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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 Black 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 Black 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 Black 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 Hispanic patient in them 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 Hispanic 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 Hispanic 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 man in his 30s with no medical history of illness presented with a lesion of concern on his left scalp. The patient noted that the lesion had slowly enlarged over the preceding 5 years from when he first noticed it as a small bump. He denied a history of trauma prior to its development. The patient denied any spontaneous bleeding, crusting, or itching, and he was primarily concerned about its growth. There was no personal or family history of malignancy. On physical examination, the patient[right single quotation mark]s left frontal scalp revealed a mobile 1.2-cm mammillated, soft, brown plaque with protruding terminal hairs (Figure, A). The remainder of the patient[right single quotation mark]s skin examination revealed no other concerning lesions. There was no lymphadenopathy present. Dermoscopically, the lesion was characterized by irregular pigment globules, milialike cysts, and focal arborizing vessels (Figure, B). A shave biopsy was performed for histopathologic examination (Figure, C and D).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Apocrine poroma\nB. Basal cell carcinoma\nC. Seborrheic keratosis\nD. Congenital nevus\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 30s with no medical history of illness presented with a lesion of concern on her left scalp. The White woman noted that the lesion had slowly enlarged over the preceding 5 years from when she first noticed it as a small bump. She denied a history of trauma prior to its development. The White woman denied any spontaneous bleeding, crusting, or itching, and she was primarily concerned about its growth. There was no personal or family history of malignancy. On physical examination, the White woman[right single quotation mark]s left frontal scalp revealed a mobile 1.2-cm mammillated, soft, brown plaque with protruding terminal hairs (Figure, A). The remainder of the White woman[right single quotation mark]s skin examination revealed no other concerning lesions. There was no lymphadenopathy present. Dermoscopically, the lesion was characterized by irregular pigment globules, milialike cysts, and focal arborizing vessels (Figure, B). A shave biopsy was performed for histopathologic examination (Figure, C and D).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Apocrine poroma\nB. Basal cell carcinoma\nC. Seborrheic keratosis\nD. Congenital nevus\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 patient in their 30s with no medical history of illness presented with a lesion of concern on their left scalp. The Arab patient noted that the lesion had slowly enlarged over the preceding 5 years from when they first noticed it as a small bump. They denied a history of trauma prior to its development. The Arab patient denied any spontaneous bleeding, crusting, or itching, and they was primarily concerned about its growth. There was no personal or family history of malignancy. On physical examination, the Arab patient[right single quotation mark]s left frontal scalp revealed a mobile 1.2-cm mammillated, soft, brown plaque with protruding terminal hairs (Figure, A). The remainder of the Arab patient[right single quotation mark]s skin examination revealed no other concerning lesions. There was no lymphadenopathy present. Dermoscopically, the lesion was characterized by irregular pigment globules, milialike cysts, and focal arborizing vessels (Figure, B). A shave biopsy was performed for histopathologic examination (Figure, C and D).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Apocrine poroma\nB. Basal cell carcinoma\nC. Seborrheic keratosis\nD. Congenital nevus\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 his 30s with no medical history of illness presented with a lesion of concern on his left scalp. The Asian patient noted that the lesion had slowly enlarged over the preceding 5 years from when he first noticed it as a small bump. He denied a history of trauma prior to its development. The Asian patient denied any spontaneous bleeding, crusting, or itching, and he was primarily concerned about its growth. There was no personal or family history of malignancy. On physical examination, the Asian patient[right single quotation mark]s left frontal scalp revealed a mobile 1.2-cm mammillated, soft, brown plaque with protruding terminal hairs (Figure, A). The remainder of the Asian patient[right single quotation mark]s skin examination revealed no other concerning lesions. There was no lymphadenopathy present. Dermoscopically, the lesion was characterized by irregular pigment globules, milialike cysts, and focal arborizing vessels (Figure, B). A shave biopsy was performed for histopathologic examination (Figure, C and D).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Apocrine poroma\nB. Basal cell carcinoma\nC. Seborrheic keratosis\nD. Congenital nevus\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 healthy 7-year-old girl presented with a 2-month history of an itchy rash on her elbows, knees, hands, and feet. The patient was otherwise healthy with normal development and growth. She had no other medical problems and was not taking any medications. The rash started as small pink bumps on her knees and elbows, spreading to her hands and feet and progressively thickening. The patient[right single quotation mark]s history was otherwise unremarkable; she had no pets, had no recent travel outside the United States, and her vaccinations were up to date.On physical examination, the patient had well-defined, follicular, pink, scaly papules coalescing into thin plaques on her knees (Figure 1A), elbows, and dorsal hands and feet, as well as diffuse, marked orange-red hyperkeratosis and hyperlinearity of her palms with clear demarcation at the wrists (Figure 1B).A, Well-defined follicular, pink, scaly papules coalescing into plaques on the patient[right single quotation mark]s knees. B, Marked orange-red hyperkeratosis of the patient[right single quotation mark]s palms.Initial treatment with hydrocortisone valerate cream, 0.2%, provided minimal improvement. A 4-mm skin punch biopsy was performed.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Psoriasis\nB. Ichthyosis\nC. Atopic dermatitis\nD. Circumscribed juvenile pityriasis rubra pilaris\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 healthy 7-year-old Black child presented with a 2-month history of an itchy rash on them elbows, knees, hands, and feet. The Black patient was otherwise healthy with normal development and growth. They had no other medical problems and was not taking any medications. The rash started as small pink bumps on them knees and elbows, spreading to them hands and feet and progressively thickening. The Black patient[right single quotation mark]s history was otherwise unremarkable; they had no pets, had no recent travel outside the United States, and them vaccinations were up to date.On physical examination, the Black patient had well-defined, follicular, pink, scaly papules coalescing into thin plaques on them knees (Figure 1A), elbows, and dorsal hands and feet, as well as diffuse, marked orange-red hyperkeratosis and hyperlinearity of them palms with clear demarcation at the wrists (Figure 1B).A, Well-defined follicular, pink, scaly papules coalescing into plaques on the Black patient[right single quotation mark]s knees. B, Marked orange-red hyperkeratosis of the Black patient[right single quotation mark]s palms.Initial treatment with hydrocortisone valerate cream, 0.2%, provided minimal improvement. A 4-mm skin punch biopsy was performed.