ossificans traumatica\nC. Tumoral calcinosis\nD. Osteosarcoma\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 Asian woman in her 50s developed severe trismus several months after treatment of a dental abscess. Approximately 10 years after onset of symptoms, she was seen by an oral surgeon who attempted mandibular release via a cervical incision. According to the Asian patient, the surgeon was [left double quotation mark]unable to reach[right double quotation mark] the affected area, and the operation was unsuccessful. There was no other significant medical or surgical history. On physical examination, severe trismus was present with maximal interdental distance of 1 mm. The Asian patient was brought to the operating room for excision. A maxillofacial computed tomographic (CT) examination was performed (Figure). A-C, Noncontrast computed tomographic images. A, Axial slice from an image of the facial bones. B, Coronal slice from an enhanced scan of the facial bones. C, Coronal image of the facial bones using a soft-tissue algorithm. Asterisk indicates left medial pterygoid artery. D, Three-dimensional reconstructed image of the facial bones.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Lymphoma\nB. Myositis ossificans traumatica\nC. Tumoral calcinosis\nD. Osteosarcoma\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 Black man in him 50s developed severe trismus several months after treatment of a dental abscess. Approximately 10 years after onset of symptoms, he was seen by an oral surgeon who attempted mandibular release via a cervical incision. According to the Black man, the surgeon was [left double quotation mark]unable to reach[right double quotation mark] the affected area, and the operation was unsuccessful. There was no other significant medical or surgical history. On physical examination, severe trismus was present with maximal interdental distance of 1 mm. The Black man was brought to the operating room for excision. A maxillofacial computed tomographic (CT) examination was performed (Figure). A-C, Noncontrast computed tomographic images. A, Axial slice from an image of the facial bones. B, Coronal slice from an enhanced scan of the facial bones. C, Coronal image of the facial bones using a soft-tissue algorithm. Asterisk indicates left medial pterygoid artery. D, Three-dimensional reconstructed image of the facial bones.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Lymphoma\nB. Myositis ossificans traumatica\nC. Tumoral calcinosis\nD. Osteosarcoma\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 man in his 30s presented to the emergency department with a worsening sinus infection and vision loss. His medical history was significant for previous nasal endoscopy with biopsy of nasal polyps 6 years previously, with a finding of benign nasal polyps by surgical pathology. The patient had then been lost to follow-up. He now complained of nasal drainage, severe headaches, and long-standing visual loss. There had been no acute worsening of headaches or visual loss in the previous months. Physical examination showed severe left proptosis, telecanthus, purulent nasal drainage, and nasal polypsis filling the bilateral nasal cavities. Ophthalmology consultation revealed no evidence of restriction of gaze or papilledema, and a recommendation was made for endoscopic sinus surgery to remove the source of infection. Computed tomographic imaging revealed extensive nasal polyposis, bony remodeling consistent with long-standing inflammation, and massive erosion of the bilateral skull base and orbits (Figure 1A). The patient underwent endoscopic sinus surgery. Nasal polyps were present and had a typical appearance superficially (Figure 1B). However, on deeper dissection, they became increasingly difficult to remove even with powered instrumentation, and an atypical, fibrotic endoscopic appearance was noted (Figure 1C). Tissue was sent for histologic evaluation. Following this, the dissection was terminated.A, Coronal computed tomographic scan demonstrating extensive nasal polyposis and bony remodeling of bilateral skull base and orbits. B, Rigid nasal endoscopy demonstrating superficial appearance consistent with nasal polyps. C, Rigid nasal endoscopy following deeper dissection of area in question, demonstrating atypical fibrotic appearance.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Allergic fungal rhinosinusitis\nB. Sinonasal undifferentiated carcinoma\nC. Chronic invasive fungal sinusitis\nD. Chronic rhinosinusitis with polyposis\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 Hispanic man in his 30s presented to the emergency department with a worsening sinus infection and vision loss. His medical history was significant for previous nasal endoscopy with biopsy of nasal polyps 6 years previously, with a finding of benign nasal polyps by surgical pathology. The Hispanic patient had then been lost to follow-up. He now complained of nasal drainage, severe headaches, and long-standing visual loss. There had been no acute worsening of headaches or visual loss in the previous months. Physical examination showed severe left proptosis, telecanthus, purulent nasal drainage, and nasal polypsis filling the bilateral nasal cavities. Ophthalmology consultation revealed no evidence of restriction of gaze or papilledema, and a recommendation was made for endoscopic sinus surgery to remove the source of infection. Computed tomographic imaging revealed extensive nasal polyposis, bony remodeling consistent with long-standing inflammation, and massive erosion of the bilateral skull base and orbits (Figure 1A). The Hispanic patient underwent endoscopic sinus surgery. Nasal polyps were present and had a typical appearance superficially (Figure 1B). However, on deeper dissection, they became increasingly difficult to remove even with powered instrumentation, and an atypical, fibrotic endoscopic appearance was noted (Figure 1C). Tissue was sent for histologic evaluation. Following this, the dissection was terminated.A, Coronal computed tomographic scan demonstrating extensive nasal polyposis and bony remodeling of bilateral skull base and orbits. B, Rigid nasal endoscopy demonstrating superficial appearance consistent with nasal polyps. C, Rigid nasal endoscopy following deeper dissection of area in question, demonstrating atypical fibrotic appearance.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Allergic fungal rhinosinusitis\nB. Sinonasal undifferentiated carcinoma\nC. Chronic invasive fungal sinusitis\nD. Chronic rhinosinusitis with polyposis\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 White patient in their 30s presented to the emergency department with a worsening sinus infection and vision loss. Their medical history was significant for previous nasal endoscopy with biopsy of nasal polyps 6 years previously, with a finding of benign nasal polyps by surgical pathology. The White patient had then been lost to follow-up. They now complained of nasal drainage, severe headaches, and long-standing visual loss. There had been no acute worsening of headaches or visual loss in the previous months. Physical examination showed severe left proptosis, telecanthus, purulent nasal drainage, and nasal polypsis filling the bilateral nasal cavities. Ophthalmology consultation revealed no evidence of restriction of gaze or papilledema, and a recommendation was made for endoscopic sinus surgery to remove the source of infection. Computed tomographic imaging revealed extensive nasal polyposis, bony remodeling consistent with long-standing inflammation, and massive erosion of the bilateral skull base and orbits (Figure 1A). The White patient underwent endoscopic sinus surgery. Nasal polyps were present and had a typical appearance superficially (Figure 1B). However, on deeper dissection, they became increasingly difficult to remove even with powered instrumentation, and an atypical, fibrotic endoscopic appearance was noted (Figure 1C). Tissue was sent for histologic evaluation. Following this, the dissection was terminated.A, Coronal computed tomographic scan demonstrating extensive nasal polyposis and bony remodeling of bilateral skull base and orbits. B, Rigid nasal endoscopy demonstrating superficial appearance consistent with nasal polyps. C, Rigid nasal endoscopy following deeper dissection of area in question, demonstrating atypical fibrotic appearance.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Allergic fungal rhinosinusitis\nB. Sinonasal undifferentiated carcinoma\nC. Chronic invasive fungal sinusitis\nD. Chronic rhinosinusitis with polyposis\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 woman in her 30s presented to the emergency department with a worsening sinus infection and vision loss. Her medical history was significant for previous nasal endoscopy with biopsy of nasal polyps 6 years previously, with a finding of benign nasal polyps by surgical pathology. The Arab woman had then been lost to follow-up. She now complained of nasal drainage, severe headaches, and long-standing visual loss. There had been no acute worsening of headaches or visual loss in the previous months. Physical examination showed severe left proptosis, telecanthus, purulent nasal drainage, and nasal polypsis filling the bilateral nasal cavities. Ophthalmology consultation revealed no evidence of restriction of gaze or papilledema, and a recommendation was made for endoscopic sinus surgery to remove the source of infection. Computed tomographic imaging revealed extensive nasal polyposis, bony remodeling consistent with long-standing inflammation, and massive erosion of the bilateral skull base and orbits (Figure 1A). The Arab woman underwent endoscopic sinus surgery. Nasal polyps were present and had a typical appearance superficially (Figure 1B). However, on deeper dissection, they became increasingly difficult to remove even with powered instrumentation, and an atypical, fibrotic endoscopic appearance was noted (Figure 1C). Tissue was sent for histologic evaluation. Following this, the dissection was terminated.A, Coronal computed tomographic scan demonstrating extensive nasal polyposis and bony remodeling of bilateral skull base and orbits. B, Rigid nasal endoscopy demonstrating superficial appearance consistent with nasal polyps. C, Rigid nasal endoscopy following deeper dissection of area in question, demonstrating atypical fibrotic appearance.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Allergic fungal rhinosinusitis\nB. Sinonasal undifferentiated carcinoma\nC. Chronic invasive fungal sinusitis\nD. Chronic rhinosinusitis with polyposis\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 woman in her 50s presented with a several-month history of symptoms that included foreign body sensation in her throat, mild odynophagia, and dyspnea. She had a history of adenoid cystic carcinoma of the right submandibular gland and had undergone wide tumor excision and postoperative radiation therapy 20 years previously (60 Gy/30 fractions in 1993). She also had a history of hyperthyroidism, which was under medical control (with propylthiouracil, 50 mg/d). She stated that she did not have blurred vision, headache, seizures, or trismus. She had no family history of neurofibromatosis. A physical examination revealed a bulge in the floor of mouth, limitation of tongue movement, and no palpable lymphadenopathy. She had no suspicious spots or nodules on the skin. No neurological deficits were revealed. Postgadolinium T1-weighted magnetic resonance imaging disclosed a 7.0[thin space][multiplication sign][thin space]4.0[thin space][multiplication sign][thin space]3.0-cm, well-defined enhancing mass in the right side of the floor of the mouth, extending posteriorly to the tongue base and medially across the midline (Figure, A). The results of laboratory investigations were normal. Transcervical removal of the tumor was performed. The surgical specimen was a 7.2[thin space][multiplication sign][thin space]5.8[thin space][multiplication sign][thin space]4.3-cm encapsulated tumor composed of a homogeneous, whitish, rubbery, and glistening content (Figure, B). Microscopic examination demonstrated oval to eel-like spindle nuclei distributed in a background of generally wavy collagenous fibers and mucinous matrix (Figure, C). The specimen showed sparse cellularity and no cellular atypia. Neither mitotic figure nor tumor necrosis was found. The specimen was immunoreactive for S-100 (Figure, D), focally positive for CD34, but nonreactive for smooth muscle actin.A, Axial T1-weighed gadolinium-enhanced magnetic resonance image of the neck. B, Gross image of the surgical specimen. C, Histopathologic image. Hematoxylin-eosin, original magnification [multiplication sign]200. D, Histopathologic image. S-100 protein stain, original magnification [multiplication sign]200.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Radiation-induced neurofibroma\nB. Radiation-induced rhabdomyosarcoma\nC. Radiation-induced liposarcoma\nD. Recurrent adenoid cystic carcinoma\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 man in him 50s presented with a several-month history of symptoms that included foreign body sensation in him throat, mild odynophagia, and dyspnea. He had a history of adenoid cystic carcinoma of the right submandibular gland and had undergone wide tumor excision and postoperative radiation therapy 20 years previously (60 Gy/30 fractions in 1993). He also had a history of hyperthyroidism, which was under medical control (with propylthiouracil, 50 mg/d). He stated that he did not have blurred vision, headache, seizures, or trismus. He had no family history of neurofibromatosis. A physical examination revealed a bulge in the floor of mouth, limitation of tongue movement, and no palpable lymphadenopathy. He had no suspicious spots or nodules on the skin. No neurological deficits were revealed. Postgadolinium T1-weighted magnetic resonance imaging disclosed a 7.0[thin space][multiplication sign][thin space]4.0[thin space][multiplication sign][thin space]3.0-cm, well-defined enhancing mass in the right side of the floor of the mouth, extending posteriorly to the tongue base and medially across the midline (Figure, A). The results of laboratory investigations were normal. Transcervical removal of the tumor was performed. The surgical specimen was a 7.2[thin space][multiplication sign][thin space]5.8[thin space][multiplication sign][thin space]4.3-cm encapsulated tumor composed of a homogeneous, whitish, rubbery, and glistening content (Figure, B). Microscopic examination demonstrated oval to eel-like spindle nuclei distributed in a background of generally wavy collagenous fibers and mucinous matrix (Figure, C). The specimen showed sparse cellularity and no cellular atypia. Neither mitotic figure nor tumor necrosis was found. The specimen was immunoreactive for S-100 (Figure, D), focally positive for CD34, but nonreactive for smooth muscle actin.A, Axial T1-weighed gadolinium-enhanced magnetic resonance image of the neck. B, Gross image of the surgical specimen. C, Histopathologic image. Hematoxylin-eosin, original magnification [multiplication sign]200. D, Histopathologic image. S-100 protein stain, original magnification [multiplication sign]200.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Radiation-induced neurofibroma\nB. Radiation-induced rhabdomyosarcoma\nC. Radiation-induced liposarcoma\nD. Recurrent adenoid cystic carcinoma\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 them 50s presented with a several-month history of symptoms that included foreign body sensation in them throat, mild odynophagia, and dyspnea. They had a history of adenoid cystic carcinoma of the right submandibular gland and had undergone wide tumor excision and postoperative radiation therapy 20 years previously (60 Gy/30 fractions in 1993). They also had a history of hyperthyroidism, which was under medical control (with propylthiouracil, 50 mg/d). They stated that they did not have blurred vision, headache, seizures, or trismus. They had no family history of neurofibromatosis. A physical examination revealed a bulge in the floor of mouth, limitation of tongue movement, and no palpable lymphadenopathy. They had no suspicious spots or nodules on the skin. No neurological deficits were revealed. Postgadolinium T1-weighted magnetic resonance imaging disclosed a 7.0[thin space][multiplication sign][thin space]4.0[thin space][multiplication sign][thin space]3.0-cm, well-defined enhancing mass in the right side of the floor of the mouth, extending posteriorly to the tongue base and medially across the midline (Figure, A). The results of laboratory investigations were normal. Transcervical removal of the tumor was performed. The surgical specimen was a 7.2[thin space][multiplication sign][thin space]5.8[thin space][multiplication sign][thin space]4.3-cm encapsulated tumor composed of a homogeneous, whitish, rubbery, and glistening content (Figure, B). Microscopic examination demonstrated oval to eel-like spindle nuclei distributed in a background of generally wavy collagenous fibers and mucinous matrix (Figure, C). The specimen showed sparse cellularity and no cellular atypia. Neither mitotic figure nor tumor necrosis was found. The specimen was immunoreactive for S-100 (Figure, D), focally positive for CD34, but nonreactive for smooth muscle actin.A, Axial T1-weighed gadolinium-enhanced magnetic resonance image of the neck. B, Gross image of the surgical specimen. C, Histopathologic image. Hematoxylin-eosin, original magnification [multiplication sign]200. D, Histopathologic image. S-100 protein stain, original magnification [multiplication sign]200.