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Psoriasis\nB. Ichthyosis\nC. Atopic dermatitis\nD. Circumscribed juvenile pityriasis rubra pilaris\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 healthy 7-year-old Hispanic boy presented with a 2-month history of an itchy rash on him elbows, knees, hands, and feet. The Hispanic man was otherwise healthy with normal development and growth. He had no other medical problems and was not taking any medications. The rash started as small pink bumps on him knees and elbows, spreading to him hands and feet and progressively thickening. The Hispanic man[right single quotation mark]s history was otherwise unremarkable; he had no pets, had no recent travel outside the United States, and him vaccinations were up to date.On physical examination, the Hispanic man had well-defined, follicular, pink, scaly papules coalescing into thin plaques on him knees (Figure 1A), elbows, and dorsal hands and feet, as well as diffuse, marked orange-red hyperkeratosis and hyperlinearity of him palms with clear demarcation at the wrists (Figure 1B).A, Well-defined follicular, pink, scaly papules coalescing into plaques on the Hispanic man[right single quotation mark]s knees. B, Marked orange-red hyperkeratosis of the Hispanic man[right single quotation mark]s palms.Initial treatment with hydrocortisone valerate cream, 0.2%, provided minimal improvement. A 4-mm skin punch biopsy was performed.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Psoriasis\nB. Ichthyosis\nC. Atopic dermatitis\nD. Circumscribed juvenile pityriasis rubra pilaris\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 healthy 7-year-old White girl presented with a 2-month history of an itchy rash on her elbows, knees, hands, and feet. The White patient was otherwise healthy with normal development and growth. She had no other medical problems and was not taking any medications. The rash started as small pink bumps on her knees and elbows, spreading to her hands and feet and progressively thickening. The White patient[right single quotation mark]s history was otherwise unremarkable; she had no pets, had no recent travel outside the United States, and her vaccinations were up to date.On physical examination, the White patient had well-defined, follicular, pink, scaly papules coalescing into thin plaques on her knees (Figure 1A), elbows, and dorsal hands and feet, as well as diffuse, marked orange-red hyperkeratosis and hyperlinearity of her palms with clear demarcation at the wrists (Figure 1B).A, Well-defined follicular, pink, scaly papules coalescing into plaques on the White patient[right single quotation mark]s knees. B, Marked orange-red hyperkeratosis of the White patient[right single quotation mark]s palms.Initial treatment with hydrocortisone valerate cream, 0.2%, provided minimal improvement. A 4-mm skin punch biopsy was performed.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Psoriasis\nB. Ichthyosis\nC. Atopic dermatitis\nD. Circumscribed juvenile pityriasis rubra pilaris\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 preteen boy presented with a 1-year history of right-sided nasal obstruction and a 4-day history of intermittent right-sided epistaxis following blunt trauma to the nose. The epistaxis occurred 3 to 4 times a day and resolved with pressure. He did not have facial pain, facial paresthesia, or visual changes. There was no family or personal history of bleeding disorders. Nasal endoscopy revealed a large, well-vascularized, polypoid mass filling the right anterior nasal cavity. A computed tomographic scan showed a right nasal cavity mass (4.5[thin space][multiplication sign][thin space]1.7 cm) extending to the posterior choana with opacification and bony remodeling of the right maxillary sinus. The mass had heterogeneous intermediate signal intensity on T2-weighted magnetic resonance imaging (Figure, A). The patient was taken to the operating room for biopsy and possible excision of the nasal mass. As the lesion was biopsied, there was brisk bleeding. However, the lesion was found to have a narrow pedicle of attachment and was resected in its entirety. The mass was based on the superior aspect of the nasal septum and cribriform plate. Hematoxylin-eosin stain showed a sheet-like proliferation of epithelioid and polygonal cells with pale eosinophilic granular cytoplasm and relatively uniform vesicular nuclei (Figure, B). The cells were arranged in nests. Branching, staghorn-like blood vessels were scattered throughout the tumor. The tumor cells stained positive for smooth muscle actin (Figure, C), muscle specific actin, Bcl-2, INI-1, and transcription factor E3 (Figure, D). A, T2-weighted magnetic resonance imaging (MRI) scan of a right nasal cavity mass extending to the posterior choana with heterogeneous intermediate signal intensity. B and C, Histopathologic images. B, A sheetlike proliferation of epithelioid and polygonal cells with pale eosinophilic granular cytoplasm and relatively uniform vesicular nuclei (hematoxylin-eosin, original magnification [multiplication sign]40). C, The tumor cells stained positive for smooth muscle actin (original magnification [multiplication sign]20). D, The tumor cells stained positive for transcription factor E3 (original magnification [multiplication sign]20).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Juvenile nasopharyngeal angiofibroma\nB. Alveolar rhabdomyosarcoma\nC. Nasal alveolar soft part sarcoma\nD. Malignant melanoma\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 preteen Arab boy presented with a 1-year history of right-sided nasal obstruction and a 4-day history of intermittent right-sided epistaxis following blunt trauma to the nose. The epistaxis occurred 3 to 4 times a day and resolved with pressure. He did not have facial pain, facial paresthesia, or visual changes. There was no family or personal history of bleeding disorders. Nasal endoscopy revealed a large, well-vascularized, polypoid mass filling the right anterior nasal cavity. A computed tomographic scan showed a right nasal cavity mass (4.5[thin space][multiplication sign][thin space]1.7 cm) extending to the posterior choana with opacification and bony remodeling of the right maxillary sinus. The mass had heterogeneous intermediate signal intensity on T2-weighted magnetic resonance imaging (Figure, A). The Arab patient was taken to the operating room for biopsy and possible excision of the nasal mass. As the lesion was biopsied, there was brisk bleeding. However, the lesion was found to have a narrow pedicle of attachment and was resected in its entirety. The mass was based on the superior aspect of the nasal septum and cribriform plate. Hematoxylin-eosin stain showed a sheet-like proliferation of epithelioid and polygonal cells with pale eosinophilic granular cytoplasm and relatively uniform vesicular nuclei (Figure, B). The cells were arranged in nests. Branching, staghorn-like blood vessels were scattered throughout the tumor. The tumor cells stained positive for smooth muscle actin (Figure, C), muscle specific actin, Bcl-2, INI-1, and transcription factor E3 (Figure, D). A, T2-weighted magnetic resonance imaging (MRI) scan of a right nasal cavity mass extending to the posterior choana with heterogeneous intermediate signal intensity. B and C, Histopathologic images. B, A sheetlike proliferation of epithelioid and polygonal cells with pale eosinophilic granular cytoplasm and relatively uniform vesicular nuclei (hematoxylin-eosin, original magnification [multiplication sign]40). C, The tumor cells stained positive for smooth muscle actin (original magnification [multiplication sign]20). D, The tumor cells stained positive for transcription factor E3 (original magnification [multiplication sign]20).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Juvenile nasopharyngeal angiofibroma\nB. Alveolar rhabdomyosarcoma\nC. Nasal alveolar soft part sarcoma\nD. Malignant melanoma\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 preteen Asian child presented with a 1-year history of right-sided nasal obstruction and a 4-day history of intermittent right-sided epistaxis following blunt trauma to the nose. The epistaxis occurred 3 to 4 times a day and resolved with pressure. They did not have facial pain, facial paresthesia, or visual changes. There was no family or personal history of bleeding disorders. Nasal endoscopy revealed a large, well-vascularized, polypoid mass filling the right anterior nasal cavity. A computed tomographic scan showed a right nasal cavity mass (4.5[thin space][multiplication sign][thin space]1.7 cm) extending to the posterior choana with opacification and bony remodeling of the right maxillary sinus. The mass had heterogeneous intermediate signal intensity on T2-weighted magnetic resonance imaging (Figure, A). The Asian patient was taken to the operating room for biopsy and possible excision of the nasal mass. As the lesion was biopsied, there was brisk bleeding. However, the lesion was found to have a narrow pedicle of attachment and was resected in its entirety. The mass was based on the superior aspect of the nasal septum and cribriform plate. Hematoxylin-eosin stain showed a sheet-like proliferation of epithelioid and polygonal cells with pale eosinophilic granular cytoplasm and relatively uniform vesicular nuclei (Figure, B). The cells were arranged in nests. Branching, staghorn-like blood vessels were scattered throughout the tumor. The tumor cells stained positive for smooth muscle actin (Figure, C), muscle specific actin, Bcl-2, INI-1, and transcription factor E3 (Figure, D). A, T2-weighted magnetic resonance imaging (MRI) scan of a right nasal cavity mass extending to the posterior choana with heterogeneous intermediate signal intensity. B and C, Histopathologic images. B, A sheetlike proliferation of epithelioid and polygonal cells with pale eosinophilic granular cytoplasm and relatively uniform vesicular nuclei (hematoxylin-eosin, original magnification [multiplication sign]40). C, The tumor cells stained positive for smooth muscle actin (original magnification [multiplication sign]20). D, The tumor cells stained positive for transcription factor E3 (original magnification [multiplication sign]20).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Juvenile nasopharyngeal angiofibroma\nB. Alveolar rhabdomyosarcoma\nC. Nasal alveolar soft part sarcoma\nD. Malignant melanoma\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 preteen Black girl presented with a 1-year history of right-sided nasal obstruction and a 4-day history of intermittent right-sided epistaxis following blunt trauma to the nose. The epistaxis occurred 3 to 4 times a day and resolved with pressure. She did not have facial pain, facial paresthesia, or visual changes. There was no family or personal history of bleeding disorders. Nasal endoscopy revealed a large, well-vascularized, polypoid mass filling the right anterior nasal cavity. A computed tomographic scan showed a right nasal cavity mass (4.5[thin space][multiplication sign][thin space]1.7 cm) extending to the posterior choana with opacification and bony remodeling of the right maxillary sinus. The mass had heterogeneous intermediate signal intensity on T2-weighted magnetic resonance imaging (Figure, A). The Black woman was taken to the operating room for biopsy and possible excision of the nasal mass. As the lesion was biopsied, there was brisk bleeding. However, the lesion was found to have a narrow pedicle of attachment and was resected in its entirety. The mass was based on the superior aspect of the nasal septum and cribriform plate. Hematoxylin-eosin stain showed a sheet-like proliferation of epithelioid and polygonal cells with pale eosinophilic granular cytoplasm and relatively uniform vesicular nuclei (Figure, B). The cells were arranged in nests. Branching, staghorn-like blood vessels were scattered throughout the tumor. The tumor cells stained positive for smooth muscle actin (Figure, C), muscle specific actin, Bcl-2, INI-1, and transcription factor E3 (Figure, D). A, T2-weighted magnetic resonance imaging (MRI) scan of a right nasal cavity mass extending to the posterior choana with heterogeneous intermediate signal intensity. B and C, Histopathologic images. B, A sheetlike proliferation of epithelioid and polygonal cells with pale eosinophilic granular cytoplasm and relatively uniform vesicular nuclei (hematoxylin-eosin, original magnification [multiplication sign]40). C, The tumor cells stained positive for smooth muscle actin (original magnification [multiplication sign]20). D, The tumor cells stained positive for transcription factor E3 (original magnification [multiplication sign]20).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Juvenile nasopharyngeal angiofibroma\nB. Alveolar rhabdomyosarcoma\nC. Nasal alveolar soft part sarcoma\nD. Malignant melanoma\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 young boy with mild developmental delay and autism presented with a 1-week history of progressive left periorbital swelling. His parents reported that he complained of left orbital pain just before they noticed the swelling, and he was treated with cold compresses with only slight improvement. He had never experienced these symptoms before. The patient had not experienced diplopia, change in visual acuity, nasal obstruction, change in oral intake, weight loss, recent upper respiratory infection, sick contacts, fevers, or chills. At the time of presentation, the patient was breathing comfortably and was afebrile. Findings from his head and neck examination were significant for a firm mass over the left zygoma and lateral infraorbital rim, 2[thin space][multiplication sign][thin space]3 cm in diameter. The mass was nontender, nonerythematous, and fixed to the underlying zygoma and lateral infraorbital rim. There was no cervical lymphadenopathy. Ophthalmology examination revealed intact extraocular movements, bilateral visual acuity of 20/50, and no evidence of afferent papillary defect. Computed tomographic (CT) images showed a round, soft-tissue mass with osseous destruction and erosion into the zygoma, infratemporal fossa, inferolateral orbit, and maxillary sinus (Figure, A and B). Concern for orbital involvement prompted magnetic resonance imaging (MRI) of the maxillofacial region (Figure, C and D). He was taken to the operating room the following day for open biopsy. A and B, Computed tomographic images of the maxillofacial region showing a round, soft-tissue mass. A, Coronal view. B, Axial view. C and D, Magnetic resonance imaging (MRI) scans of the maxillofacial region; C, T2-weighted MRI scan, axial view. D, Postcontrast T1-weighted MRI scan, coronal view.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Lymphoma\nB. Lipoma\nC. Rhabdomyosarcoma\nD. Metastatic neuroblastoma\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 young Hispanic child with mild developmental delay and autism presented with a 1-week history of progressive left periorbital swelling. Their parents reported that they complained of left orbital pain just before they noticed the swelling, and they was treated with cold compresses with only slight improvement. They had never experienced these symptoms before. The Hispanic patient had not experienced diplopia, change in visual acuity, nasal obstruction, change in oral intake, weight loss, recent upper respiratory infection, sick contacts, fevers, or chills. At the time of presentation, the Hispanic patient was breathing comfortably and was afebrile. Findings from their head and neck examination were significant for a firm mass over the left zygoma and lateral infraorbital rim, 2[thin space][multiplication sign][thin space]3 cm in diameter. The mass was nontender, nonerythematous, and fixed to the underlying zygoma and lateral infraorbital rim. There was no cervical lymphadenopathy. Ophthalmology examination revealed intact extraocular movements, bilateral visual acuity of 20/50, and no evidence of afferent papillary defect. Computed tomographic (CT) images showed a round, soft-tissue mass with osseous destruction and erosion into the zygoma, infratemporal fossa, inferolateral orbit, and maxillary sinus (Figure, A and B). Concern for orbital involvement prompted magnetic resonance imaging (MRI) of the maxillofacial region (Figure, C and D). They was taken to the operating room the following day for open biopsy. A and B, Computed tomographic images of the maxillofacial region showing a round, soft-tissue mass. A, Coronal view. B, Axial view. C and D, Magnetic resonance imaging (MRI) scans of the maxillofacial region; C, T2-weighted MRI scan, axial view. D, Postcontrast T1-weighted MRI scan, coronal view.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Lymphoma\nB. Lipoma\nC. Rhabdomyosarcoma\nD. Metastatic neuroblastoma\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 young White girl with mild developmental delay and autism presented with a 1-week history of progressive left periorbital swelling. Her parents reported that she complained of left orbital pain just before they noticed the swelling, and she was treated with cold compresses with only slight improvement. She had never experienced these symptoms before. The White woman had not experienced diplopia, change in visual acuity, nasal obstruction, change in oral intake, weight loss, recent upper respiratory infection, sick contacts, fevers, or chills. At the time of presentation, the White woman was breathing comfortably and was afebrile. Findings from her head and neck examination were significant for a firm mass over the left zygoma and lateral infraorbital rim, 2[thin space][multiplication sign][thin space]3 cm in diameter. The mass was nontender, nonerythematous, and fixed to the underlying zygoma and lateral infraorbital rim. There was no cervical lymphadenopathy. Ophthalmology examination revealed intact extraocular movements, bilateral visual acuity of 20/50, and no evidence of afferent papillary defect. Computed tomographic (CT) images showed a round, soft-tissue mass with osseous destruction and erosion into the zygoma, infratemporal fossa, inferolateral orbit, and maxillary sinus (Figure, A and B). Concern for orbital involvement prompted magnetic resonance imaging (MRI) of the maxillofacial region (Figure, C and D). She was taken to the operating room the following day for open biopsy. A and B, Computed tomographic images of the maxillofacial region showing a round, soft-tissue mass. A, Coronal view. B, Axial view. C and D, Magnetic resonance imaging (MRI) scans of the maxillofacial region; C, T2-weighted MRI scan, axial view. D, Postcontrast T1-weighted MRI scan, coronal view.