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Radiation-induced neurofibroma\nB. Radiation-induced rhabdomyosarcoma\nC. Radiation-induced liposarcoma\nD. Recurrent adenoid cystic carcinoma\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 woman in her 50s presented with a several-month history of symptoms that included foreign body sensation in her throat, mild odynophagia, and dyspnea. She had a history of adenoid cystic carcinoma of the right submandibular gland and had undergone wide tumor excision and postoperative radiation therapy 20 years previously (60 Gy/30 fractions in 1993). She also had a history of hyperthyroidism, which was under medical control (with propylthiouracil, 50 mg/d). She stated that she did not have blurred vision, headache, seizures, or trismus. She had no family history of neurofibromatosis. A physical examination revealed a bulge in the floor of mouth, limitation of tongue movement, and no palpable lymphadenopathy. She had no suspicious spots or nodules on the skin. No neurological deficits were revealed. Postgadolinium T1-weighted magnetic resonance imaging disclosed a 7.0[thin space][multiplication sign][thin space]4.0[thin space][multiplication sign][thin space]3.0-cm, well-defined enhancing mass in the right side of the floor of the mouth, extending posteriorly to the tongue base and medially across the midline (Figure, A). The results of laboratory investigations were normal. Transcervical removal of the tumor was performed. The surgical specimen was a 7.2[thin space][multiplication sign][thin space]5.8[thin space][multiplication sign][thin space]4.3-cm encapsulated tumor composed of a homogeneous, whitish, rubbery, and glistening content (Figure, B). Microscopic examination demonstrated oval to eel-like spindle nuclei distributed in a background of generally wavy collagenous fibers and mucinous matrix (Figure, C). The specimen showed sparse cellularity and no cellular atypia. Neither mitotic figure nor tumor necrosis was found. The specimen was immunoreactive for S-100 (Figure, D), focally positive for CD34, but nonreactive for smooth muscle actin.A, Axial T1-weighed gadolinium-enhanced magnetic resonance image of the neck. B, Gross image of the surgical specimen. C, Histopathologic image. Hematoxylin-eosin, original magnification [multiplication sign]200. D, Histopathologic image. S-100 protein stain, original magnification [multiplication sign]200.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Radiation-induced neurofibroma\nB. Radiation-induced rhabdomyosarcoma\nC. Radiation-induced liposarcoma\nD. Recurrent adenoid cystic carcinoma\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>\nThe patient was a woman in her 30s with a history of goiter, hypertension, asthma, obstructive sleep apnea, and skin lesions in the lower extremities for which biopsy findings more a decade before suggested sarcoidosis. She presented with a 1-day history of sore throat, fever, chills, productive cough, globus sensation, dysphagia, and a change in her voice to the point it had become muffled and hoarse. Throughout the day she noticed progressive worsening of her symptoms in addition to becoming dyspneic. The patient tried using her albuterol inhaler, but this provided no relief of her symptoms. The patient was afebrile at presentation, and there were no signs of infection. On examination, there was mildly tender right cervical lymphadenopathy but no evidence of peritonsillar exudates. Laryngoscopy demonstrated diffuse swelling of the supraglottic structures, particularly the epiglottis and left aryepiglottic fold, with a pale appearance of the mucosa (Figure, A). In addition, a neck computed tomographic (CT) scan was obtained, which showed marked swelling of the supraglottic structures with areas of patchy enhancement and narrowing of the airway, as well as enlarged right cervical lymph nodes (Figure, B-D). Owing to airway compromise, the patient was intubated and received intravenous steroids and ceftriaxone. Subsequently, she underwent debulking surgery and carbon dioxide laser ablation of the left arytenoid.A, Laryngoscopic photograph. B, Axial contrast-enhanced computed tomographic (CT) image through level of the aryepiglottic folds. C, Axial contrast-enhanced CT through level of the epiglottis. D, Sagittal contrast-enhanced CT image.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Laryngeal sarcoidosis\nB. Laryngeal tuberculosis\nC. Laryngeal squamous cell carcinoma\nD. Angioedema\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>\nThe White patient was a White woman in her 30s with a history of goiter, hypertension, asthma, obstructive sleep apnea, and skin lesions in the lower extremities for which biopsy findings more a decade before suggested sarcoidosis. She presented with a 1-day history of sore throat, fever, chills, productive cough, globus sensation, dysphagia, and a change in her voice to the point it had become muffled and hoarse. Throughout the day she noticed progressive worsening of her symptoms in addition to becoming dyspneic. The White patient tried using her albuterol inhaler, but this provided no relief of her symptoms. The White patient was afebrile at presentation, and there were no signs of infection. On examination, there was mildly tender right cervical lymphadenopathy but no evidence of peritonsillar exudates. Laryngoscopy demonstrated diffuse swelling of the supraglottic structures, particularly the epiglottis and left aryepiglottic fold, with a pale appearance of the mucosa (Figure, A). In addition, a neck computed tomographic (CT) scan was obtained, which showed marked swelling of the supraglottic structures with areas of patchy enhancement and narrowing of the airway, as well as enlarged right cervical lymph nodes (Figure, B-D). Owing to airway compromise, the White patient was intubated and received intravenous steroids and ceftriaxone. Subsequently, she underwent debulking surgery and carbon dioxide laser ablation of the left arytenoid.A, Laryngoscopic photograph. B, Axial contrast-enhanced computed tomographic (CT) image through level of the aryepiglottic folds. C, Axial contrast-enhanced CT through level of the epiglottis. D, Sagittal contrast-enhanced CT image.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Laryngeal sarcoidosis\nB. Laryngeal tuberculosis\nC. Laryngeal squamous cell carcinoma\nD. Angioedema\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>\nThe Arab man was a Arab man in him 30s with a history of goiter, hypertension, asthma, obstructive sleep apnea, and skin lesions in the lower extremities for which biopsy findings more a decade before suggested sarcoidosis. He presented with a 1-day history of sore throat, fever, chills, productive cough, globus sensation, dysphagia, and a change in him voice to the point it had become muffled and hoarse. Throughout the day he noticed progressive worsening of him symptoms in addition to becoming dyspneic. The Arab man tried using him albuterol inhaler, but this provided no relief of him symptoms. The Arab man was afebrile at presentation, and there were no signs of infection. On examination, there was mildly tender right cervical lymphadenopathy but no evidence of peritonsillar exudates. Laryngoscopy demonstrated diffuse swelling of the supraglottic structures, particularly the epiglottis and left aryepiglottic fold, with a pale appearance of the mucosa (Figure, A). In addition, a neck computed tomographic (CT) scan was obtained, which showed marked swelling of the supraglottic structures with areas of patchy enhancement and narrowing of the airway, as well as enlarged right cervical lymph nodes (Figure, B-D). Owing to airway compromise, the Arab man was intubated and received intravenous steroids and ceftriaxone. Subsequently, he underwent debulking surgery and carbon dioxide laser ablation of the left arytenoid.A, Laryngoscopic photograph. B, Axial contrast-enhanced computed tomographic (CT) image through level of the aryepiglottic folds. C, Axial contrast-enhanced CT through level of the epiglottis. D, Sagittal contrast-enhanced CT image.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Laryngeal sarcoidosis\nB. Laryngeal tuberculosis\nC. Laryngeal squamous cell carcinoma\nD. Angioedema\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>\nThe Asian patient was a Asian patient in them 30s with a history of goiter, hypertension, asthma, obstructive sleep apnea, and skin lesions in the lower extremities for which biopsy findings more a decade before suggested sarcoidosis. They presented with a 1-day history of sore throat, fever, chills, productive cough, globus sensation, dysphagia, and a change in them voice to the point it had become muffled and hoarse. Throughout the day they noticed progressive worsening of them symptoms in addition to becoming dyspneic. The Asian patient tried using them albuterol inhaler, but this provided no relief of them symptoms. The Asian patient was afebrile at presentation, and there were no signs of infection. On examination, there was mildly tender right cervical lymphadenopathy but no evidence of peritonsillar exudates. Laryngoscopy demonstrated diffuse swelling of the supraglottic structures, particularly the epiglottis and left aryepiglottic fold, with a pale appearance of the mucosa (Figure, A). In addition, a neck computed tomographic (CT) scan was obtained, which showed marked swelling of the supraglottic structures with areas of patchy enhancement and narrowing of the airway, as well as enlarged right cervical lymph nodes (Figure, B-D). Owing to airway compromise, the Asian patient was intubated and received intravenous steroids and ceftriaxone. Subsequently, they underwent debulking surgery and carbon dioxide laser ablation of the left arytenoid.A, Laryngoscopic photograph. B, Axial contrast-enhanced computed tomographic (CT) image through level of the aryepiglottic folds. C, Axial contrast-enhanced CT through level of the epiglottis. D, Sagittal contrast-enhanced CT image.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Laryngeal sarcoidosis\nB. Laryngeal tuberculosis\nC. Laryngeal squamous cell carcinoma\nD. Angioedema\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>\nTwo brothers in their late teens presented with bilateral eyelid swelling and irritation that had lasted 1 year. There was no history of associated eyelid pain or bleeding. The older brother had an extensive medical history, including dysphonia, oral mucosal lesions, alopecia, recurrent parotitis, vocal cord swelling, and recurrent vesicular eruptions on his face, trunk, and perineum. He had seen several medical specialists and had been comprehensively evaluated for these concerns yet remained undiagnosed since birth. Two skin biopsies were performed at 2 and 6 years of age, but the findings were considered unremarkable.Findings from ophthalmological examination of the older sibling showed confluent waxy nodular lesions extending from the lashes to the mucocutaneous junction on all 4 eyelids (Figure 1), impairing eyelid closure bilaterally. Focal trichiasis was associated with superficial punctate keratitis. There were no other corneal findings. There were no lesions on the conjunctiva or iris bilaterally. The lenses were clear and no abnormalities were visualized using funduscopy. Findings from the remainder of the ocular examination were unremarkable.Clinical appearance of eyelid margin nodules in the older brother. Waxy nodular lesions (arrowheads) are present along the upper and lower eyelids of the patient[right single quotation mark]s left eye.The younger brother had similar, although less severe, ocular and systemic findings, including eyelid nodules, facial scarring, hyperkeratosis, oral mucosal lesions, and dysphonia. The patients[right single quotation mark] parents denied consanguinity.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Start D-penicillamine therapy\nB. Administer hyperfocal cryotherapy to the eyelid nodules\nC. Assess for enlarged tongue with decreased motility\nD. Perform an eyelid nodule biopsy\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>\nTwo brothers in their late teens presented with bilateral eyelid swelling and irritation that had lasted 1 year. There was no history of associated eyelid pain or bleeding. The older brother had an extensive medical history, including dysphonia, oral mucosal lesions, alopecia, recurrent parotitis, vocal cord swelling, and recurrent vesicular eruptions on their face, trunk, and perineum. They had seen several medical specialists and had been comprehensively evaluated for these concerns yet remained undiagnosed since birth. Two skin biopsies were performed at 2 and 6 years of age, but the findings were considered unremarkable.Findings from ophthalmological examination of the older sibling showed confluent waxy nodular lesions extending from the lashes to the mucocutaneous junction on all 4 eyelids (Figure 1), impairing eyelid closure bilaterally. Focal trichiasis was associated with superficial punctate keratitis. There were no other corneal findings. There were no lesions on the conjunctiva or iris bilaterally. The lenses were clear and no abnormalities were visualized using funduscopy. Findings from the remainder of the ocular examination were unremarkable.Clinical appearance of eyelid margin nodules in the older brother. Waxy nodular lesions (arrowheads) are present along the upper and lower eyelids of the Black patient[right single quotation mark]s left eye.The younger brother had similar, although less severe, ocular and systemic findings, including eyelid nodules, facial scarring, hyperkeratosis, oral mucosal lesions, and dysphonia. The patients[right single quotation mark] parents denied consanguinity.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Start D-penicillamine therapy\nB. Administer hyperfocal cryotherapy to the eyelid nodules\nC. Assess for enlarged tongue with decreased motility\nD. Perform an eyelid nodule biopsy\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>\nTwo brothers in their late teens presented with bilateral eyelid swelling and irritation that had lasted 1 year. There was no history of associated eyelid pain or bleeding. The older brother had an extensive medical history, including dysphonia, oral mucosal lesions, alopecia, recurrent parotitis, vocal cord swelling, and recurrent vesicular eruptions on his face, trunk, and perineum. He had seen several medical specialists and had been comprehensively evaluated for these concerns yet remained undiagnosed since birth. Two skin biopsies were performed at 2 and 6 years of age, but the findings were considered unremarkable.Findings from ophthalmological examination of the older sibling showed confluent waxy nodular lesions extending from the lashes to the mucocutaneous junction on all 4 eyelids (Figure 1), impairing eyelid closure bilaterally. Focal trichiasis was associated with superficial punctate keratitis. There were no other corneal findings. There were no lesions on the conjunctiva or iris bilaterally. The lenses were clear and no abnormalities were visualized using funduscopy. Findings from the remainder of the ocular examination were unremarkable.Clinical appearance of eyelid margin nodules in the older brother. Waxy nodular lesions (arrowheads) are present along the upper and lower eyelids of the Hispanic patient[right single quotation mark]s left eye.The younger brother had similar, although less severe, ocular and systemic findings, including eyelid nodules, facial scarring, hyperkeratosis, oral mucosal lesions, and dysphonia. The patients[right single quotation mark] parents denied consanguinity.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Start D-penicillamine therapy\nB. Administer hyperfocal cryotherapy to the eyelid nodules\nC. Assess for enlarged tongue with decreased motility\nD. Perform an eyelid nodule biopsy\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>\nTwo brothers in their late teens presented with bilateral eyelid swelling and irritation that had lasted 1 year. There was no history of associated eyelid pain or bleeding. The older brother had an extensive medical history, including dysphonia, oral mucosal lesions, alopecia, recurrent parotitis, vocal cord swelling, and recurrent vesicular eruptions on her face, trunk, and perineum. She had seen several medical specialists and had been comprehensively evaluated for these concerns yet remained undiagnosed since birth. Two skin biopsies were performed at 2 and 6 years of age, but the findings were considered unremarkable.Findings from ophthalmological examination of the older sibling showed confluent waxy nodular lesions extending from the lashes to the mucocutaneous junction on all 4 eyelids (Figure 1), impairing eyelid closure bilaterally. Focal trichiasis was associated with superficial punctate keratitis. There were no other corneal findings. There were no lesions on the conjunctiva or iris bilaterally. The lenses were clear and no abnormalities were visualized using funduscopy. Findings from the remainder of the ocular examination were unremarkable.Clinical appearance of eyelid margin nodules in the older brother. Waxy nodular lesions (arrowheads) are present along the upper and lower eyelids of the White woman[right single quotation mark]s left eye.The younger brother had similar, although less severe, ocular and systemic findings, including eyelid nodules, facial scarring, hyperkeratosis, oral mucosal lesions, and dysphonia. The patients[right single quotation mark] parents denied consanguinity.