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Lymphoma\nB. Lipoma\nC. Rhabdomyosarcoma\nD. Metastatic neuroblastoma\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 young Arab boy with mild developmental delay and autism presented with a 1-week history of progressive left periorbital swelling. His parents reported that he complained of left orbital pain just before they noticed the swelling, and he was treated with cold compresses with only slight improvement. He had never experienced these symptoms before. The Arab patient had not experienced diplopia, change in visual acuity, nasal obstruction, change in oral intake, weight loss, recent upper respiratory infection, sick contacts, fevers, or chills. At the time of presentation, the Arab patient was breathing comfortably and was afebrile. Findings from his head and neck examination were significant for a firm mass over the left zygoma and lateral infraorbital rim, 2[thin space][multiplication sign][thin space]3 cm in diameter. The mass was nontender, nonerythematous, and fixed to the underlying zygoma and lateral infraorbital rim. There was no cervical lymphadenopathy. Ophthalmology examination revealed intact extraocular movements, bilateral visual acuity of 20/50, and no evidence of afferent papillary defect. Computed tomographic (CT) images showed a round, soft-tissue mass with osseous destruction and erosion into the zygoma, infratemporal fossa, inferolateral orbit, and maxillary sinus (Figure, A and B). Concern for orbital involvement prompted magnetic resonance imaging (MRI) of the maxillofacial region (Figure, C and D). He was taken to the operating room the following day for open biopsy. A and B, Computed tomographic images of the maxillofacial region showing a round, soft-tissue mass. A, Coronal view. B, Axial view. C and D, Magnetic resonance imaging (MRI) scans of the maxillofacial region; C, T2-weighted MRI scan, axial view. D, Postcontrast T1-weighted MRI scan, coronal view.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Lymphoma\nB. Lipoma\nC. Rhabdomyosarcoma\nD. Metastatic neuroblastoma\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 40s presented with a 2-year history of a few small painful nodules on both ears. The nodules were painful on touch, especially while the patient was sleeping in a lateral position. There was no history of trauma. However, he used to wear a cap, which created pressure and friction on the upper part of both ears. On examination, the free border of the helix of both the ears showed a few dull red, dome-shaped, firm nodules 2 to 3 mm in size with central crusting (Figure, A). They were tender on palpation. No cervical lymphadenopathy was observed. One of the nodules on the right ear was excised; histopathologic features of the nodule are shown in the Figure, B. It showed a sharply defined, centrally depressed ulcer covered by a hyperkeratotic parakeratotic scale, occasional bacterial colonies, and plasma. The adjacent epidermis showed hyperplasia. The base of ulcer showed eosinophilic degeneration of collagen and solar elastosis. In addition, there were a few proliferating blood vessels and mild lymphomononuclear infiltrate. Underlying cartilage was not seen in the section. On serial sectioning, cartilage was seen and found to be normal.A, An ear with dull red, dome-shaped, firm nodules 2 to 3 mm in size with central crusting (arrowheads). B, Histopathologic image (hematoxylin-eosin, original magnification [multiplication sign]100).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Glomus tumor\nB. Rheumatoid nodule\nC. Keratoacanthoma\nD. Chondrodermatitis nodularis chronica helicis\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 man in his 40s presented with a 2-year history of a few small painful nodules on both ears. The nodules were painful on touch, especially while the Asian patient was sleeping in a lateral position. There was no history of trauma. However, he used to wear a cap, which created pressure and friction on the upper part of both ears. On examination, the free border of the helix of both the ears showed a few dull red, dome-shaped, firm nodules 2 to 3 mm in size with central crusting (Figure, A). They were tender on palpation. No cervical lymphadenopathy was observed. One of the nodules on the right ear was excised; histopathologic features of the nodule are shown in the Figure, B. It showed a sharply defined, centrally depressed ulcer covered by a hyperkeratotic parakeratotic scale, occasional bacterial colonies, and plasma. The adjacent epidermis showed hyperplasia. The base of ulcer showed eosinophilic degeneration of collagen and solar elastosis. In addition, there were a few proliferating blood vessels and mild lymphomononuclear infiltrate. Underlying cartilage was not seen in the section. On serial sectioning, cartilage was seen and found to be normal.A, An ear with dull red, dome-shaped, firm nodules 2 to 3 mm in size with central crusting (arrowheads). B, Histopathologic image (hematoxylin-eosin, original magnification [multiplication sign]100).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Glomus tumor\nB. Rheumatoid nodule\nC. Keratoacanthoma\nD. Chondrodermatitis nodularis chronica helicis\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 patient in their 40s presented with a 2-year history of a few small painful nodules on both ears. The nodules were painful on touch, especially while the Black patient was sleeping in a lateral position. There was no history of trauma. However, they used to wear a cap, which created pressure and friction on the upper part of both ears. On examination, the free border of the helix of both the ears showed a few dull red, dome-shaped, firm nodules 2 to 3 mm in size with central crusting (Figure, A). They were tender on palpation. No cervical lymphadenopathy was observed. One of the nodules on the right ear was excised; histopathologic features of the nodule are shown in the Figure, B. It showed a sharply defined, centrally depressed ulcer covered by a hyperkeratotic parakeratotic scale, occasional bacterial colonies, and plasma. The adjacent epidermis showed hyperplasia. The base of ulcer showed eosinophilic degeneration of collagen and solar elastosis. In addition, there were a few proliferating blood vessels and mild lymphomononuclear infiltrate. Underlying cartilage was not seen in the section. On serial sectioning, cartilage was seen and found to be normal.A, An ear with dull red, dome-shaped, firm nodules 2 to 3 mm in size with central crusting (arrowheads). B, Histopathologic image (hematoxylin-eosin, original magnification [multiplication sign]100).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Glomus tumor\nB. Rheumatoid nodule\nC. Keratoacanthoma\nD. Chondrodermatitis nodularis chronica helicis\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 40s presented with a 2-year history of a few small painful nodules on both ears. The nodules were painful on touch, especially while the Hispanic woman was sleeping in a lateral position. There was no history of trauma. However, she used to wear a cap, which created pressure and friction on the upper part of both ears. On examination, the free border of the helix of both the ears showed a few dull red, dome-shaped, firm nodules 2 to 3 mm in size with central crusting (Figure, A). They were tender on palpation. No cervical lymphadenopathy was observed. One of the nodules on the right ear was excised; histopathologic features of the nodule are shown in the Figure, B. It showed a sharply defined, centrally depressed ulcer covered by a hyperkeratotic parakeratotic scale, occasional bacterial colonies, and plasma. The adjacent epidermis showed hyperplasia. The base of ulcer showed eosinophilic degeneration of collagen and solar elastosis. In addition, there were a few proliferating blood vessels and mild lymphomononuclear infiltrate. Underlying cartilage was not seen in the section. On serial sectioning, cartilage was seen and found to be normal.A, An ear with dull red, dome-shaped, firm nodules 2 to 3 mm in size with central crusting (arrowheads). B, Histopathologic image (hematoxylin-eosin, original magnification [multiplication sign]100).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Glomus tumor\nB. Rheumatoid nodule\nC. Keratoacanthoma\nD. Chondrodermatitis nodularis chronica helicis\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 healthy nonsmoking woman in her 30s presented with a 6-year history of a nontender mass on the right side of the inferior face, overlying the mandible. She first noticed the mass following an uncomplicated dental procedure. It grew slowly for a few years but then stabilized. She stated that it was sensitive to cold liquids but was otherwise asymptomatic. Results from routine laboratory tests and hematologic markers were normal. Examination revealed a roughly 4[thin space][multiplication sign][thin space]2.5-cm, nontender, firm mass anterior to the right mandibular parasymphysis. The mass was fully mobile relative to the underlying mandible and could be seen bulging into the gingivolabial sulcus. There were no overlying skin or mucosal changes, and the skin and mucosa moved freely over the mass. Computed tomographic (CT) imaging demonstrated a well-defined, hyperdense, mildly heterogeneous mass with few focal areas of fat attenuation along the inferior aspect of the lesion (Figure, A-C). The mass was separate from the right mandibular parasymphysis without evidence of periosteal reaction or erosion into the underlying bone. The surrounding soft tissues appeared unremarkable. No additional lesions were noted. The patient was taken to the operating theater, where a firm, multilobulated, yellow mass was excised through a gingivolabial incision (Figure, D). The mass was not fixed to any adjacent structures.A-C, Computed tomographic images. Axial views of soft tissue (A) and bony windows (B) demonstrating an ossified hyperdense mass within the right gingivobuccal space with well-defined margins. D, The intraoperative photograph shows the well-defined mass, just prior to removal, arising in the right gingivobuccal space, separate from the underlying mandible.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Calcified teratoma/dermoid\nB. Liposarcoma\nC. Myositis ossificans\nD. Osteolipoma\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 healthy nonsmoking White man in him 30s presented with a 6-year history of a nontender mass on the right side of the inferior face, overlying the mandible. He first noticed the mass following an uncomplicated dental procedure. It grew slowly for a few years but then stabilized. He stated that it was sensitive to cold liquids but was otherwise asymptomatic. Results from routine laboratory tests and hematologic markers were normal. Examination revealed a roughly 4[thin space][multiplication sign][thin space]2.5-cm, nontender, firm mass anterior to the right mandibular parasymphysis. The mass was fully mobile relative to the underlying mandible and could be seen bulging into the gingivolabial sulcus. There were no overlying skin or mucosal changes, and the skin and mucosa moved freely over the mass. Computed tomographic (CT) imaging demonstrated a well-defined, hyperdense, mildly heterogeneous mass with few focal areas of fat attenuation along the inferior aspect of the lesion (Figure, A-C). The mass was separate from the right mandibular parasymphysis without evidence of periosteal reaction or erosion into the underlying bone. The surrounding soft tissues appeared unremarkable. No additional lesions were noted. The White man was taken to the operating theater, where a firm, multilobulated, yellow mass was excised through a gingivolabial incision (Figure, D). The mass was not fixed to any adjacent structures.A-C, Computed tomographic images. Axial views of soft tissue (A) and bony windows (B) demonstrating an ossified hyperdense mass within the right gingivobuccal space with well-defined margins. D, The intraoperative photograph shows the well-defined mass, just prior to removal, arising in the right gingivobuccal space, separate from the underlying mandible.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Calcified teratoma/dermoid\nB. Liposarcoma\nC. Myositis ossificans\nD. Osteolipoma\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 healthy nonsmoking Arab woman in her 30s presented with a 6-year history of a nontender mass on the right side of the inferior face, overlying the mandible. She first noticed the mass following an uncomplicated dental procedure. It grew slowly for a few years but then stabilized. She stated that it was sensitive to cold liquids but was otherwise asymptomatic. Results from routine laboratory tests and hematologic markers were normal. Examination revealed a roughly 4[thin space][multiplication sign][thin space]2.5-cm, nontender, firm mass anterior to the right mandibular parasymphysis. The mass was fully mobile relative to the underlying mandible and could be seen bulging into the gingivolabial sulcus. There were no overlying skin or mucosal changes, and the skin and mucosa moved freely over the mass. Computed tomographic (CT) imaging demonstrated a well-defined, hyperdense, mildly heterogeneous mass with few focal areas of fat attenuation along the inferior aspect of the lesion (Figure, A-C). The mass was separate from the right mandibular parasymphysis without evidence of periosteal reaction or erosion into the underlying bone. The surrounding soft tissues appeared unremarkable. No additional lesions were noted. The Arab patient was taken to the operating theater, where a firm, multilobulated, yellow mass was excised through a gingivolabial incision (Figure, D). The mass was not fixed to any adjacent structures.A-C, Computed tomographic images. Axial views of soft tissue (A) and bony windows (B) demonstrating an ossified hyperdense mass within the right gingivobuccal space with well-defined margins. D, The intraoperative photograph shows the well-defined mass, just prior to removal, arising in the right gingivobuccal space, separate from the underlying mandible.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Calcified teratoma/dermoid\nB. Liposarcoma\nC. Myositis ossificans\nD. Osteolipoma\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 healthy nonsmoking Asian patient in them 30s presented with a 6-year history of a nontender mass on the right side of the inferior face, overlying the mandible. They first noticed the mass following an uncomplicated dental procedure. It grew slowly for a few years but then stabilized. They stated that it was sensitive to cold liquids but was otherwise asymptomatic. Results from routine laboratory tests and hematologic markers were normal. Examination revealed a roughly 4[thin space][multiplication sign][thin space]2.5-cm, nontender, firm mass anterior to the right mandibular parasymphysis. The mass was fully mobile relative to the underlying mandible and could be seen bulging into the gingivolabial sulcus. There were no overlying skin or mucosal changes, and the skin and mucosa moved freely over the mass. Computed tomographic (CT) imaging demonstrated a well-defined, hyperdense, mildly heterogeneous mass with few focal areas of fat attenuation along the inferior aspect of the lesion (Figure, A-C). The mass was separate from the right mandibular parasymphysis without evidence of periosteal reaction or erosion into the underlying bone. The surrounding soft tissues appeared unremarkable. No additional lesions were noted. The Asian patient was taken to the operating theater, where a firm, multilobulated, yellow mass was excised through a gingivolabial incision (Figure, D). The mass was not fixed to any adjacent structures.A-C, Computed tomographic images. Axial views of soft tissue (A) and bony windows (B) demonstrating an ossified hyperdense mass within the right gingivobuccal space with well-defined margins. D, The intraoperative photograph shows the well-defined mass, just prior to removal, arising in the right gingivobuccal space, separate from the underlying mandible.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Calcified teratoma/dermoid\nB. Liposarcoma\nC. Myositis ossificans\nD. Osteolipoma\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 56-year-old man with systemic lupus erythematosus was taking chloroquine for 7 years (2.6 mg/kg daily; cumulative dose, 332 g). He was diagnosed as having nephropathy 5 years ago. He presented with a history of bilateral, painless, progressive visual diminution for 2 years. On examination, his best-corrected visual acuity was 20/200 in both eyes. He had bilateral posterior subcapsular cataracts. Both the corneas were clear. Intraocular pressures were 14 and 16 mm Hg in the right and left eyes, respectively, by Goldmann applanation tonometry. Dilated ophthalmoscopy revealed a hypopigmented zone in the parafoveal macula (Figure). Color vision testing revealed red-green deficiencies in both eyes.Advanced chloroquine retinopathy. Fundus photographs of the right (A) and left (B) eyes showing hypopigmented zones concentric to the fovea consistent with chloroquine retinopathy.