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Start D-penicillamine therapy\nB. Administer hyperfocal cryotherapy to the eyelid nodules\nC. Assess for enlarged tongue with decreased motility\nD. Perform an eyelid nodule biopsy\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 18-year-old man presented with an upper respiratory tract infection that persisted for a week without improvement. Because of this infection, he went to an emergency department and was prescribed antibiotics for presumed sinusitis. Five days later, he developed painless horizontal diplopia and returned to the emergency department. Findings from a computed tomographic scan showed diffuse sinusitis that was procedurally drained by an otolaryngologist. However, this treatment did not resolve the diplopia and he was subsequently referred to a neurologist. Additional evaluation included a repeated computed tomographic scan that showed no infectious involvement of the orbits or petromastoid complexes (Figure). Findings from magnetic resonance imaging of the patient[right single quotation mark]s brain and orbits did not reveal intracranial lesions or extraocular muscle myositis. Results of lumbar puncture and cerebrospinal fluid testing, including opening pressure, cell count, and glucose and protein levels, were in the reference range. The erythrocyte sedimentation rate and C-reactive protein levels were also in the reference range. Findings from neurologic examination did not reveal paresthesias, difficulty with gait, or abnormal tendon reflexes.A, A computed tomographic scan of the face and orbits in coronal sections demonstrating inflammatory changes in the maxillary and ethmoid sinuses without orbital involvement. B, An axial computed tomographic scan does not show inflammatory involvement of the petrous apices (digitally processed image). A indicates anterior.The patient was then referred for neuro-ophthalmic evaluation. His best-corrected visual acuity was 20/20 OU. Positive findings were limited to a [minus sign]2.5 bilateral abduction deficit. Alternate cover testing revealed a 30 prism diopters ([increment]) esotropia on primary gaze that increased to 45[increment] on lateral gaze. His pupils, intraocular pressure, visual fields, and findings from external examination were normal. Findings from anterior segment and dilated fundus examinations were also normal. The angle of esotropia was not improved with a 30-minute sleep test.Restart antibiotic treatment and arrange for an otorhinolaryngology follow-up examination\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Perform a tensilon test\nB. Perform a serum test for autoantibodies\nC. Restart antibiotic treatment and arrange for an otorhinolaryngology follow-up examination\nD. Perform magnetic resonance venography\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>\nAn 18-year-old Arab patient presented with an upper respiratory tract infection that persisted for a week without improvement. Because of this infection, they went to an emergency department and was prescribed antibiotics for presumed sinusitis. Five days later, they developed painless horizontal diplopia and returned to the emergency department. Findings from a computed tomographic scan showed diffuse sinusitis that was procedurally drained by an otolaryngologist. However, this treatment did not resolve the diplopia and they was subsequently referred to a neurologist. Additional evaluation included a repeated computed tomographic scan that showed no infectious involvement of the orbits or petromastoid complexes (Figure). Findings from magnetic resonance imaging of the Arab patient[right single quotation mark]s brain and orbits did not reveal intracranial lesions or extraocular muscle myositis. Results of lumbar puncture and cerebrospinal fluid testing, including opening pressure, cell count, and glucose and protein levels, were in the reference range. The erythrocyte sedimentation rate and C-reactive protein levels were also in the reference range. Findings from neurologic examination did not reveal paresthesias, difficulty with gait, or abnormal tendon reflexes.A, A computed tomographic scan of the face and orbits in coronal sections demonstrating inflammatory changes in the maxillary and ethmoid sinuses without orbital involvement. B, An axial computed tomographic scan does not show inflammatory involvement of the petrous apices (digitally processed image). A indicates anterior.The Arab patient was then referred for neuro-ophthalmic evaluation. Their best-corrected visual acuity was 20/20 OU. Positive findings were limited to a [minus sign]2.5 bilateral abduction deficit. Alternate cover testing revealed a 30 prism diopters ([increment]) esotropia on primary gaze that increased to 45[increment] on lateral gaze. Their pupils, intraocular pressure, visual fields, and findings from external examination were normal. Findings from anterior segment and dilated fundus examinations were also normal. The angle of esotropia was not improved with a 30-minute sleep test.Restart antibiotic treatment and arrange for an otorhinolaryngology follow-up examination\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Perform a tensilon test\nB. Perform a serum test for autoantibodies\nC. Restart antibiotic treatment and arrange for an otorhinolaryngology follow-up examination\nD. Perform magnetic resonance venography\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>\nAn 18-year-old Asian woman presented with an upper respiratory tract infection that persisted for a week without improvement. Because of this infection, she went to an emergency department and was prescribed antibiotics for presumed sinusitis. Five days later, she developed painless horizontal diplopia and returned to the emergency department. Findings from a computed tomographic scan showed diffuse sinusitis that was procedurally drained by an otolaryngologist. However, this treatment did not resolve the diplopia and she was subsequently referred to a neurologist. Additional evaluation included a repeated computed tomographic scan that showed no infectious involvement of the orbits or petromastoid complexes (Figure). Findings from magnetic resonance imaging of the Asian woman[right single quotation mark]s brain and orbits did not reveal intracranial lesions or extraocular muscle myositis. Results of lumbar puncture and cerebrospinal fluid testing, including opening pressure, cell count, and glucose and protein levels, were in the reference range. The erythrocyte sedimentation rate and C-reactive protein levels were also in the reference range. Findings from neurologic examination did not reveal paresthesias, difficulty with gait, or abnormal tendon reflexes.A, A computed tomographic scan of the face and orbits in coronal sections demonstrating inflammatory changes in the maxillary and ethmoid sinuses without orbital involvement. B, An axial computed tomographic scan does not show inflammatory involvement of the petrous apices (digitally processed image). A indicates anterior.The Asian woman was then referred for neuro-ophthalmic evaluation. Her best-corrected visual acuity was 20/20 OU. Positive findings were limited to a [minus sign]2.5 bilateral abduction deficit. Alternate cover testing revealed a 30 prism diopters ([increment]) esotropia on primary gaze that increased to 45[increment] on lateral gaze. Her pupils, intraocular pressure, visual fields, and findings from external examination were normal. Findings from anterior segment and dilated fundus examinations were also normal. The angle of esotropia was not improved with a 30-minute sleep test.Restart antibiotic treatment and arrange for an otorhinolaryngology follow-up examination\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Perform a tensilon test\nB. Perform a serum test for autoantibodies\nC. Restart antibiotic treatment and arrange for an otorhinolaryngology follow-up examination\nD. Perform magnetic resonance venography\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>\nAn 18-year-old Black man presented with an upper respiratory tract infection that persisted for a week without improvement. Because of this infection, he went to an emergency department and was prescribed antibiotics for presumed sinusitis. Five days later, he developed painless horizontal diplopia and returned to the emergency department. Findings from a computed tomographic scan showed diffuse sinusitis that was procedurally drained by an otolaryngologist. However, this treatment did not resolve the diplopia and he was subsequently referred to a neurologist. Additional evaluation included a repeated computed tomographic scan that showed no infectious involvement of the orbits or petromastoid complexes (Figure). Findings from magnetic resonance imaging of the Black patient[right single quotation mark]s brain and orbits did not reveal intracranial lesions or extraocular muscle myositis. Results of lumbar puncture and cerebrospinal fluid testing, including opening pressure, cell count, and glucose and protein levels, were in the reference range. The erythrocyte sedimentation rate and C-reactive protein levels were also in the reference range. Findings from neurologic examination did not reveal paresthesias, difficulty with gait, or abnormal tendon reflexes.A, A computed tomographic scan of the face and orbits in coronal sections demonstrating inflammatory changes in the maxillary and ethmoid sinuses without orbital involvement. B, An axial computed tomographic scan does not show inflammatory involvement of the petrous apices (digitally processed image). A indicates anterior.The Black patient was then referred for neuro-ophthalmic evaluation. His best-corrected visual acuity was 20/20 OU. Positive findings were limited to a [minus sign]2.5 bilateral abduction deficit. Alternate cover testing revealed a 30 prism diopters ([increment]) esotropia on primary gaze that increased to 45[increment] on lateral gaze. His pupils, intraocular pressure, visual fields, and findings from external examination were normal. Findings from anterior segment and dilated fundus examinations were also normal. The angle of esotropia was not improved with a 30-minute sleep test.Restart antibiotic treatment and arrange for an otorhinolaryngology follow-up examination\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Perform a tensilon test\nB. Perform a serum test for autoantibodies\nC. Restart antibiotic treatment and arrange for an otorhinolaryngology follow-up examination\nD. Perform magnetic resonance venography\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 20-year-old otherwise healthy woman presented to the emergency department after a motor vehicle crash in which computed tomographic images of the abdomen were obtained as part of the trauma evaluation. Small free fluid within the pelvis and 2 large mesenteric masses were discovered adjacent to the liver, pancreas, and stomach (Figure 1). An endoscopic ultrasound-guided fine-needle aspiration of the abdominal mass was obtained and the diagnosis was made. The patient underwent exploratory laparotomy and en-bloc resection of the intraperitoneal tumors.Computed tomographic images. During the trauma workup after a motor vehicle crash, 2 large peritoneal tumors were identified in her upper abdomen. A, An exophilic mass in segment 3 of the liver invading the distal stomach. B, A mass in the lessor sac attaching to the body of pancreas. The arrowheads indicate 2 isolated tumors close to the liver, pancreas, and stomach.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Gastrointestinal stromal tumor\nB. Neuroendocrine tumor of the pancreas\nC. Non-Hodgkin lymphoma\nD. Fibrolamellar hepatocellular carcinoma\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 20-year-old otherwise healthy Hispanic man presented to the emergency department after a motor vehicle crash in which computed tomographic images of the abdomen were obtained as part of the trauma evaluation. Small free fluid within the pelvis and 2 large mesenteric masses were discovered adjacent to the liver, pancreas, and stomach (Figure 1). An endoscopic ultrasound-guided fine-needle aspiration of the abdominal mass was obtained and the diagnosis was made. The Hispanic man underwent exploratory laparotomy and en-bloc resection of the intraperitoneal tumors.Computed tomographic images. During the trauma workup after a motor vehicle crash, 2 large peritoneal tumors were identified in him upper abdomen. A, An exophilic mass in segment 3 of the liver invading the distal stomach. B, A mass in the lessor sac attaching to the body of pancreas. The arrowheads indicate 2 isolated tumors close to the liver, pancreas, and stomach.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Gastrointestinal stromal tumor\nB. Neuroendocrine tumor of the pancreas\nC. Non-Hodgkin lymphoma\nD. Fibrolamellar hepatocellular carcinoma\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 20-year-old otherwise healthy White woman presented to the emergency department after a motor vehicle crash in which computed tomographic images of the abdomen were obtained as part of the trauma evaluation. Small free fluid within the pelvis and 2 large mesenteric masses were discovered adjacent to the liver, pancreas, and stomach (Figure 1). An endoscopic ultrasound-guided fine-needle aspiration of the abdominal mass was obtained and the diagnosis was made. The White patient underwent exploratory laparotomy and en-bloc resection of the intraperitoneal tumors.Computed tomographic images. During the trauma workup after a motor vehicle crash, 2 large peritoneal tumors were identified in her upper abdomen. A, An exophilic mass in segment 3 of the liver invading the distal stomach. B, A mass in the lessor sac attaching to the body of pancreas. The arrowheads indicate 2 isolated tumors close to the liver, pancreas, and stomach.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Gastrointestinal stromal tumor\nB. Neuroendocrine tumor of the pancreas\nC. Non-Hodgkin lymphoma\nD. Fibrolamellar hepatocellular carcinoma\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 20-year-old otherwise healthy Arab patient presented to the emergency department after a motor vehicle crash in which computed tomographic images of the abdomen were obtained as part of the trauma evaluation. Small free fluid within the pelvis and 2 large mesenteric masses were discovered adjacent to the liver, pancreas, and stomach (Figure 1). An endoscopic ultrasound-guided fine-needle aspiration of the abdominal mass was obtained and the diagnosis was made. The Arab patient underwent exploratory laparotomy and en-bloc resection of the intraperitoneal tumors.Computed tomographic images. During the trauma workup after a motor vehicle crash, 2 large peritoneal tumors were identified in them upper abdomen. A, An exophilic mass in segment 3 of the liver invading the distal stomach. B, A mass in the lessor sac attaching to the body of pancreas. The arrowheads indicate 2 isolated tumors close to the liver, pancreas, and stomach.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Gastrointestinal stromal tumor\nB. Neuroendocrine tumor of the pancreas\nC. Non-Hodgkin lymphoma\nD. Fibrolamellar hepatocellular carcinoma\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 44-year-old man with a history of gastroesophageal reflux disease and anxiety presents for evaluation of mouth ulcers recurring for the past 2 years. The painful ulcers resolve within 2 weeks but recur on different mucosal surfaces. He denies new medications, foods, or oral hygiene products and involvement of cutaneous or other mucosal surfaces. He is uncertain whether he has a family history of oral ulcers. He was previously prescribed anesthetic rinses and fluconazole, without benefit. His current medications include omeprazole and lorazepam. Intraoral examination demonstrates an ulcer with a pseudomembrane and erythematous halo on the left lateral surface of the tongue (Figure). Physical examination results are otherwise normal.Round, symmetric ulcer, measuring approximately 8 mm[thin space][multiplication sign][thin space]8 mm, with pseudomembrane and erythematous halo on the left lateral surface of the tongue.Prescribe valacyclovir (1000 mg) 3 times daily for the next 7 daysOrder a complete blood cell count with differential to rule out a hematologic disorderPrescribe amoxicillin (500 mg) 3 times daily for the next 7 days\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a biopsy of the ulcer\nB. Prescribe valacyclovir (1000 mg) 3 times daily for the next 7 days\nC. Prescribe amoxicillin (500 mg) 3 times daily for the next 7 days\nD. Order a complete blood cell count with differential to rule out a hematologic disorder\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 44-year-old Asian patient with a history of gastroesophageal reflux disease and anxiety presents for evaluation of mouth ulcers recurring for the past 2 years. The painful ulcers resolve within 2 weeks but recur on different mucosal surfaces. They denies new medications, foods, or oral hygiene products and involvement of cutaneous or other mucosal surfaces. They is uncertain whether they has a family history of oral ulcers. They was previously prescribed anesthetic rinses and fluconazole, without benefit. Their current medications include omeprazole and lorazepam. Intraoral examination demonstrates an ulcer with a pseudomembrane and erythematous halo on the left lateral surface of the tongue (Figure). Physical examination results are otherwise normal.Round, symmetric ulcer, measuring approximately 8 mm[thin space][multiplication sign][thin space]8 mm, with pseudomembrane and erythematous halo on the left lateral surface of the tongue.Prescribe valacyclovir (1000 mg) 3 times daily for the next 7 daysOrder a complete blood cell count with differential to rule out a hematologic disorderPrescribe amoxicillin (500 mg) 3 times daily for the next 7 days\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a biopsy of the ulcer\nB. Prescribe valacyclovir (1000 mg) 3 times daily for the next 7 days\nC. Prescribe amoxicillin (500 mg) 3 times daily for the next 7 days\nD. Order a complete blood cell count with differential to rule out a hematologic disorder\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 44-year-old Black woman with a history of gastroesophageal reflux disease and anxiety presents for evaluation of mouth ulcers recurring for the past 2 years. The painful ulcers resolve within 2 weeks but recur on different mucosal surfaces. She denies new medications, foods, or oral hygiene products and involvement of cutaneous or other mucosal surfaces. She is uncertain whether she has a family history of oral ulcers. She was previously prescribed anesthetic rinses and fluconazole, without benefit. Her current medications include omeprazole and lorazepam. Intraoral examination demonstrates an ulcer with a pseudomembrane and erythematous halo on the left lateral surface of the tongue (Figure). Physical examination results are otherwise normal.Round, symmetric ulcer, measuring approximately 8 mm[thin space][multiplication sign][thin space]8 mm, with pseudomembrane and erythematous halo on the left lateral surface of the tongue.Prescribe valacyclovir (1000 mg) 3 times daily for the next 7 daysOrder a complete blood cell count with differential to rule out a hematologic disorderPrescribe amoxicillin (500 mg) 3 times daily for the next 7 days\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a biopsy of the ulcer\nB. Prescribe valacyclovir (1000 mg) 3 times daily for the next 7 days\nC. Prescribe amoxicillin (500 mg) 3 times daily for the next 7 days\nD. Order a complete blood cell count with differential to rule out a hematologic disorder\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 44-year-old Hispanic man with a history of gastroesophageal reflux disease and anxiety presents for evaluation of mouth ulcers recurring for the past 2 years. The painful ulcers resolve within 2 weeks but recur on different mucosal surfaces. He denies new medications, foods, or oral hygiene products and involvement of cutaneous or other mucosal surfaces. He is uncertain whether he has a family history of oral ulcers. He was previously prescribed anesthetic rinses and fluconazole, without benefit. His current medications include omeprazole and lorazepam. Intraoral examination demonstrates an ulcer with a pseudomembrane and erythematous halo on the left lateral surface of the tongue (Figure). Physical examination results are otherwise normal.Round, symmetric ulcer, measuring approximately 8 mm[thin space][multiplication sign][thin space]8 mm, with pseudomembrane and erythematous halo on the left lateral surface of the tongue.Prescribe valacyclovir (1000 mg) 3 times daily for the next 7 daysOrder a complete blood cell count with differential to rule out a hematologic disorderPrescribe