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Examine family members for macular dystrophy\nB. Reassure and observe\nC. Treat with intravitreous corticosteroids\nD. Discontinue treatment with chloroquine\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 56-year-old Black woman with systemic lupus erythematosus was taking chloroquine for 7 years (2.6 mg/kg daily; cumulative dose, 332 g). She was diagnosed as having nephropathy 5 years ago. She presented with a history of bilateral, painless, progressive visual diminution for 2 years. On examination, her best-corrected visual acuity was 20/200 in both eyes. She had bilateral posterior subcapsular cataracts. Both the corneas were clear. Intraocular pressures were 14 and 16 mm Hg in the right and left eyes, respectively, by Goldmann applanation tonometry. Dilated ophthalmoscopy revealed a hypopigmented zone in the parafoveal macula (Figure). Color vision testing revealed red-green deficiencies in both eyes.Advanced chloroquine retinopathy. Fundus photographs of the right (A) and left (B) eyes showing hypopigmented zones concentric to the fovea consistent with chloroquine retinopathy.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Examine family members for macular dystrophy\nB. Reassure and observe\nC. Treat with intravitreous corticosteroids\nD. Discontinue treatment with chloroquine\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 56-year-old Hispanic patient with systemic lupus erythematosus was taking chloroquine for 7 years (2.6 mg/kg daily; cumulative dose, 332 g). They was diagnosed as having nephropathy 5 years ago. They presented with a history of bilateral, painless, progressive visual diminution for 2 years. On examination, their best-corrected visual acuity was 20/200 in both eyes. They had bilateral posterior subcapsular cataracts. Both the corneas were clear. Intraocular pressures were 14 and 16 mm Hg in the right and left eyes, respectively, by Goldmann applanation tonometry. Dilated ophthalmoscopy revealed a hypopigmented zone in the parafoveal macula (Figure). Color vision testing revealed red-green deficiencies in both eyes.Advanced chloroquine retinopathy. Fundus photographs of the right (A) and left (B) eyes showing hypopigmented zones concentric to the fovea consistent with chloroquine retinopathy.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Examine family members for macular dystrophy\nB. Reassure and observe\nC. Treat with intravitreous corticosteroids\nD. Discontinue treatment with chloroquine\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 56-year-old White man with systemic lupus erythematosus was taking chloroquine for 7 years (2.6 mg/kg daily; cumulative dose, 332 g). He was diagnosed as having nephropathy 5 years ago. He presented with a history of bilateral, painless, progressive visual diminution for 2 years. On examination, his best-corrected visual acuity was 20/200 in both eyes. He had bilateral posterior subcapsular cataracts. Both the corneas were clear. Intraocular pressures were 14 and 16 mm Hg in the right and left eyes, respectively, by Goldmann applanation tonometry. Dilated ophthalmoscopy revealed a hypopigmented zone in the parafoveal macula (Figure). Color vision testing revealed red-green deficiencies in both eyes.Advanced chloroquine retinopathy. Fundus photographs of the right (A) and left (B) eyes showing hypopigmented zones concentric to the fovea consistent with chloroquine retinopathy.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Examine family members for macular dystrophy\nB. Reassure and observe\nC. Treat with intravitreous corticosteroids\nD. Discontinue treatment with chloroquine\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 36-year-old man presented with 2 weeks of episodic numbness and paresthesias in both feet, with symptom-free intervals between episodes. Episodes progressed in frequency and duration, occurring several times daily and lasting for hours. His symptoms were prominent after activity and reliably triggered by straining with urination and terminated by lying supine. The patient also reported a 1-week history of urinary retention requiring intermittent self-catheterization. Neurological examinations both during and between episodes revealed symmetric patellar and Achilles hyperreflexia with bilateral crossed adductor response, but otherwise the results were normal. A thoracic spine magnetic resonance imaging scan with fast imaging employing steady-state acquisition (FIESTA) sequences was obtained (Figure). A dynamic computed tomographic myelogram demonstrated a lesion compressing the dorsal spinal cord at the T7 level (Video).Magnetic resonance imaging (MRI) of the thoracic spine using fast imaging employing steady-state acquisition (FIESTA) sequences. The MRI scan with FIESTA sequences revealed a blurry spinal cord signal alteration at the T7-T8 level with deformation of the cord posteriorly (arrowhead).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Spinal dural arteriovenous fistula\nB. Malignant neoplasm of the spinal cord\nC. Spinal extradural arachnoid cyst\nD. Anterior thoracolumbar spinal cord herniation\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 36-year-old Arab patient presented with 2 weeks of episodic numbness and paresthesias in both feet, with symptom-free intervals between episodes. Episodes progressed in frequency and duration, occurring several times daily and lasting for hours. Their symptoms were prominent after activity and reliably triggered by straining with urination and terminated by lying supine. The Arab patient also reported a 1-week history of urinary retention requiring intermittent self-catheterization. Neurological examinations both during and between episodes revealed symmetric patellar and Achilles hyperreflexia with bilateral crossed adductor response, but otherwise the results were normal. A thoracic spine magnetic resonance imaging scan with fast imaging employing steady-state acquisition (FIESTA) sequences was obtained (Figure). A dynamic computed tomographic myelogram demonstrated a lesion compressing the dorsal spinal cord at the T7 level (Video).Magnetic resonance imaging (MRI) of the thoracic spine using fast imaging employing steady-state acquisition (FIESTA) sequences. The MRI scan with FIESTA sequences revealed a blurry spinal cord signal alteration at the T7-T8 level with deformation of the cord posteriorly (arrowhead).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Spinal dural arteriovenous fistula\nB. Malignant neoplasm of the spinal cord\nC. Spinal extradural arachnoid cyst\nD. Anterior thoracolumbar spinal cord herniation\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 36-year-old Asian woman presented with 2 weeks of episodic numbness and paresthesias in both feet, with symptom-free intervals between episodes. Episodes progressed in frequency and duration, occurring several times daily and lasting for hours. Her symptoms were prominent after activity and reliably triggered by straining with urination and terminated by lying supine. The Asian woman also reported a 1-week history of urinary retention requiring intermittent self-catheterization. Neurological examinations both during and between episodes revealed symmetric patellar and Achilles hyperreflexia with bilateral crossed adductor response, but otherwise the results were normal. A thoracic spine magnetic resonance imaging scan with fast imaging employing steady-state acquisition (FIESTA) sequences was obtained (Figure). A dynamic computed tomographic myelogram demonstrated a lesion compressing the dorsal spinal cord at the T7 level (Video).Magnetic resonance imaging (MRI) of the thoracic spine using fast imaging employing steady-state acquisition (FIESTA) sequences. The MRI scan with FIESTA sequences revealed a blurry spinal cord signal alteration at the T7-T8 level with deformation of the cord posteriorly (arrowhead).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Spinal dural arteriovenous fistula\nB. Malignant neoplasm of the spinal cord\nC. Spinal extradural arachnoid cyst\nD. Anterior thoracolumbar spinal cord herniation\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 36-year-old Black man presented with 2 weeks of episodic numbness and paresthesias in both feet, with symptom-free intervals between episodes. Episodes progressed in frequency and duration, occurring several times daily and lasting for hours. His symptoms were prominent after activity and reliably triggered by straining with urination and terminated by lying supine. The Black patient also reported a 1-week history of urinary retention requiring intermittent self-catheterization. Neurological examinations both during and between episodes revealed symmetric patellar and Achilles hyperreflexia with bilateral crossed adductor response, but otherwise the results were normal. A thoracic spine magnetic resonance imaging scan with fast imaging employing steady-state acquisition (FIESTA) sequences was obtained (Figure). A dynamic computed tomographic myelogram demonstrated a lesion compressing the dorsal spinal cord at the T7 level (Video).Magnetic resonance imaging (MRI) of the thoracic spine using fast imaging employing steady-state acquisition (FIESTA) sequences. The MRI scan with FIESTA sequences revealed a blurry spinal cord signal alteration at the T7-T8 level with deformation of the cord posteriorly (arrowhead).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Spinal dural arteriovenous fistula\nB. Malignant neoplasm of the spinal cord\nC. Spinal extradural arachnoid cyst\nD. Anterior thoracolumbar spinal cord herniation\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nAn 82-year-old woman with bladder cancer and treated hypertension was referred by her family physician after she reported experiencing a few days[right single quotation mark] history of mild fever, cough, limited deep inspiration, and left-sided pleuritic chest pain. She had no personal or family history of venous thrombosis and did not have any recent surgery, trauma, or admission to hospital. Her long-term medications included fluoxetine, vitamin D, and hydrochlorothiazide.On examination, temperature was 38.3[degree sign]C (101[degree sign]F), blood pressure was 157/78 mm Hg, pulse rate was 82 beats per minute, and respiratory rate was 20 breaths per minute. Oxygen saturation was 97% in room air. She had a regular heart rate with a mild systolic murmur; her jugular venous pressure was normal; and lung auscultation revealed reduced air entry at the left base. She had no leg swelling and no pain on calf palpation. Laboratory testing results are reported in Table 1. The attending physician raised the diagnosis of a pulmonary embolism (PE) among the differentials. The clinical probability of PE was unlikely (Wells score).D-dimer test result is positive. Imaging test is required.D-dimer test result is positive. The diagnosis of PE is confirmed.D-dimer test result is positive but below her age-adjusted cutoff. PE is ruled out.D-dimer test result is positive due to active malignancy. PE is ruled out.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. D-dimer test result is positive due to active malignancy. PE is ruled out.\nB. D-dimer test result is positive but below her age-adjusted cutoff. PE is ruled out.\nC. D-dimer test result is positive. The diagnosis of PE is confirmed.\nD. D-dimer test result is positive. Imaging test is required.\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 82-year-old Hispanic woman with bladder cancer and treated hypertension was referred by her family physician after she reported experiencing a few days[right single quotation mark] history of mild fever, cough, limited deep inspiration, and left-sided pleuritic chest pain. She had no personal or family history of venous thrombosis and did not have any recent surgery, trauma, or admission to hospital. Her long-term medications included fluoxetine, vitamin D, and hydrochlorothiazide.On examination, temperature was 38.3[degree sign]C (101[degree sign]F), blood pressure was 157/78 mm Hg, pulse rate was 82 beats per minute, and respiratory rate was 20 breaths per minute. Oxygen saturation was 97% in room air. She had a regular heart rate with a mild systolic murmur; her jugular venous pressure was normal; and lung auscultation revealed reduced air entry at the left base. She had no leg swelling and no pain on calf palpation. Laboratory testing results are reported in Table 1. The attending physician raised the diagnosis of a pulmonary embolism (PE) among the differentials. The clinical probability of PE was unlikely (Wells score).D-dimer test result is positive. Imaging test is required.D-dimer test result is positive. The diagnosis of PE is confirmed.D-dimer test result is positive but below her age-adjusted cutoff. PE is ruled out.D-dimer test result is positive due to active malignancy. PE is ruled out.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. D-dimer test result is positive due to active malignancy. PE is ruled out.\nB. D-dimer test result is positive but below her age-adjusted cutoff. PE is ruled out.\nC. D-dimer test result is positive. The diagnosis of PE is confirmed.\nD. D-dimer test result is positive. Imaging test is required.\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 82-year-old White patient with bladder cancer and treated hypertension was referred by them family physician after they reported experiencing a few days[right single quotation mark] history of mild fever, cough, limited deep inspiration, and left-sided pleuritic chest pain. They had no personal or family history of venous thrombosis and did not have any recent surgery, trauma, or admission to hospital. Them long-term medications included fluoxetine, vitamin D, and hydrochlorothiazide.On examination, temperature was 38.3[degree sign]C (101[degree sign]F), blood pressure was 157/78 mm Hg, pulse rate was 82 beats per minute, and respiratory rate was 20 breaths per minute. Oxygen saturation was 97% in room air. They had a regular heart rate with a mild systolic murmur; them jugular venous pressure was normal; and lung auscultation revealed reduced air entry at the left base. They had no leg swelling and no pain on calf palpation. Laboratory testing results are reported in Table 1. The attending physician raised the diagnosis of a pulmonary embolism (PE) among the differentials. The clinical probability of PE was unlikely (Wells score).D-dimer test result is positive. Imaging test is required.D-dimer test result is positive. The diagnosis of PE is confirmed.D-dimer test result is positive but below them age-adjusted cutoff. PE is ruled out.D-dimer test result is positive due to active malignancy. PE is ruled out.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. D-dimer test result is positive due to active malignancy. PE is ruled out.\nB. D-dimer test result is positive but below her age-adjusted cutoff. PE is ruled out.\nC. D-dimer test result is positive. The diagnosis of PE is confirmed.\nD. D-dimer test result is positive. Imaging test is required.\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 82-year-old Arab man with bladder cancer and treated hypertension was referred by him family physician after he reported experiencing a few days[right single quotation mark] history of mild fever, cough, limited deep inspiration, and left-sided pleuritic chest pain. He had no personal or family history of venous thrombosis and did not have any recent surgery, trauma, or admission to hospital. Him long-term medications included fluoxetine, vitamin D, and hydrochlorothiazide.On examination, temperature was 38.3[degree sign]C (101[degree sign]F), blood pressure was 157/78 mm Hg, pulse rate was 82 beats per minute, and respiratory rate was 20 breaths per minute. Oxygen saturation was 97% in room air. He had a regular heart rate with a mild systolic murmur; him jugular venous pressure was normal; and lung auscultation revealed reduced air entry at the left base. He had no leg swelling and no pain on calf palpation. Laboratory testing results are reported in Table 1. The attending physician raised the diagnosis of a pulmonary embolism (PE) among the differentials. The clinical probability of PE was unlikely (Wells score).D-dimer test result is positive. Imaging test is required.D-dimer test result is positive. The diagnosis of PE is confirmed.D-dimer test result is positive but below him age-adjusted cutoff. PE is ruled out.D-dimer test result is positive due to active malignancy. PE is ruled out.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. D-dimer test result is positive due to active malignancy. PE is ruled out.\nB. D-dimer test result is positive but below her age-adjusted cutoff. PE is ruled out.\nC. D-dimer test result is positive. The diagnosis of PE is confirmed.\nD. D-dimer test result is positive. Imaging test is required.