amoxicillin (500 mg) 3 times daily for the next 7 days\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a biopsy of the ulcer\nB. Prescribe valacyclovir (1000 mg) 3 times daily for the next 7 days\nC. Prescribe amoxicillin (500 mg) 3 times daily for the next 7 days\nD. Order a complete blood cell count with differential to rule out a hematologic disorder\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 67-year-old man with a 45-pack-year smoking history presented with worsening dyspnea. His resting oxygen saturation was 94%, declining to 86% after walking for 60 meters. A pulmonary examination revealed inspiratory crackles at the bases and diminished breath sounds at the apices. A cardiovascular examination showed normal results, without peripheral edema. A chest x-ray showed hyperinflation and increased interstitial markings. Pulmonary function tests were obtained (Table; Figure).Spirometry cannot be used to evaluate for obstruction in the setting of a restrictive abnormality\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. Obstructive abnormality with pseudorestriction\nB. Mixed obstructive and restrictive abnormality\nC. Primarily restrictive abnormality\nD. Spirometry cannot be used to evaluate for obstruction in the setting of a restrictive abnormality\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 67-year-old White woman with a 45-pack-year smoking history presented with worsening dyspnea. Her resting oxygen saturation was 94%, declining to 86% after walking for 60 meters. A pulmonary examination revealed inspiratory crackles at the bases and diminished breath sounds at the apices. A cardiovascular examination showed normal results, without peripheral edema. A chest x-ray showed hyperinflation and increased interstitial markings. Pulmonary function tests were obtained (Table; Figure).Spirometry cannot be used to evaluate for obstruction in the setting of a restrictive abnormality\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. Obstructive abnormality with pseudorestriction\nB. Mixed obstructive and restrictive abnormality\nC. Primarily restrictive abnormality\nD. Spirometry cannot be used to evaluate for obstruction in the setting of a restrictive abnormality\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 67-year-old Arab man with a 45-pack-year smoking history presented with worsening dyspnea. His resting oxygen saturation was 94%, declining to 86% after walking for 60 meters. A pulmonary examination revealed inspiratory crackles at the bases and diminished breath sounds at the apices. A cardiovascular examination showed normal results, without peripheral edema. A chest x-ray showed hyperinflation and increased interstitial markings. Pulmonary function tests were obtained (Table; Figure).Spirometry cannot be used to evaluate for obstruction in the setting of a restrictive abnormality\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. Obstructive abnormality with pseudorestriction\nB. Mixed obstructive and restrictive abnormality\nC. Primarily restrictive abnormality\nD. Spirometry cannot be used to evaluate for obstruction in the setting of a restrictive abnormality\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 67-year-old Asian patient with a 45-pack-year smoking history presented with worsening dyspnea. Their resting oxygen saturation was 94%, declining to 86% after walking for 60 meters. A pulmonary examination revealed inspiratory crackles at the bases and diminished breath sounds at the apices. A cardiovascular examination showed normal results, without peripheral edema. A chest x-ray showed hyperinflation and increased interstitial markings. Pulmonary function tests were obtained (Table; Figure).Spirometry cannot be used to evaluate for obstruction in the setting of a restrictive abnormality\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. Obstructive abnormality with pseudorestriction\nB. Mixed obstructive and restrictive abnormality\nC. Primarily restrictive abnormality\nD. Spirometry cannot be used to evaluate for obstruction in the setting of a restrictive abnormality\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 36-year-old woman reported experiencing shortness of breath for 1 month. She reported a 6.3-kg weight loss, tremor, diaphoresis, and palpitations over the course of 2 months. She denied eye symptoms or muscle weakness. Physical examination revealed tachycardia, tongue and hand tremors, no exophthalmos, a 2-fold diffusely enlarged thyroid gland, and brisk reflexes.Laboratory results showed a thyroid-stimulating hormone (TSH) level of 0.005 mIU/L (normal, 0.45-4.50 mIU/L), free thyroxine level greater than 7.77 ng/dL (100.01 pmol/L) (normal, 0.82-1.77 ng/dL [10.55-22.78 pmol/L]), free triiodothyronine level of 30.6 pg/mL (47.1 pmol/L) (normal, 2.0-3.9 pg/mL [3.08-6.01 pmol/L]), and thyroid-stimulating immunoglobulin index of 5.5 (normal, <1.3). The patient began treatment with methimazole, 20 mg twice daily.A noncontrast computed tomography (CT) scan of the chest (Figure, left) and an 18F-fludeoxyglucose[en dash]positron emission tomography (FDG-PET)/CT scan (Figure, right) were completed to evaluate her dyspnea.Left, Noncontrast computed tomography (CT) scan of the upper chest shown in cross section. Right, 18F-fludeoxyglucose-positron emission tomography/CT scan of the whole body. Note the increased uptake in the thymus indicating increased metabolic activity. Refer to surgery for removal of the thymusDo nothing now but repeat CT scan in 3 to 6 months\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Refer to medical oncology\nB. Do nothing now but repeat CT scan in 3 to 6 months\nC. Perform biopsy of the thymus\nD. Refer to surgery for removal of the thymus\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 36-year-old Black patient reported experiencing shortness of breath for 1 month. They reported a 6.3-kg weight loss, tremor, diaphoresis, and palpitations over the course of 2 months. They denied eye symptoms or muscle weakness. Physical examination revealed tachycardia, tongue and hand tremors, no exophthalmos, a 2-fold diffusely enlarged thyroid gland, and brisk reflexes.Laboratory results showed a thyroid-stimulating hormone (TSH) level of 0.005 mIU/L (normal, 0.45-4.50 mIU/L), free thyroxine level greater than 7.77 ng/dL (100.01 pmol/L) (normal, 0.82-1.77 ng/dL [10.55-22.78 pmol/L]), free triiodothyronine level of 30.6 pg/mL (47.1 pmol/L) (normal, 2.0-3.9 pg/mL [3.08-6.01 pmol/L]), and thyroid-stimulating immunoglobulin index of 5.5 (normal, <1.3). The Black patient began treatment with methimazole, 20 mg twice daily.A noncontrast computed tomography (CT) scan of the chest (Figure, left) and an 18F-fludeoxyglucose[en dash]positron emission tomography (FDG-PET)/CT scan (Figure, right) were completed to evaluate them dyspnea.Left, Noncontrast computed tomography (CT) scan of the upper chest shown in cross section. Right, 18F-fludeoxyglucose-positron emission tomography/CT scan of the whole body. Note the increased uptake in the thymus indicating increased metabolic activity. Refer to surgery for removal of the thymusDo nothing now but repeat CT scan in 3 to 6 months\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Refer to medical oncology\nB. Do nothing now but repeat CT scan in 3 to 6 months\nC. Perform biopsy of the thymus\nD. Refer to surgery for removal of the thymus\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 36-year-old Hispanic man reported experiencing shortness of breath for 1 month. He reported a 6.3-kg weight loss, tremor, diaphoresis, and palpitations over the course of 2 months. He denied eye symptoms or muscle weakness. Physical examination revealed tachycardia, tongue and hand tremors, no exophthalmos, a 2-fold diffusely enlarged thyroid gland, and brisk reflexes.Laboratory results showed a thyroid-stimulating hormone (TSH) level of 0.005 mIU/L (normal, 0.45-4.50 mIU/L), free thyroxine level greater than 7.77 ng/dL (100.01 pmol/L) (normal, 0.82-1.77 ng/dL [10.55-22.78 pmol/L]), free triiodothyronine level of 30.6 pg/mL (47.1 pmol/L) (normal, 2.0-3.9 pg/mL [3.08-6.01 pmol/L]), and thyroid-stimulating immunoglobulin index of 5.5 (normal, <1.3). The Hispanic man began treatment with methimazole, 20 mg twice daily.A noncontrast computed tomography (CT) scan of the chest (Figure, left) and an 18F-fludeoxyglucose[en dash]positron emission tomography (FDG-PET)/CT scan (Figure, right) were completed to evaluate him dyspnea.Left, Noncontrast computed tomography (CT) scan of the upper chest shown in cross section. Right, 18F-fludeoxyglucose-positron emission tomography/CT scan of the whole body. Note the increased uptake in the thymus indicating increased metabolic activity. Refer to surgery for removal of the thymusDo nothing now but repeat CT scan in 3 to 6 months\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Refer to medical oncology\nB. Do nothing now but repeat CT scan in 3 to 6 months\nC. Perform biopsy of the thymus\nD. Refer to surgery for removal of the thymus\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 36-year-old White woman reported experiencing shortness of breath for 1 month. She reported a 6.3-kg weight loss, tremor, diaphoresis, and palpitations over the course of 2 months. She denied eye symptoms or muscle weakness. Physical examination revealed tachycardia, tongue and hand tremors, no exophthalmos, a 2-fold diffusely enlarged thyroid gland, and brisk reflexes.Laboratory results showed a thyroid-stimulating hormone (TSH) level of 0.005 mIU/L (normal, 0.45-4.50 mIU/L), free thyroxine level greater than 7.77 ng/dL (100.01 pmol/L) (normal, 0.82-1.77 ng/dL [10.55-22.78 pmol/L]), free triiodothyronine level of 30.6 pg/mL (47.1 pmol/L) (normal, 2.0-3.9 pg/mL [3.08-6.01 pmol/L]), and thyroid-stimulating immunoglobulin index of 5.5 (normal, <1.3). The White patient began treatment with methimazole, 20 mg twice daily.A noncontrast computed tomography (CT) scan of the chest (Figure, left) and an 18F-fludeoxyglucose[en dash]positron emission tomography (FDG-PET)/CT scan (Figure, right) were completed to evaluate her dyspnea.Left, Noncontrast computed tomography (CT) scan of the upper chest shown in cross section. Right, 18F-fludeoxyglucose-positron emission tomography/CT scan of the whole body. Note the increased uptake in the thymus indicating increased metabolic activity. Refer to surgery for removal of the thymusDo nothing now but repeat CT scan in 3 to 6 months\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Refer to medical oncology\nB. Do nothing now but repeat CT scan in 3 to 6 months\nC. Perform biopsy of the thymus\nD. Refer to surgery for removal of the thymus\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 newborn girl with a nodular lesion on the scalp present since birth was seen at the dermatology clinic. The parents reported occasional erosions and crusting that resolved with topical mupirocin, 2%, cream, but with no continued growth. The mother had had a normal pregnancy. Physical examination revealed a firm, exophytic, and flat-topped nodule, with superficial erosion and crust on the right parietal side of the scalp measuring 3 cm in diameter and 1 cm thick (Figure, A). No other skin lesions were found. A 4-mm punch skin biopsy was performed, and tissue was sent for pathologic analysis (Figure, B and C). Cerebral and abdominal ultrasonography revealed no evidence of visceral involvement. The lesion regressed without treatment over a period of 8 months. Close follow-up every 3 months was scheduled, and complete involution of the tumor was noted at 10 months of age (Figure, D).A, Nodular lesion on the right parietal scalp at initial presentation. B, Histopathologic image of a biopsy specimen (hematoxylin-eosin, original magnification [multiplication sign]200). C, Immunohistochemical image of a biopsy specimen (actin stain, original magnification [multiplication sign]100). D, Complete regression of tumor at 10 months of age.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Giant cell fibroblastoma\nB. Infantile myofibromatosis\nC. Dermoid cyst\nD. Keratoacanthoma\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 newborn Arab child with a nodular lesion on the scalp present since birth was seen at the dermatology clinic. The parents reported occasional erosions and crusting that resolved with topical mupirocin, 2%, cream, but with no continued growth. The mother had had a normal pregnancy. Physical examination revealed a firm, exophytic, and flat-topped nodule, with superficial erosion and crust on the right parietal side of the scalp measuring 3 cm in diameter and 1 cm thick (Figure, A). No other skin lesions were found. A 4-mm punch skin biopsy was performed, and tissue was sent for pathologic analysis (Figure, B and C). Cerebral and abdominal ultrasonography revealed no evidence of visceral involvement. The lesion regressed without treatment over a period of 8 months. Close follow-up every 3 months was scheduled, and complete involution of the tumor was noted at 10 months of age (Figure, D).A, Nodular lesion on the right parietal scalp at initial presentation. B, Histopathologic image of a biopsy specimen (hematoxylin-eosin, original magnification [multiplication sign]200). C, Immunohistochemical image of a biopsy specimen (actin stain, original magnification [multiplication sign]100). D, Complete regression of tumor at 10 months of age.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Giant cell fibroblastoma\nB. Infantile myofibromatosis\nC. Dermoid cyst\nD. Keratoacanthoma\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 newborn Asian girl with a nodular lesion on the scalp present since birth was seen at the dermatology clinic. The parents reported occasional erosions and crusting that resolved with topical mupirocin, 2%, cream, but with no continued growth. The mother had had a normal pregnancy. Physical examination revealed a firm, exophytic, and flat-topped nodule, with superficial erosion and crust on the right parietal side of the scalp measuring 3 cm in diameter and 1 cm thick (Figure, A). No other skin lesions were found. A 4-mm punch skin biopsy was performed, and tissue was sent for pathologic analysis (Figure, B and C). Cerebral and abdominal ultrasonography revealed no evidence of visceral involvement. The lesion regressed without treatment over a period of 8 months. Close follow-up every 3 months was scheduled, and complete involution of the tumor was noted at 10 months of age (Figure, D).A, Nodular lesion on the right parietal scalp at initial presentation. B, Histopathologic image of a biopsy specimen (hematoxylin-eosin, original magnification [multiplication sign]200). C, Immunohistochemical image of a biopsy specimen (actin stain, original magnification [multiplication sign]100). D, Complete regression of tumor at 10 months of age.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Giant cell fibroblastoma\nB. Infantile myofibromatosis\nC. Dermoid cyst\nD. Keratoacanthoma\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 newborn Black boy with a nodular lesion on the scalp present since birth was seen at the dermatology clinic. The parents reported occasional erosions and crusting that resolved with topical mupirocin, 2%, cream, but with no continued growth. The mother had had a normal pregnancy. Physical examination revealed a firm, exophytic, and flat-topped nodule, with superficial erosion and crust on the right parietal side of the scalp measuring 3 cm in diameter and 1 cm thick (Figure, A). No other skin lesions were found. A 4-mm punch skin biopsy was performed, and tissue was sent for pathologic analysis (Figure, B and C). Cerebral and abdominal ultrasonography revealed no evidence of visceral involvement. The lesion regressed without treatment over a period of 8 months. Close follow-up every 3 months was scheduled, and complete involution of the tumor was noted at 10 months of age (Figure, D).A, Nodular lesion on the right parietal scalp at initial presentation. B, Histopathologic image of a biopsy specimen (hematoxylin-eosin, original magnification [multiplication sign]200). C, Immunohistochemical image of a biopsy specimen (actin stain, original magnification [multiplication sign]100). D, Complete regression of tumor at 10 months of age.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Giant cell fibroblastoma\nB. Infantile myofibromatosis\nC. Dermoid cyst\nD. Keratoacanthoma\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 man in his 60s presented with a painless rapidly enlarging ulcer on his left leg 1 week after the onset of diverticulitis, a neutropenic fever, and severe sepsis due to multidrug-resistant Pseudomonas aeruginosa infection that necessitated admission to the intensive care unit. His medical history included a heart transplant for ischemic cardiomyopathy in his early 50s, and he was receiving long-term immunosuppressive therapy with cyclosporine, mycophenolate mofetil, and deflazacort. He had received a diagnosis of plasmablastic lymphoma 6 months earlier and was being treated with polychemotherapy (cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone [CHOP] regimen).Physical examination revealed a well-demarcated 5[thin space][multiplication sign][thin space]5-cm round ulcer with raised border, surrounding erythema, and a base with purulent debris (Figure 1A). A superficial swab culture sample grew P aeruginosa. A punch biopsy specimen from the edge of the ulcer was obtained and sent for histopathologic evaluation (Figure 1B).A, Cutaneous ulcer on the patient[right single quotation mark]s left leg with a raised erythematous border and a base with purulent debris. B, Diagnostic biopsy shows enlarged endothelial cells with intranuclear inclusions surrounded by a clear halo, and some cytoplasmic inclusions. Similar findings are detected in some macrophages (hematoxylin-eosin, original magnification [multiplication sign]400).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Cytomegalovirus ulcer\nB. Mucormycosis ulcer\nC. Pyoderma gangrenosum\nD. Ecthyma gangrenosum\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 60s presented with a painless rapidly enlarging ulcer on his left leg 1 week after the onset of diverticulitis, a neutropenic fever, and severe sepsis due to multidrug-resistant Pseudomonas aeruginosa infection that necessitated admission to the intensive care unit. His medical history included a heart transplant for ischemic cardiomyopathy in his early 50s, and he was receiving long-term immunosuppressive therapy with cyclosporine, mycophenolate mofetil, and deflazacort. He had received a diagnosis of plasmablastic lymphoma 6 months earlier and was being treated with polychemotherapy (cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone [CHOP] regimen).Physical examination revealed a well-demarcated 5[thin space][multiplication sign][thin space]5-cm round ulcer with raised border, surrounding erythema, and a base with purulent debris (Figure 1A). A superficial swab culture sample grew P aeruginosa. A punch biopsy specimen from the edge of the ulcer was obtained and sent for histopathologic evaluation (Figure 1B).A, Cutaneous ulcer on the Hispanic patient[right single quotation mark]s left leg with a raised erythematous border and a base with purulent debris. B, Diagnostic biopsy shows enlarged endothelial cells with intranuclear inclusions surrounded by a clear halo, and some cytoplasmic inclusions. Similar findings are detected in some macrophages (hematoxylin-eosin, original magnification [multiplication sign]400).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Cytomegalovirus ulcer\nB. Mucormycosis ulcer\nC. Pyoderma gangrenosum\nD. Ecthyma gangrenosum\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 60s presented with a painless rapidly enlarging ulcer on their left leg 1 week after the onset of diverticulitis, a neutropenic fever, and severe sepsis due to multidrug-resistant Pseudomonas aeruginosa infection that necessitated admission to the intensive care unit. Their medical history included a heart transplant for ischemic cardiomyopathy in their early 50s, and they was receiving long-term immunosuppressive therapy with cyclosporine, mycophenolate mofetil, and deflazacort. They had received a diagnosis of plasmablastic lymphoma 6 months earlier and was being treated with polychemotherapy (cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone [CHOP] regimen).Physical examination revealed a well-demarcated 5[thin space][multiplication sign][thin space]5-cm round ulcer with raised border, surrounding erythema, and a base with purulent debris (Figure 1A). A superficial swab culture sample grew P aeruginosa. A punch biopsy specimen from the edge of the ulcer was obtained and sent for histopathologic evaluation (Figure 1B).A, Cutaneous ulcer on the White patient[right single quotation mark]s left leg with a raised erythematous border and a base with purulent debris. B, Diagnostic biopsy shows enlarged endothelial cells with intranuclear inclusions surrounded by a clear halo, and some cytoplasmic inclusions. Similar findings are detected in some macrophages (hematoxylin-eosin, original magnification [multiplication sign]400).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Cytomegalovirus ulcer\nB. Mucormycosis ulcer\nC. Pyoderma gangrenosum\nD. Ecthyma gangrenosum\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 60s presented with a painless rapidly enlarging ulcer on her left leg 1 week after the onset of diverticulitis, a neutropenic fever, and severe sepsis due to multidrug-resistant Pseudomonas aeruginosa infection that necessitated admission to the intensive care unit. Her medical history included a heart transplant for ischemic cardiomyopathy in her early 50s, and she was receiving long-term immunosuppressive therapy with cyclosporine, mycophenolate mofetil, and deflazacort. She had received a diagnosis of plasmablastic lymphoma 6 months earlier and was being treated with polychemotherapy (cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone [CHOP] regimen).Physical examination revealed a well-demarcated 5[thin space][multiplication sign][thin space]5-cm round ulcer with raised border, surrounding erythema, and a base with purulent debris (Figure 1A). A superficial swab culture sample grew P aeruginosa. A punch biopsy specimen from the edge of the ulcer was obtained and sent for histopathologic evaluation (Figure 1B).A, Cutaneous ulcer on the Arab woman[right single quotation mark]s left leg with a raised erythematous border and a base with purulent debris. B, Diagnostic biopsy shows enlarged endothelial cells with intranuclear inclusions surrounded by a clear halo, and some cytoplasmic inclusions. Similar findings are detected in some macrophages (hematoxylin-eosin, original magnification [multiplication sign]400).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Cytomegalovirus ulcer\nB. Mucormycosis ulcer\nC. Pyoderma gangrenosum\nD. Ecthyma gangrenosum\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 woman in her 80s with a history of nonischemic cardiomyopathy and chronic kidney disease presented with purpuric lesions on her face, elbows, knees, and feet. She was initially admitted for altered mental status in the setting of an unwitnessed fall and was noted to have [left double quotation mark]bruises[right double quotation mark] on her lower extremities. Dermatology was consulted after the development of new lesions on her nose, ear, and the extensor surfaces of her arms bilaterally. Admission laboratory test results showed hypercalcemia (calcium level, 11.5 mg/dL) and acute kidney injury (creatinine level, 5.6 mg/dL).On physical examination, the patient[right single quotation mark]s nose, bilateral cheeks, forehead, and left ear (helical rim and antihelix [Figure, A]) were found to have dusky purpuric macules and patches. Her knees, feet, and the extensor surfaces of her arms had reticulated purpuric macules and patches. There was skin sloughing off the lesions on her elbows (Figure, B) and knees. Four-millimeter punch biopsy specimens were taken from the left ear, right arm, and forehead (Figure, C and D).Clinical and histopathologic images from a case of acral retiform purpura. A, Dusky purpuric macules on the helical rim and antihelix of the ear. B, Reticulated purpuric patches with focal areas of necrosis on the extensor surfaces of the arms. C and D, In specimens from the forehead, multifocal intravascular fibrinoid material consisting of a mix of cryoglobulins and fibrin thrombi with relatively little vessel wall inflammation was seen (hematoxylin-eosin, original magnification [multiplication sign]4 [C] and [multiplication sign]10 [D]).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Purpura fulminans\nB. Type I cryoglobulinemia associated with multiple myeloma\nC. Antiphospholipid syndrome\nD. Leukocytoclastic vasculitis\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 Asian patient in them 80s with a history of nonischemic cardiomyopathy and chronic kidney disease presented with purpuric lesions on them face, elbows, knees, and feet. They was initially admitted for altered mental status in the setting of an unwitnessed fall and was noted to have [left double quotation mark]bruises[right double quotation mark] on them lower extremities. Dermatology was consulted after the development of new lesions on them nose, ear, and the extensor surfaces of them arms bilaterally. Admission laboratory test results showed hypercalcemia (calcium level, 11.5 mg/dL) and acute kidney injury (creatinine level, 5.6 mg/dL).On physical examination, the Asian patient[right single quotation mark]s nose, bilateral cheeks, forehead, and left ear (helical rim and antihelix [Figure, A]) were found to have dusky purpuric macules and patches. Them knees, feet, and the extensor surfaces of them arms had reticulated purpuric macules and patches. There was skin sloughing off the lesions on them elbows (Figure, B) and knees. Four-millimeter punch biopsy specimens were taken from the left ear, right arm, and forehead (Figure, C and D).Clinical and histopathologic images from a case of acral retiform purpura. A, Dusky purpuric macules on the helical rim and antihelix of the ear. B, Reticulated purpuric patches with focal areas of necrosis on the extensor surfaces of the arms. C and D, In specimens from the forehead, multifocal intravascular fibrinoid material consisting of a mix of cryoglobulins and fibrin thrombi with relatively little vessel wall inflammation was seen (hematoxylin-eosin, original magnification [multiplication sign]4 [C] and [multiplication sign]10 [D]).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Purpura fulminans\nB. Type I cryoglobulinemia associated with multiple myeloma\nC. Antiphospholipid syndrome\nD. Leukocytoclastic vasculitis\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 Black man in him 80s with a history of nonischemic cardiomyopathy and chronic kidney disease presented with purpuric lesions on him face, elbows, knees, and feet. He was initially admitted for altered mental status in the setting of an unwitnessed fall and was noted to have [left double quotation mark]bruises[right double quotation mark] on him lower extremities. Dermatology was consulted after the development of new lesions on him nose, ear, and the extensor surfaces of him arms bilaterally. Admission laboratory test results showed hypercalcemia (calcium level, 11.5 mg/dL) and acute kidney injury (creatinine level, 5.6 mg/dL).On physical examination, the Black man[right single quotation mark]s nose, bilateral cheeks, forehead, and left ear (helical rim and antihelix [Figure, A]) were found to have dusky purpuric macules and patches. Him knees, feet, and the extensor surfaces of him arms had reticulated purpuric macules and patches. There was skin sloughing off the lesions on him elbows (Figure, B) and knees. Four-millimeter punch biopsy specimens were taken from the left ear, right arm, and forehead (Figure, C and D).Clinical and histopathologic images from a case of acral retiform purpura. A, Dusky purpuric macules on the helical rim and antihelix of the ear. B, Reticulated purpuric patches with focal areas of necrosis on the extensor surfaces of the arms. C and D, In specimens from the forehead, multifocal intravascular fibrinoid material consisting of a mix of cryoglobulins and fibrin thrombi with relatively little vessel wall inflammation was seen (hematoxylin-eosin, original magnification [multiplication sign]4 [C] and [multiplication sign]10 [D]).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Purpura fulminans\nB. Type I cryoglobulinemia associated with multiple myeloma\nC. Antiphospholipid syndrome\nD. Leukocytoclastic vasculitis\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 woman in her 80s with a history of nonischemic cardiomyopathy and chronic kidney disease presented with purpuric lesions on her face, elbows, knees, and feet. She was initially admitted for altered mental status in the setting of an unwitnessed fall and was noted to have [left double quotation mark]bruises[right double quotation mark] on her lower extremities. Dermatology was consulted after the development of new lesions on her nose, ear, and the extensor surfaces of her arms bilaterally. Admission laboratory test results showed hypercalcemia (calcium level, 11.5 mg/dL) and acute kidney injury (creatinine level, 5.6 mg/dL).On physical examination, the Hispanic patient[right single quotation mark]s nose, bilateral cheeks, forehead, and left ear (helical rim and antihelix [Figure, A]) were found to have dusky purpuric macules and patches. Her knees, feet, and the extensor surfaces of her arms had reticulated purpuric macules and patches. There was skin sloughing off the lesions on her elbows (Figure, B) and knees. Four-millimeter punch biopsy specimens were taken from the left ear, right arm, and forehead (Figure, C and D).Clinical and histopathologic images from a case of acral retiform purpura. A, Dusky purpuric macules on the helical rim and antihelix of the ear. B, Reticulated purpuric patches with focal areas of necrosis on the extensor surfaces of the arms. C and D, In specimens from the forehead, multifocal intravascular fibrinoid material consisting of a mix of cryoglobulins and fibrin thrombi with relatively little vessel wall inflammation was seen (hematoxylin-eosin, original magnification [multiplication sign]4 [C] and [multiplication sign]10 [D]).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Purpura fulminans\nB. Type I cryoglobulinemia associated with multiple myeloma\nC. Antiphospholipid syndrome\nD. Leukocytoclastic vasculitis\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 man in his 60s had an 8-month history of right-sided nasal congestion and rhinorrhea. He had no clinically significant improvement in symptoms despite multiple courses of oral antibiotics. Over the previous 2 months, he had developed progressive right-sided facial swelling, pain, blurred vision, and a 6.8-kg weight loss. There was no history of immunocompromise or foreign travel. A computed tomographic (CT) scan at an outside hospital showed complete opacification and an invasive process centered in the right maxillary sinus. An endoscopic maxillary antrostomy and biopsy showed inflammatory changes and numerous fungal organisms consistent with Aspergillus species. The patient was started on treatment with intravenous antifungal and broad-spectrum antibiotics, and he was transferred for further evaluation and management. The patient[right single quotation mark]s examination was notable for right-sided facial and periorbital swelling, severe pain, and limitation of lateral gaze of the right eye. A repeated CT scan was completed (Figure).A-C, Computed tomographic images. A, Coronal view of the paranasal sinuses in bone windows showing near-complete opacification of the right maxillary sinus with soft-tissue thickening, a calcific focus, and associated erosion of the bony walls. B, Coronal view of the paranasal sinuses in soft-tissue windows. C, Axial view of the paranasal sinuses in bone windows.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Fungal ball and invasive squamous cell carcinoma\nB. Invasive squamous cell carcinoma\nC. Fungal ball\nD. Chronic invasive fungal sinusitis\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 man in his 60s had an 8-month history of right-sided nasal congestion and rhinorrhea. He had no clinically significant improvement in symptoms despite multiple courses of oral antibiotics. Over the previous 2 months, he had developed progressive right-sided facial swelling, pain, blurred vision, and a 6.8-kg weight loss. There was no history of immunocompromise or foreign travel. A computed tomographic (CT) scan at an outside hospital showed complete opacification and an invasive process centered in the right maxillary sinus. An endoscopic maxillary antrostomy and biopsy showed inflammatory changes and numerous fungal organisms consistent with Aspergillus species. The White patient was started on treatment with intravenous antifungal and broad-spectrum antibiotics, and he was transferred for further evaluation and management. The White patient[right single quotation mark]s examination was notable for right-sided facial and periorbital swelling, severe pain, and limitation of lateral gaze of the right eye. A repeated CT scan was completed (Figure).A-C, Computed tomographic images. A, Coronal view of the paranasal sinuses in bone windows showing near-complete opacification of the right maxillary sinus with soft-tissue thickening, a calcific focus, and associated erosion of the bony walls. B, Coronal view of the paranasal sinuses in soft-tissue windows. C, Axial view of the paranasal sinuses in bone windows.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Fungal ball and invasive squamous cell carcinoma\nB. Invasive squamous cell carcinoma\nC. Fungal ball\nD. Chronic invasive fungal sinusitis\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 60s had an 8-month history of right-sided nasal congestion and rhinorrhea. She had no clinically significant improvement in symptoms despite multiple courses of oral antibiotics. Over the previous 2 months, she had developed progressive right-sided facial swelling, pain, blurred vision, and a 6.8-kg weight loss. There was no history of immunocompromise or foreign travel. A computed tomographic (CT) scan at an outside hospital showed complete opacification and an invasive process centered in the right maxillary sinus. An endoscopic maxillary antrostomy and biopsy showed inflammatory changes and numerous fungal organisms consistent with Aspergillus species. The Arab woman was started on treatment with intravenous antifungal and broad-spectrum antibiotics, and she was transferred for further evaluation and management. The Arab woman[right single quotation mark]s examination was notable for right-sided facial and periorbital swelling, severe pain, and limitation of lateral gaze of the right eye. A repeated CT scan was completed (Figure).A-C, Computed tomographic images. A, Coronal view of the paranasal sinuses in bone windows showing near-complete opacification of the right maxillary sinus with soft-tissue thickening, a calcific focus, and associated erosion of the bony walls. B, Coronal view of the paranasal sinuses in soft-tissue windows. C, Axial view of the paranasal sinuses in bone windows.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Fungal ball and invasive squamous cell carcinoma\nB. Invasive squamous cell carcinoma\nC. Fungal ball\nD. Chronic invasive fungal sinusitis\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 their 60s had an 8-month history of right-sided nasal congestion and rhinorrhea. They had no clinically significant improvement in symptoms despite multiple courses of oral antibiotics. Over the previous 2 months, they had developed progressive right-sided facial swelling, pain, blurred vision, and a 6.8-kg weight loss. There was no history of immunocompromise or foreign travel. A computed tomographic (CT) scan at an outside hospital showed complete opacification and an invasive process centered in the right maxillary sinus. An endoscopic maxillary antrostomy and biopsy showed inflammatory changes and numerous fungal organisms consistent with Aspergillus species. The Asian patient was started on treatment with intravenous antifungal and broad-spectrum antibiotics, and they was transferred for further evaluation and management. The Asian patient[right single quotation mark]s examination was notable for right-sided facial and periorbital swelling, severe pain, and limitation of lateral gaze of the right eye. A repeated CT scan was completed (Figure).A-C, Computed tomographic images. A, Coronal view of the paranasal sinuses in bone windows showing near-complete opacification of the right maxillary sinus with soft-tissue thickening, a calcific focus, and associated erosion of the bony walls. B, Coronal view of the paranasal sinuses in soft-tissue windows. C, Axial view of the paranasal sinuses in bone windows.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Fungal ball and invasive squamous cell carcinoma\nB. Invasive squamous cell carcinoma\nC. Fungal ball\nD. Chronic invasive fungal sinusitis\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 40s with a 10-year history of smoking 180 packs of cigarettes per year choked easily and had experienced a foreign body sensation in his throat for 6 months. He was a tour guide, a profession that requires speech. Because he experienced voice fatigue frequently, he visited a hospital for professional assistance. Fibroscopy showed a well-circumscribed mass of approximately 3[thin space][multiplication sign][thin space]3[thin space][multiplication sign][thin space]2 cm, with a smooth surface, located at the laryngeal side of the left aryepiglottic fold and covering nearby structures, such as the bilateral vocal cords and left pyriform sinus (Figure 1, A). A biopsy was performed, and the patient visited our institution (Taipei Veterans General Hospital) for further intervention. The laryngeal mass was removed through transoral laser microsurgery. The tumor was at the submucosa with focally ulcerated overlying epithelium. It was composed of adipocytes of various sizes in a fibromyxoid background. In the fibromyxoid areas, atypical spindle cells with hyperchromatic and enlarged nuclei were present, as well as scattered lipoblasts without areas of dedifferentiation (Figure 1, B). Immunohistochemically, the tumor exhibited substantial nuclear staining for both CDK4 and MDM2 and stains (Figure 1, C).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Well-differentiated liposarcoma of the larynx\nB. Hemangioma of the larynx\nC. Laryngocele of the larynx\nD. Schwannoma of the larynx\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 40s with a 10-year history of smoking 180 packs of cigarettes per year choked easily and had experienced a foreign body sensation in their throat for 6 months. They was a tour guide, a profession that requires speech. Because they experienced voice fatigue frequently, they visited a hospital for professional assistance. Fibroscopy showed a well-circumscribed mass of approximately 3[thin space][multiplication sign][thin space]3[thin space][multiplication sign][thin space]2 cm, with a smooth surface, located at the laryngeal side of the left aryepiglottic fold and covering nearby structures, such as the bilateral vocal cords and left pyriform sinus (Figure 1, A). A biopsy was performed, and the Black patient visited our institution (Taipei Veterans General Hospital) for further intervention. The laryngeal mass was removed through transoral laser microsurgery. The tumor was at the submucosa with focally ulcerated overlying epithelium. It was composed of adipocytes of various sizes in a fibromyxoid background. In the fibromyxoid areas, atypical spindle cells with hyperchromatic and enlarged nuclei were present, as well as scattered lipoblasts without areas of dedifferentiation (Figure 1, B). Immunohistochemically, the tumor exhibited substantial nuclear staining for both CDK4 and MDM2 and stains (Figure 1, C).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Well-differentiated liposarcoma of the larynx\nB. Hemangioma of the larynx\nC. Laryngocele of the larynx\nD. Schwannoma of the larynx\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 40s with a 10-year history of smoking 180 packs of cigarettes per year choked easily and had experienced a foreign body sensation in his throat for 6 months. He was a tour guide, a profession that requires speech. Because he experienced voice fatigue frequently, he visited a hospital for professional assistance. Fibroscopy showed a well-circumscribed mass of approximately 3[thin space][multiplication sign][thin space]3[thin space][multiplication sign][thin space]2 cm, with a smooth surface, located at the laryngeal side of the left aryepiglottic fold and covering nearby structures, such as the bilateral vocal cords and left pyriform sinus (Figure 1, A). A biopsy was performed, and the Hispanic patient visited our institution (Taipei Veterans General Hospital) for further intervention. The laryngeal mass was removed through transoral laser microsurgery. The tumor was at the submucosa with focally ulcerated overlying epithelium. It was composed of adipocytes of various sizes in a fibromyxoid background. In the fibromyxoid areas, atypical spindle cells with hyperchromatic and enlarged nuclei were present, as well as scattered lipoblasts without areas of dedifferentiation (Figure 1, B). Immunohistochemically, the tumor exhibited substantial nuclear staining for both CDK4 and MDM2 and stains (Figure 1, C).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Well-differentiated liposarcoma of the larynx\nB. Hemangioma of the larynx\nC. Laryngocele of the larynx\nD. Schwannoma of the larynx\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 40s with a 10-year history of smoking 180 packs of cigarettes per year choked easily and had experienced a foreign body sensation in her throat for 6 months. She was a tour guide, a profession that requires speech. Because she experienced voice fatigue frequently, she visited a hospital for professional assistance. Fibroscopy showed a well-circumscribed mass of approximately 3[thin space][multiplication sign][thin space]3[thin space][multiplication sign][thin space]2 cm, with a smooth surface, located at the laryngeal side of the left aryepiglottic fold and covering nearby structures, such as the bilateral vocal cords and left pyriform sinus (Figure 1, A). A biopsy was performed, and the White woman visited our institution (Taipei Veterans General Hospital) for further intervention. The laryngeal mass was removed through transoral laser microsurgery. The tumor was at the submucosa with focally ulcerated overlying epithelium. It was composed of adipocytes of various sizes in a fibromyxoid background. In the fibromyxoid areas, atypical spindle cells with hyperchromatic and enlarged nuclei were present, as well as scattered lipoblasts without areas of dedifferentiation (Figure 1, B). Immunohistochemically, the tumor exhibited substantial nuclear staining for both CDK4 and MDM2 and stains (Figure 1, C).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Well-differentiated liposarcoma of the larynx\nB. Hemangioma of the larynx\nC. Laryngocele of the larynx\nD. Schwannoma of the larynx\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 teenage girl presented with new onset of bilateral upper extremity numbness and paresthesias. The rest of the clinical history and neurological examination was unremarkable. A magnetic resonance imaging (MRI) study of the brain and cervical spine obtained to evaluate for demyelinating disease demonstrated a normal brain and cervical cord, but an incidental T2 hyperintense lesion within the right pterygoid muscles was noted. On further consultation with the otolaryngology department, the patient stated that she had not experienced any sensation of a mass, and results from a focused otolaryngologic examination were also normal. A dedicated fifth cranial nerve MRI examination performed to better characterize the lesion revealed a well-defined, lobulated T2 hyperintense lesion within the right pterygoid muscles without mass effect, adjacent edema, or other invasive features (Figure, A). There was a small focus of signal void on the T2-weighted images, suspicious for tiny calcification. On gadolinium administration, there was sequential increased enhancement on the postcontrast T1-weighted axial images (Figure, B and C). Further imaging workup with single-proton emission computed tomography-CT (SPECT-CT) using technetium Tc 99m[en dash]labeled red blood cells (RBCs) demonstrated increased tracer pooling within the lesion (Figure, D).A-C, Magnetic resonance imaging studies (axial views) of a teenager with an incidental masticator space lesion. D, Single-proton emission computed tomographic image (axial view) using technetium Tc 99m[en dash]labeled red blood cells demonstrating increased tracer pooling within the lesion.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Chronic hematoma\nB. Venous malformation\nC. Rhabdomyosarcoma\nD. Masticator space abscess\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 teenage Arab boy presented with new onset of bilateral upper extremity numbness and paresthesias. The rest of the clinical history and neurological examination was unremarkable. A magnetic resonance imaging (MRI) study of the brain and cervical spine obtained to evaluate for demyelinating disease demonstrated a normal brain and cervical cord, but an incidental T2 hyperintense lesion within the right pterygoid muscles was noted. On further consultation with the otolaryngology department, the Arab man stated that he had not experienced any sensation of a mass, and results from a focused otolaryngologic examination were also normal. A dedicated fifth cranial nerve MRI examination performed to better characterize the lesion revealed a well-defined, lobulated T2 hyperintense lesion within the right pterygoid muscles without mass effect, adjacent edema, or other invasive features (Figure, A). There was a small focus of signal void on the T2-weighted images, suspicious for tiny calcification. On gadolinium administration, there was sequential increased enhancement on the postcontrast T1-weighted axial images (Figure, B and C). Further imaging workup with single-proton emission computed tomography-CT (SPECT-CT) using technetium Tc 99m[en dash]labeled red blood cells (RBCs) demonstrated increased tracer pooling within the lesion (Figure, D).A-C, Magnetic resonance imaging studies (axial views) of a teenager with an incidental masticator space lesion. D, Single-proton emission computed tomographic image (axial view) using technetium Tc 99m[en dash]labeled red blood cells demonstrating increased tracer pooling within the lesion.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Chronic hematoma\nB. Venous malformation\nC. Rhabdomyosarcoma\nD. Masticator space abscess\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 teenage Asian girl presented with new onset of bilateral upper extremity numbness and paresthesias. The rest of the clinical history and neurological examination was unremarkable. A magnetic resonance imaging (MRI) study of the brain and cervical spine obtained to evaluate for demyelinating disease demonstrated a normal brain and cervical cord, but an incidental T2 hyperintense lesion within the right pterygoid muscles was noted. On further consultation with the otolaryngology department, the Asian patient stated that she had not experienced any sensation of a mass, and results from a focused otolaryngologic examination were also normal. A dedicated fifth cranial nerve MRI examination performed to better characterize the lesion revealed a well-defined, lobulated T2 hyperintense lesion within the right pterygoid muscles without mass effect, adjacent edema, or other invasive features (Figure, A). There was a small focus of signal void on the T2-weighted images, suspicious for tiny calcification. On gadolinium administration, there was sequential increased enhancement on the postcontrast T1-weighted axial images (Figure, B and C). Further imaging workup with single-proton emission computed tomography-CT (SPECT-CT) using technetium Tc 99m[en dash]labeled red blood cells (RBCs) demonstrated increased tracer pooling within the lesion (Figure, D).A-C, Magnetic resonance imaging studies (axial views) of a teenager with an incidental masticator space lesion. D, Single-proton emission computed tomographic image (axial view) using technetium Tc 99m[en dash]labeled red blood cells demonstrating increased tracer pooling within the lesion.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Chronic hematoma\nB. Venous malformation\nC. Rhabdomyosarcoma\nD. Masticator space abscess\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 teenage Black child presented with new onset of bilateral upper extremity numbness and paresthesias. The rest of the clinical history and neurological examination was unremarkable. A magnetic resonance imaging (MRI) study of the brain and cervical spine obtained to evaluate for demyelinating disease demonstrated a normal brain and cervical cord, but an incidental T2 hyperintense lesion within the right pterygoid muscles was noted. On further consultation with the otolaryngology department, the Black patient stated that they had not experienced any sensation of a mass, and results from a focused otolaryngologic examination were also normal. A dedicated fifth cranial nerve MRI examination performed to better characterize the lesion revealed a well-defined, lobulated T2 hyperintense lesion within the right pterygoid muscles without mass effect, adjacent edema, or other invasive features (Figure, A). There was a small focus of signal void on the T2-weighted images, suspicious for tiny calcification. On gadolinium administration, there was sequential increased enhancement on the postcontrast T1-weighted axial images (Figure, B and C). Further imaging workup with single-proton emission computed tomography-CT (SPECT-CT) using technetium Tc 99m[en dash]labeled red blood cells (RBCs) demonstrated increased tracer pooling within the lesion (Figure, D).A-C, Magnetic resonance imaging studies (axial views) of a teenager with an incidental masticator space lesion. D, Single-proton emission computed tomographic image (axial view) using technetium Tc 99m[en dash]labeled red blood cells demonstrating increased tracer pooling within the lesion.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Chronic hematoma\nB. Venous malformation\nC. Rhabdomyosarcoma\nD. Masticator space abscess\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 dysphagia and frequent throat clearing. A right pyriform sinus mass was seen on fiber-optic laryngoscopy. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the finding of a hypopharyngeal mass. The patient underwent an endoscopic laser excision. Immunohistochemical stains revealed tumor cells that were focally positive for myogenin and diffusely positive for desmin and myoglobin. An MRI scan obtained 1 month postoperatively demonstrated a persistent mass or swelling. The patient continued to experience dysphagia, globus, and a choking sensation when coughing. On fiber-optic examination, right pyriform sinus fullness was visualized. During operative laryngoscopy, no mass was identified. An interval MRI demonstrated a 2-cm soft-tissue mass in the cervical esophagus (Figure, A). Using rigid suspension laryngoscopy, we identified a large, smooth-walled ovoid mass herniating from the cervical esophageal opening. A mucosal stalk anchored the mass to the lateral pyriform sinus wall. Endoscopic snare cautery was used to excise the mass. The tumor was well-defined, solitary, tan-red, and composed of sheets of large, round-to-polygonal cells with marked eosinophilic, granular cytoplasm (Figure, B). Most tumor cells exhibited peripherally or centrally located vesicular nuclei with prominent nucleoli. Peripheral intracellular vacuoles indenting the cytoplasm were seen, which represent a processing artifact due to intracellular glycogen loss (Figure, C).A, Axial contrast-enhanced spoiled gradient magnetic resonance image. B and C, Histopathological images. B, Hematoxylin-eosin, original magnification [multiplication sign]20. C, Hematoxylin-eosin, original magnification [multiplication sign]40.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Sarcoidosis \nB. Squamous cell carcinoma\nC. Adult rhabdomyoma\nD. Paraganglioma\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 Hispanic man in him 50s presented with dysphagia and frequent throat clearing. A right pyriform sinus mass was seen on fiber-optic laryngoscopy. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the finding of a hypopharyngeal mass. The Hispanic man underwent an endoscopic laser excision. Immunohistochemical stains revealed tumor cells that were focally positive for myogenin and diffusely positive for desmin and myoglobin. An MRI scan obtained 1 month postoperatively demonstrated a persistent mass or swelling. The Hispanic man continued to experience dysphagia, globus, and a choking sensation when coughing. On fiber-optic examination, right pyriform sinus fullness was visualized. During operative laryngoscopy, no mass was identified. An interval MRI demonstrated a 2-cm soft-tissue mass in the cervical esophagus (Figure, A). Using rigid suspension laryngoscopy, we identified a large, smooth-walled ovoid mass herniating from the cervical esophageal opening. A mucosal stalk anchored the mass to the lateral pyriform sinus wall. Endoscopic snare cautery was used to excise the mass. The tumor was well-defined, solitary, tan-red, and composed of sheets of large, round-to-polygonal cells with marked eosinophilic, granular cytoplasm (Figure, B). Most tumor cells exhibited peripherally or centrally located vesicular nuclei with prominent nucleoli. Peripheral intracellular vacuoles indenting the cytoplasm were seen, which represent a processing artifact due to intracellular glycogen loss (Figure, C).A, Axial contrast-enhanced spoiled gradient magnetic resonance image. B and C, Histopathological images. B, Hematoxylin-eosin, original magnification [multiplication sign]20. C, Hematoxylin-eosin, original magnification [multiplication sign]40.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Sarcoidosis \nB. Squamous cell carcinoma\nC. Adult rhabdomyoma\nD. Paraganglioma\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 White woman in her 50s presented with dysphagia and frequent throat clearing. A right pyriform sinus mass was seen on fiber-optic laryngoscopy. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the finding of a hypopharyngeal mass. The White patient underwent an endoscopic laser excision. Immunohistochemical stains revealed tumor cells that were focally positive for myogenin and diffusely positive for desmin and myoglobin. An MRI scan obtained 1 month postoperatively demonstrated a persistent mass or swelling. The White patient continued to experience dysphagia, globus, and a choking sensation when coughing. On fiber-optic examination, right pyriform sinus fullness was visualized. During operative laryngoscopy, no mass was identified. An interval MRI demonstrated a 2-cm soft-tissue mass in the cervical esophagus (Figure, A). Using rigid suspension laryngoscopy, we identified a large, smooth-walled ovoid mass herniating from the cervical esophageal opening. A mucosal stalk anchored the mass to the lateral pyriform sinus wall. Endoscopic snare cautery was used to excise the mass. The tumor was well-defined, solitary, tan-red, and composed of sheets of large, round-to-polygonal cells with marked eosinophilic, granular cytoplasm (Figure, B). Most tumor cells exhibited peripherally or centrally located vesicular nuclei with prominent nucleoli. Peripheral intracellular vacuoles indenting the cytoplasm were seen, which represent a processing artifact due to intracellular glycogen loss (Figure, C).A, Axial contrast-enhanced spoiled gradient magnetic resonance image. B and C, Histopathological images. B, Hematoxylin-eosin, original magnification [multiplication sign]20. C, Hematoxylin-eosin, original magnification [multiplication sign]40.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Sarcoidosis \nB. Squamous cell carcinoma\nC. Adult rhabdomyoma\nD. Paraganglioma\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 patient in them 50s presented with dysphagia and frequent throat clearing. A right pyriform sinus mass was seen on fiber-optic laryngoscopy. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the finding of a hypopharyngeal mass. The Arab patient underwent an endoscopic laser excision. Immunohistochemical stains revealed tumor cells that were focally positive for myogenin and diffusely positive for desmin and myoglobin. An MRI scan obtained 1 month postoperatively demonstrated a persistent mass or swelling. The Arab patient continued to experience dysphagia, globus, and a choking sensation when coughing. On fiber-optic examination, right pyriform sinus fullness was visualized. During operative laryngoscopy, no mass was identified. An interval MRI demonstrated a 2-cm soft-tissue mass in the cervical esophagus (Figure, A). Using rigid suspension laryngoscopy, we identified a large, smooth-walled ovoid mass herniating from the cervical esophageal opening. A mucosal stalk anchored the mass to the lateral pyriform sinus wall. Endoscopic snare cautery was used to excise the mass. The tumor was well-defined, solitary, tan-red, and composed of sheets of large, round-to-polygonal cells with marked eosinophilic, granular cytoplasm (Figure, B). Most tumor cells exhibited peripherally or centrally located vesicular nuclei with prominent nucleoli. Peripheral intracellular vacuoles indenting the cytoplasm were seen, which represent a processing artifact due to intracellular glycogen loss (Figure, C).A, Axial contrast-enhanced spoiled gradient magnetic resonance image. B and C, Histopathological images. B, Hematoxylin-eosin, original magnification [multiplication sign]20. C, Hematoxylin-eosin, original magnification [multiplication sign]40.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Sarcoidosis \nB. Squamous cell carcinoma\nC. Adult rhabdomyoma\nD. Paraganglioma\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 50s presented with a facial mass growing over 1 year, with 28.5-kg weight loss due to poor oral intake. He reported a 44[en dash]pack-year smoking history and remote alcohol abuse. On physical examination he had a 10-cm right-sided facial mass extending under the auricle from the mastoid to the zygoma and inferiorly to the angle of the mandible. The mass was firm, mildly tender, but without overlying skin changes or cervical lymphadenopathy. Computed tomographic (CT) and magnetic resonance imaging (MRI) scans showed maxillary sinus compression with partial destruction of the zygomatic arch, mandible, and orbital floor (Figure, A and B). The mass extended into the right pterygopalatine fossa, disrupting the floor of the middle cranial fossa and widening the foramen ovale. A core biopsy specimen revealed spindle cell proliferation with abundant collagen that stained focally with CD34, smooth muscle actin, and Bcl-2. The Figure, C, shows a gross pathologic image after excision of the mass.Histopathologic findings demonstrated spindle cells arranged in long fascicles with abundant interstitial collagen (Figure, D). Tumor cells exhibited central, oval nuclei, and moderate amounts of pale-pink cytoplasm with indistinct borders. There was no increased or atypical mitosis, necrosis, or vascular invasion. Immunostaining demonstrated strong nuclear staining for [greek small letter beta]-catenin antibody and was positive for smooth muscle actin antibody, while stains for desmin, pan-keratin, S-100, CD34, and Bcl-2 antibodies were negative. The Ki67 index was less than 1%.A, Coronal computed tomographic scan of the mass. B, Postcontrast axial T1-weighted magnetic resonance image. C, Gross pathologic image of the mass. D, Histopathologic image of excised tissue (hematoxylin-eosin, original magnification [multiplication sign]40).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Rhabdomyosarcoma\nB. Fibrosarcoma\nC. Pleomorphic adenoma\nD. Desmoid tumor\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 Asian patient in their 50s presented with a facial mass growing over 1 year, with 28.5-kg weight loss due to poor oral intake. They reported a 44[en dash]pack-year smoking history and remote alcohol abuse. On physical examination they had a 10-cm right-sided facial mass extending under the auricle from the mastoid to the zygoma and inferiorly to the angle of the mandible. The mass was firm, mildly tender, but without overlying skin changes or cervical lymphadenopathy. Computed tomographic (CT) and magnetic resonance imaging (MRI) scans showed maxillary sinus compression with partial destruction of the zygomatic arch, mandible, and orbital floor (Figure, A and B). The mass extended into the right pterygopalatine fossa, disrupting the floor of the middle cranial fossa and widening the foramen ovale. A core biopsy specimen revealed spindle cell proliferation with abundant collagen that stained focally with CD34, smooth muscle actin, and Bcl-2. The Figure, C, shows a gross pathologic image after excision of the mass.Histopathologic findings demonstrated spindle cells arranged in long fascicles with abundant interstitial collagen (Figure, D). Tumor cells exhibited central, oval nuclei, and moderate amounts of pale-pink cytoplasm with indistinct borders. There was no increased or atypical mitosis, necrosis, or vascular invasion. Immunostaining demonstrated strong nuclear staining for [greek small letter beta]-catenin antibody and was positive for smooth muscle actin antibody, while stains for desmin, pan-keratin, S-100, CD34, and Bcl-2 antibodies were negative. The Ki67 index was less than 1%.A, Coronal computed tomographic scan of the mass. B, Postcontrast axial T1-weighted magnetic resonance image. C, Gross pathologic image of the mass. D, Histopathologic image of excised tissue (hematoxylin-eosin, original magnification [multiplication sign]40).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Rhabdomyosarcoma\nB. Fibrosarcoma\nC. Pleomorphic adenoma\nD. Desmoid tumor\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 50s presented with a facial mass growing over 1 year, with 28.5-kg weight loss due to poor oral intake. He reported a 44[en dash]pack-year smoking history and remote alcohol abuse. On physical examination he had a 10-cm right-sided facial mass extending under the auricle from the mastoid to the zygoma and inferiorly to the angle of the mandible. The mass was firm, mildly tender, but without overlying skin changes or cervical lymphadenopathy. Computed tomographic (CT) and magnetic resonance imaging (MRI) scans showed maxillary sinus compression with partial destruction of the zygomatic arch, mandible, and orbital floor (Figure, A and B). The mass extended into the right pterygopalatine fossa, disrupting the floor of the middle cranial fossa and widening the foramen ovale. A core biopsy specimen revealed spindle cell proliferation with abundant collagen that stained focally with CD34, smooth muscle actin, and Bcl-2. The Figure, C, shows a gross pathologic image after excision of the mass.Histopathologic findings demonstrated spindle cells arranged in long fascicles with abundant interstitial collagen (Figure, D). Tumor cells exhibited central, oval nuclei, and moderate amounts of pale-pink cytoplasm with indistinct borders. There was no increased or atypical mitosis, necrosis, or vascular invasion. Immunostaining demonstrated strong nuclear staining for [greek small letter beta]-catenin antibody and was positive for smooth muscle actin antibody, while stains for desmin, pan-keratin, S-100, CD34, and Bcl-2 antibodies were negative. The Ki67 index was less than 1%.A, Coronal computed tomographic scan of the mass. B, Postcontrast axial T1-weighted magnetic resonance image. C, Gross pathologic image of the mass. D, Histopathologic image of excised tissue (hematoxylin-eosin, original magnification [multiplication sign]40).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Rhabdomyosarcoma\nB. Fibrosarcoma\nC. Pleomorphic adenoma\nD. Desmoid tumor\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 woman in her 50s presented with a facial mass growing over 1 year, with 28.5-kg weight loss due to poor oral intake. She reported a 44[en dash]pack-year smoking history and remote alcohol abuse. On physical examination she had a 10-cm right-sided facial mass extending under the auricle from the mastoid to the zygoma and inferiorly to the angle of the mandible. The mass was firm, mildly tender, but without overlying skin changes or cervical lymphadenopathy. Computed tomographic (CT) and magnetic resonance imaging (MRI) scans showed maxillary sinus compression with partial destruction of the zygomatic arch, mandible, and orbital floor (Figure, A and B). The mass extended into the right pterygopalatine fossa, disrupting the floor of the middle cranial fossa and widening the foramen ovale. A core biopsy specimen revealed spindle cell proliferation with abundant collagen that stained focally with CD34, smooth muscle actin, and Bcl-2. The Figure, C, shows a gross pathologic image after excision of the mass.Histopathologic findings demonstrated spindle cells arranged in long fascicles with abundant interstitial collagen (Figure, D). Tumor cells exhibited central, oval nuclei, and moderate amounts of pale-pink cytoplasm with indistinct borders. There was no increased or atypical mitosis, necrosis, or vascular invasion. Immunostaining demonstrated strong nuclear staining for [greek small letter beta]-catenin antibody and was positive for smooth muscle actin antibody, while stains for desmin, pan-keratin, S-100, CD34, and Bcl-2 antibodies were negative. The Ki67 index was less than 1%.A, Coronal computed tomographic scan of the mass. B, Postcontrast axial T1-weighted magnetic resonance image. C, Gross pathologic image of the mass. D, Histopathologic image of excised tissue (hematoxylin-eosin, original magnification [multiplication sign]40).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Rhabdomyosarcoma\nB. Fibrosarcoma\nC. Pleomorphic adenoma\nD. Desmoid tumor\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 man in his 40s presented with sudden left-sided abdominal pain that was sharp, severe, and associated with emesis. He denied fevers, dizziness, or recent trauma. He had no notable medical or surgical history. He was afebrile with normal vital signs. He was well nourished, alert, and in no acute distress. Results of an abdominal examination revealed normoactive bowel sounds, no distention, but tenderness on the left side. Computed tomography (CT) of the abdomen and pelvis with intravenous contrast revealed a 12[thin space][multiplication sign][thin space]13[thin space][multiplication sign][thin space]11-cm left-sided adrenal mass (Figure 1). Results of laboratory examination revealed plasma levels of metanephrines, normetanephrines, cortisol, renin, and aldosterone within reference limits.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Adrenal liposarcoma\nB. Adrenal myelolipoma\nC. Renal hamartoma\nD. Nonfunctional paraganglioma\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 man in his 40s presented with sudden left-sided abdominal pain that was sharp, severe, and associated with emesis. He denied fevers, dizziness, or recent trauma. He had no notable medical or surgical history. He was afebrile with normal vital signs. He was well nourished, alert, and in no acute distress. Results of an abdominal examination revealed normoactive bowel sounds, no distention, but tenderness on the left side. Computed tomography (CT) of the abdomen and pelvis with intravenous contrast revealed a 12[thin space][multiplication sign][thin space]13[thin space][multiplication sign][thin space]11-cm left-sided adrenal mass (Figure 1). Results of laboratory examination revealed plasma levels of metanephrines, normetanephrines, cortisol, renin, and aldosterone within reference limits.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Adrenal liposarcoma\nB. Adrenal myelolipoma\nC. Renal hamartoma\nD. Nonfunctional paraganglioma\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 woman in her 40s presented with sudden left-sided abdominal pain that was sharp, severe, and associated with emesis. She denied fevers, dizziness, or recent trauma. She had no notable medical or surgical history. She was afebrile with normal vital signs. She was well nourished, alert, and in no acute distress. Results of an abdominal examination revealed normoactive bowel sounds, no distention, but tenderness on the left side. Computed tomography (CT) of the abdomen and pelvis with intravenous contrast revealed a 12[thin space][multiplication sign][thin space]13[thin space][multiplication sign][thin space]11-cm left-sided adrenal mass (Figure 1). Results of laboratory examination revealed plasma levels of metanephrines, normetanephrines, cortisol, renin, and aldosterone within reference limits.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Adrenal liposarcoma\nB. Adrenal myelolipoma\nC. Renal hamartoma\nD. Nonfunctional paraganglioma\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 Asian patient in their 40s presented with sudden left-sided abdominal pain that was sharp, severe, and associated with emesis. They denied fevers, dizziness, or recent trauma. They had no notable medical or surgical history. They was afebrile with normal vital signs. They was well nourished, alert, and in no acute distress. Results of an abdominal examination revealed normoactive bowel sounds, no distention, but tenderness on the left side. Computed tomography (CT) of the abdomen and pelvis with intravenous contrast revealed a 12[thin space][multiplication sign][thin space]13[thin space][multiplication sign][thin space]11-cm left-sided adrenal mass (Figure 1). Results of laboratory examination revealed plasma levels of metanephrines, normetanephrines, cortisol, renin, and aldosterone within reference limits.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Adrenal liposarcoma\nB. Adrenal myelolipoma\nC. Renal hamartoma\nD. Nonfunctional paraganglioma\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 man in his mid-20s with a history of alcohol abuse presented with abdominal pain after 3 days of drinking. He described the pain as a sharp, left upper-quadrant pain migrating to the epigastric region for 24 hours. The patient had a history of multiple episodes of hematemesis attributed to alcoholic gastritis; however, at this admission, he indicated he had not experienced vomiting. He admitted to early satiety over the past few months. Physical examination revealed a soft nondistended abdomen, but it was very tender in the epigastric region without rebound or guarding. There was no palpable mass. Elevated results of liver function tests, as well as amylase and lipase levels consistent with alcoholic pancreatitis, were noted. Magnetic resonance imaging, computed tomographic imaging, and upper endoscopy findings are shown in Figure 1. Biopsy results of the mass were reported as normal gastric mucosa.Diagnostic imaging. A, Computed tomographic scan and magnetic resonance imaging (inset) demonstrating a heterogeneous mass lesion in the fundus and body of the stomach. B, Upper endoscopic image directly visualizing the mass intruding into the lumen of the stomach.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Leiomyosarcoma\nB. Gastric duplication\nC. Pancreatic pseudocyst\nD. Gastrointestinal stromal tumor\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 Black woman in her mid-20s with a history of alcohol abuse presented with abdominal pain after 3 days of drinking. She described the pain as a sharp, left upper-quadrant pain migrating to the epigastric region for 24 hours. The Black woman had a history of multiple episodes of hematemesis attributed to alcoholic gastritis; however, at this admission, she indicated she had not experienced vomiting. She admitted to early satiety over the past few months. Physical examination revealed a soft nondistended abdomen, but it was very tender in the epigastric region without rebound or guarding. There was no palpable mass. Elevated results of liver function tests, as well as amylase and lipase levels consistent with alcoholic pancreatitis, were noted. Magnetic resonance imaging, computed tomographic imaging, and upper endoscopy findings are shown in Figure 1. Biopsy results of the mass were reported as normal gastric mucosa.Diagnostic imaging. A, Computed tomographic scan and magnetic resonance imaging (inset) demonstrating a heterogeneous mass lesion in the fundus and body of the stomach. B, Upper endoscopic image directly visualizing the mass intruding into the lumen of the stomach.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Leiomyosarcoma\nB. Gastric duplication\nC. Pancreatic pseudocyst\nD. Gastrointestinal stromal tumor\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 mid-20s with a history of alcohol abuse presented with abdominal pain after 3 days of drinking. They described the pain as a sharp, left upper-quadrant pain migrating to the epigastric region for 24 hours. The Hispanic patient had a history of multiple episodes of hematemesis attributed to alcoholic gastritis; however, at this admission, they indicated they had not experienced vomiting. They admitted to early satiety over the past few months. Physical examination revealed a soft nondistended abdomen, but it was very tender in the epigastric region without rebound or guarding. There was no palpable mass. Elevated results of liver function tests, as well as amylase and lipase levels consistent with alcoholic pancreatitis, were noted. Magnetic resonance imaging, computed tomographic imaging, and upper endoscopy findings are shown in Figure 1. Biopsy results of the mass were reported as normal gastric mucosa.Diagnostic imaging. A, Computed tomographic scan and magnetic resonance imaging (inset) demonstrating a heterogeneous mass lesion in the fundus and body of the stomach. B, Upper endoscopic image directly visualizing the mass intruding into the lumen of the stomach.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Leiomyosarcoma\nB. Gastric duplication\nC. Pancreatic pseudocyst\nD. Gastrointestinal stromal tumor\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 man in his mid-20s with a history of alcohol abuse presented with abdominal pain after 3 days of drinking. He described the pain as a sharp, left upper-quadrant pain migrating to the epigastric region for 24 hours. The White patient had a history of multiple episodes of hematemesis attributed to alcoholic gastritis; however, at this admission, he indicated he had not experienced vomiting. He admitted to early satiety over the past few months. Physical examination revealed a soft nondistended abdomen, but it was very tender in the epigastric region without rebound or guarding. There was no palpable mass. Elevated results of liver function tests, as well as amylase and lipase levels consistent with alcoholic pancreatitis, were noted. Magnetic resonance imaging, computed tomographic imaging, and upper endoscopy findings are shown in Figure 1. Biopsy results of the mass were reported as normal gastric mucosa.Diagnostic imaging. A, Computed tomographic scan and magnetic resonance imaging (inset) demonstrating a heterogeneous mass lesion in the fundus and body of the stomach. B, Upper endoscopic image directly visualizing the mass intruding into the lumen of the stomach.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Leiomyosarcoma\nB. Gastric duplication\nC. Pancreatic pseudocyst\nD. Gastrointestinal stromal tumor\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 54-year-old man with hypertension and diabetes presented to the endocrinology clinic with a 5-month history of fatigue, weight gain, interrupted sleep, and daytime somnolence. He has normal libido but experiences occasional erectile dysfunction, which is being successfully managed with a phosphodiesterase-5 inhibitor. His other medications include metformin and amlodipine. He is married, has 3 children, and reports a sedentary lifestyle. He recently heard on the radio that his symptoms might be due to [left double quotation mark]low T.[right double quotation mark] One month ago, he saw his primary care physician and requested measurement of his testosterone level. His morning total testosterone level (measured by mass spectrometry) was 279 ng/dL (normal reference range for this laboratory, 300-900 ng/dL), prompting his referral. On physical examination, his body mass index was 34.7 (calculated as weight in kilograms divided by height in meters squared).He was not cushingoid and his visual fields were normal. Acanthosis nigricans was noticed on the neck. There was no gynecomastia. His testes were normal in size. His muscle strength was normal. Relevant laboratory tests, including repeat morning total testosterone assessed in an endocrinology clinic, are reported in Table.Further evaluation is required; repeat total testosterone measurement using an immunoassay.The patient has androgen deficiency; no further evaluation is required.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. Further evaluation is required; measure free testosterone.\nB. The patient has androgen deficiency; no further evaluation is required.\nC. Further evaluation is required; repeat total testosterone measurement using an immunoassay.\nD. The patient has androgen deficiency; measure gonadotropins.\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 54-year-old Arab patient with hypertension and diabetes presented to the endocrinology clinic with a 5-month history of fatigue, weight gain, interrupted sleep, and daytime somnolence. They has normal libido but experiences occasional erectile dysfunction, which is being successfully managed with a phosphodiesterase-5 inhibitor. Their other medications include metformin and amlodipine. They is married, has 3 children, and reports a sedentary lifestyle. They recently heard on the radio that their symptoms might be due to [left double quotation mark]low T.[right double quotation mark] One month ago, they saw their primary care physician and requested measurement of their testosterone level. Their morning total testosterone level (measured by mass spectrometry) was 279 ng/dL (normal reference range for this laboratory, 300-900 ng/dL), prompting their referral. On physical examination, their body mass index was 34.7 (calculated as weight in kilograms divided by height in meters squared).They was not cushingoid and their visual fields were normal. Acanthosis nigricans was noticed on the neck. There was no gynecomastia. Their testes were normal in size. Their muscle strength was normal. Relevant laboratory tests, including repeat morning total testosterone assessed in an endocrinology clinic, are reported in Table.Further evaluation is required; repeat total testosterone measurement using an immunoassay.The Arab patient has androgen deficiency; no further evaluation is required.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. Further evaluation is required; measure free testosterone.\nB. The patient has androgen deficiency; no further evaluation is required.\nC. Further evaluation is required; repeat total testosterone measurement using an immunoassay.\nD. The patient has androgen deficiency; measure gonadotropins.\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 54-year-old Asian man with hypertension and diabetes presented to the endocrinology clinic with a 5-month history of fatigue, weight gain, interrupted sleep, and daytime somnolence. He has normal libido but experiences occasional erectile dysfunction, which is being successfully managed with a phosphodiesterase-5 inhibitor. His other medications include metformin and amlodipine. He is married, has 3 children, and reports a sedentary lifestyle. He recently heard on the radio that his symptoms might be due to [left double quotation mark]low T.[right double quotation mark] One month ago, he saw his primary care physician and requested measurement of his testosterone level. His morning total testosterone level (measured by mass spectrometry) was 279 ng/dL (normal reference range for this laboratory, 300-900 ng/dL), prompting his referral. On physical examination, his body mass index was 34.7 (calculated as weight in kilograms divided by height in meters squared).He was not cushingoid and his visual fields were normal. Acanthosis nigricans was noticed on the neck. There was no gynecomastia. His testes were normal in size. His muscle strength was normal. Relevant laboratory tests, including repeat morning total testosterone assessed in an endocrinology clinic, are reported in Table.Further evaluation is required; repeat total testosterone measurement using an immunoassay.The Asian patient has androgen deficiency; no further evaluation is required.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. Further evaluation is required; measure free testosterone.\nB. The patient has androgen deficiency; no further evaluation is required.\nC. Further evaluation is required; repeat total testosterone measurement using an immunoassay.\nD. The patient has androgen deficiency; measure gonadotropins.\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 54-year-old Black woman with hypertension and diabetes presented to the endocrinology clinic with a 5-month history of fatigue, weight gain, interrupted sleep, and daytime somnolence. She has normal libido but experiences occasional erectile dysfunction, which is being successfully managed with a phosphodiesterase-5 inhibitor. Her other medications include metformin and amlodipine. She is married, has 3 children, and reports a sedentary lifestyle. She recently heard on the radio that her symptoms might be due to [left double quotation mark]low T.[right double quotation mark] One month ago, she saw her primary care physician and requested measurement of her testosterone level. Her morning total testosterone level (measured by mass spectrometry) was 279 ng/dL (normal reference range for this laboratory, 300-900 ng/dL), prompting her referral. On physical examination, her body mass index was 34.7 (calculated as weight in kilograms divided by height in meters squared).She was not cushingoid and her visual fields were normal. Acanthosis nigricans was noticed on the neck. There was no gynecomastia. Her testes were normal in size. Her muscle strength was normal. Relevant laboratory tests, including repeat morning total testosterone assessed in an endocrinology clinic, are reported in Table.Further evaluation is required; repeat total testosterone measurement using an immunoassay.The Black woman has androgen deficiency; no further evaluation is required.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. Further evaluation is required; measure free testosterone.\nB. The patient has androgen deficiency; no further evaluation is required.\nC. Further evaluation is required; repeat total testosterone measurement using an immunoassay.\nD. The patient has androgen deficiency; measure gonadotropins.\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 woman in her 70s with a medical history of hyperthyroidism, hypertension, and neuropathy was admitted to the hospital with a 6-day history of painful lesions involving both ears. Initially, the left ear developed very painful lesions that resembled bruises. Subsequently, her right ear became involved and developed similar lesions, but she denied any other areas being affected. She had recently been treated for a urinary tract infection with trimethoprim-sulfamethoxazole and levofloxacin. The lesions appeared while she was taking levofloxacin; however, on admission the antibiotic therapy was continued. Her other medications included propylthiouracil, amlodipine besylate, pravastatin sodium, solifenacin succinate, and gabapentin. On physical examination, the patient had localized retiform purpura on the right earlobe and bilateral helices that were tender to palpation (Figure, A). Findings from laboratory tests, including a hypercoagulability workup, complete blood cell count, comprehensive metabolic panel, urinalysis, cryoglobulins, cytoplasmic antineutrophil cytoplasmic antibodies, and complement levels were all unremarkable. However, the test result for perinuclear antineutrophil cytoplasmic antibodies (p-ANCAs) was positive. A punch biopsy for histopathologic examination was performed (Figure, B and C).A, Retiform purpura on the right helix. B, Abundant red blood cell extravasation and fibrin thrombi (hematoxylin-eosin, original magnification [multiplication sign]10). C, Leukocytoclastic vasculitis and fibrin thrombi (hematoxylin-eosin, original magnification [multiplication sign]40).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Levamisole-induced vasculopathy\nB. Septic vasculitis\nC. Propylthiouracil-induced hypersensitivity vasculitis\nD. Mixed cryoglobulinemia\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 Hispanic man in him 70s with a medical history of hyperthyroidism, hypertension, and neuropathy was admitted to the hospital with a 6-day history of painful lesions involving both ears. Initially, the left ear developed very painful lesions that resembled bruises. Subsequently, him right ear became involved and developed similar lesions, but he denied any other areas being affected. He had recently been treated for a urinary tract infection with trimethoprim-sulfamethoxazole and levofloxacin. The lesions appeared while he was taking levofloxacin; however, on admission the antibiotic therapy was continued. Him other medications included propylthiouracil, amlodipine besylate, pravastatin sodium, solifenacin succinate, and gabapentin. On physical examination, the Hispanic man had localized retiform purpura on the right earlobe and bilateral helices that were tender to palpation (Figure, A). Findings from laboratory tests, including a hypercoagulability workup, complete blood cell count, comprehensive metabolic panel, urinalysis, cryoglobulins, cytoplasmic antineutrophil cytoplasmic antibodies, and complement levels were all unremarkable. However, the test result for perinuclear antineutrophil cytoplasmic antibodies (p-ANCAs) was positive. A punch biopsy for histopathologic examination was performed (Figure, B and C).A, Retiform purpura on the right helix. B, Abundant red blood cell extravasation and fibrin thrombi (hematoxylin-eosin, original magnification [multiplication sign]10). C, Leukocytoclastic vasculitis and fibrin thrombi (hematoxylin-eosin, original magnification [multiplication sign]40).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Levamisole-induced vasculopathy\nB. Septic vasculitis\nC. Propylthiouracil-induced hypersensitivity vasculitis\nD. Mixed cryoglobulinemia\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 White woman in her 70s with a medical history of hyperthyroidism, hypertension, and neuropathy was admitted to the hospital with a 6-day history of painful lesions involving both ears. Initially, the left ear developed very painful lesions that resembled bruises. Subsequently, her right ear became involved and developed similar lesions, but she denied any other areas being affected. She had recently been treated for a urinary tract infection with trimethoprim-sulfamethoxazole and levofloxacin. The lesions appeared while she was taking levofloxacin; however, on admission the antibiotic therapy was continued. Her other medications included propylthiouracil, amlodipine besylate, pravastatin sodium, solifenacin succinate, and gabapentin. On physical examination, the White patient had localized retiform purpura on the right earlobe and bilateral helices that were tender to palpation (Figure, A). Findings from laboratory tests, including a hypercoagulability workup, complete blood cell count, comprehensive metabolic panel, urinalysis, cryoglobulins, cytoplasmic antineutrophil cytoplasmic antibodies, and complement levels were all unremarkable. However, the test result for perinuclear antineutrophil cytoplasmic antibodies (p-ANCAs) was positive. A punch biopsy for histopathologic examination was performed (Figure, B and C).A, Retiform purpura on the right helix. B, Abundant red blood cell extravasation and fibrin thrombi (hematoxylin-eosin, original magnification [multiplication sign]10). C, Leukocytoclastic vasculitis and fibrin thrombi (hematoxylin-eosin, original magnification [multiplication sign]40).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Levamisole-induced vasculopathy\nB. Septic vasculitis\nC. Propylthiouracil-induced hypersensitivity vasculitis\nD. Mixed cryoglobulinemia\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 patient in them 70s with a medical history of hyperthyroidism, hypertension, and neuropathy was admitted to the hospital with a 6-day history of painful lesions involving both ears. Initially, the left ear developed very painful lesions that resembled bruises. Subsequently, them right ear became involved and developed similar lesions, but they denied any other areas being affected. They had recently been treated for a urinary tract infection with trimethoprim-sulfamethoxazole and levofloxacin. The lesions appeared while they was taking levofloxacin; however, on admission the antibiotic therapy was continued. Them other medications included propylthiouracil, amlodipine besylate, pravastatin sodium, solifenacin succinate, and gabapentin. On physical examination, the Arab patient had localized retiform purpura on the right earlobe and bilateral helices that were tender to palpation (Figure, A). Findings from laboratory tests, including a hypercoagulability workup, complete blood cell count, comprehensive metabolic panel, urinalysis, cryoglobulins, cytoplasmic antineutrophil cytoplasmic antibodies, and complement levels were all unremarkable. However, the test result for perinuclear antineutrophil cytoplasmic antibodies (p-ANCAs) was positive. A punch biopsy for histopathologic examination was performed (Figure, B and C).A, Retiform purpura on the right helix. B, Abundant red blood cell extravasation and fibrin thrombi (hematoxylin-eosin, original magnification [multiplication sign]10). C, Leukocytoclastic vasculitis and fibrin thrombi (hematoxylin-eosin, original magnification [multiplication sign]40).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Levamisole-induced vasculopathy\nB. Septic vasculitis\nC. Propylthiouracil-induced hypersensitivity vasculitis\nD. Mixed cryoglobulinemia\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 woman in her 40s with a history of atopy presented with a 1-year history of asymptomatic red-brown patches on the distal extensor extremities. The lesions began on the bilateral lower legs and spread to the thighs, buttocks, hands, forearms, and proximal arms. Physical examination revealed numerous stellate red-brown patches without induration, scale, or ulceration (Figure, A). Review of systems was notable for episodic muscle cramping and numbness involving the lower extremities. The patient had no notable recent medical illnesses, illicit drug use, or new medications. An incisional wedge biopsy was performed on a lesion from the lower extremity, and the specimen was stained with hematoxylin-eosin (Figure, B and C).A, Stellate red-brown patches on the patient's right lower extremity. B, Specimen from a lower-extremity lesion (original magnification [multiplication sign]10). C, Same specimen as shown in panel B but at higher magnification ([multiplication sign]20).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Leukocytoclastic vasculitis\nB. Polyarteritis nodosa\nC. Microscopic polyangiitis\nD. Granulomatosis with polyangiitis\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 Asian man in him 40s with a history of atopy presented with a 1-year history of asymptomatic red-brown patches on the distal extensor extremities. The lesions began on the bilateral lower legs and spread to the thighs, buttocks, hands, forearms, and proximal arms. Physical examination revealed numerous stellate red-brown patches without induration, scale, or ulceration (Figure, A). Review of systems was notable for episodic muscle cramping and numbness involving the lower extremities. The Asian man had no notable recent medical illnesses, illicit drug use, or new medications. An incisional wedge biopsy was performed on a lesion from the lower extremity, and the specimen was stained with hematoxylin-eosin (Figure, B and C).A, Stellate red-brown patches on the Asian man's right lower extremity. B, Specimen from a lower-extremity lesion (original magnification [multiplication sign]10). C, Same specimen as shown in panel B but at higher magnification ([multiplication sign]20).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Leukocytoclastic vasculitis\nB. Polyarteritis nodosa\nC. Microscopic polyangiitis\nD. Granulomatosis with polyangiitis\n</options>" }, { "role": "assistant", "content": "B" } ]