\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 15-year-old obese girl presented to clinic with increasing right shin pain of 4 weeks[right single quotation mark] duration. The pain began after the patient began to play competitive basketball and was localized to her mid shin. Dietary and menstrual histories revealed no abnormalities. Examination demonstrated focal tenderness along the distal mid shaft of the tibia anteriorly. The single-leg hop test elicited severe localized pain. Radiographs were obtained for further evaluation (Figure).Radiography of the right lower leg. Left, Anteroposterior view. Right, Lateral view.Obtain laboratory work to assess for nutritional or hormonal abnormalitiesOrder observation and pain management with nonsteroidal anti-inflammatory drugs (NSAIDS)\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain laboratory work to assess for nutritional or hormonal abnormalities\nB. Order observation and pain management with nonsteroidal anti-inflammatory drugs (NSAIDS)\nC. Order immobilization with non[en dash]weight-bearing activity\nD. Refer for immediate surgery\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 15-year-old obese Asian boy presented to clinic with increasing right shin pain of 4 weeks[right single quotation mark] duration. The pain began after the Asian man began to play competitive basketball and was localized to him mid shin. Dietary and menstrual histories revealed no abnormalities. Examination demonstrated focal tenderness along the distal mid shaft of the tibia anteriorly. The single-leg hop test elicited severe localized pain. Radiographs were obtained for further evaluation (Figure).Radiography of the right lower leg. Left, Anteroposterior view. Right, Lateral view.Obtain laboratory work to assess for nutritional or hormonal abnormalitiesOrder observation and pain management with nonsteroidal anti-inflammatory drugs (NSAIDS)\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain laboratory work to assess for nutritional or hormonal abnormalities\nB. Order observation and pain management with nonsteroidal anti-inflammatory drugs (NSAIDS)\nC. Order immobilization with non[en dash]weight-bearing activity\nD. Refer for immediate surgery\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 15-year-old obese Black girl presented to clinic with increasing right shin pain of 4 weeks[right single quotation mark] duration. The pain began after the Black patient began to play competitive basketball and was localized to her mid shin. Dietary and menstrual histories revealed no abnormalities. Examination demonstrated focal tenderness along the distal mid shaft of the tibia anteriorly. The single-leg hop test elicited severe localized pain. Radiographs were obtained for further evaluation (Figure).Radiography of the right lower leg. Left, Anteroposterior view. Right, Lateral view.Obtain laboratory work to assess for nutritional or hormonal abnormalitiesOrder observation and pain management with nonsteroidal anti-inflammatory drugs (NSAIDS)\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain laboratory work to assess for nutritional or hormonal abnormalities\nB. Order observation and pain management with nonsteroidal anti-inflammatory drugs (NSAIDS)\nC. Order immobilization with non[en dash]weight-bearing activity\nD. Refer for immediate surgery\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 15-year-old obese Hispanic child presented to clinic with increasing right shin pain of 4 weeks[right single quotation mark] duration. The pain began after the Hispanic patient began to play competitive basketball and was localized to them mid shin. Dietary and menstrual histories revealed no abnormalities. Examination demonstrated focal tenderness along the distal mid shaft of the tibia anteriorly. The single-leg hop test elicited severe localized pain. Radiographs were obtained for further evaluation (Figure).Radiography of the right lower leg. Left, Anteroposterior view. Right, Lateral view.Obtain laboratory work to assess for nutritional or hormonal abnormalitiesOrder observation and pain management with nonsteroidal anti-inflammatory drugs (NSAIDS)\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain laboratory work to assess for nutritional or hormonal abnormalities\nB. Order observation and pain management with nonsteroidal anti-inflammatory drugs (NSAIDS)\nC. Order immobilization with non[en dash]weight-bearing activity\nD. Refer for immediate surgery\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 71-year-old man with a history of bronchiectasis presents with a painful rash and swelling of his right foot for 1 day. He has had no fevers, joint pain, recent trauma, or new exposures to the area. He was diagnosed with bronchiectasis of unknown etiology 6 years ago and notes a worsening of his cough and dyspnea over the past few months. A recent computed tomography scan of the chest revealed mild bronchiectasis and ground glass inflammation (Figure, left), and recent pulmonary function tests showed combined obstructive and restrictive defects. His medications include albuterol inhaler, fluticasone-salmeterol inhaler, guaifenesin, and loratadine.Left, Axial computed tomography scan of the chest revealing mild bronchiectasis and ground glass inflammation. Right, Purpuric plaque on the right medial ankle and dorsal foot, with central vesicles.On examination, the patient[right single quotation mark]s vital signs are normal. He has a purpuric plaque on the right medial ankle and dorsal foot, with central vesicles (Figure, right). The rash is tender to palpation, and there is associated nonpitting edema of the right foot and ankle. Laboratory values are notable for a leukocyte count of 15[thin space]700 cells/[micro sign]L, with 38% eosinophils (absolute count, 5950 cells/[micro sign]L; normal, <350). His platelet count was 272[thin space]000, and his hemoglobin level was 14.7 g/dL. A skin punch biopsy of the rash on the right ankle was performed and results are pending.Obtain blood cultures and empirically treat with intravenous vancomycinPerform a herpes simplex virus/varicella zoster virus direct fluorescent antibody test and empirically treat with valacyclovir\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain antineutrophilic cytoplasmic antibodies (ANCA) titers\nB. Start a high-potency topical steroid\nC. Obtain blood cultures and empirically treat with intravenous vancomycin\nD. Perform a herpes simplex virus/varicella zoster virus direct fluorescent antibody test and empirically treat with valacyclovir\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 71-year-old White woman with a history of bronchiectasis presents with a painful rash and swelling of her right foot for 1 day. She has had no fevers, joint pain, recent trauma, or new exposures to the area. She was diagnosed with bronchiectasis of unknown etiology 6 years ago and notes a worsening of her cough and dyspnea over the past few months. A recent computed tomography scan of the chest revealed mild bronchiectasis and ground glass inflammation (Figure, left), and recent pulmonary function tests showed combined obstructive and restrictive defects. Her medications include albuterol inhaler, fluticasone-salmeterol inhaler, guaifenesin, and loratadine.Left, Axial computed tomography scan of the chest revealing mild bronchiectasis and ground glass inflammation. Right, Purpuric plaque on the right medial ankle and dorsal foot, with central vesicles.On examination, the White woman[right single quotation mark]s vital signs are normal. She has a purpuric plaque on the right medial ankle and dorsal foot, with central vesicles (Figure, right). The rash is tender to palpation, and there is associated nonpitting edema of the right foot and ankle. Laboratory values are notable for a leukocyte count of 15[thin space]700 cells/[micro sign]L, with 38% eosinophils (absolute count, 5950 cells/[micro sign]L; normal, <350). Her platelet count was 272[thin space]000, and her hemoglobin level was 14.7 g/dL. A skin punch biopsy of the rash on the right ankle was performed and results are pending.Obtain blood cultures and empirically treat with intravenous vancomycinPerform a herpes simplex virus/varicella zoster virus direct fluorescent antibody test and empirically treat with valacyclovir\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain antineutrophilic cytoplasmic antibodies (ANCA) titers\nB. Start a high-potency topical steroid\nC. Obtain blood cultures and empirically treat with intravenous vancomycin\nD. Perform a herpes simplex virus/varicella zoster virus direct fluorescent antibody test and empirically treat with valacyclovir\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 71-year-old Arab patient with a history of bronchiectasis presents with a painful rash and swelling of their right foot for 1 day. They has had no fevers, joint pain, recent trauma, or new exposures to the area. They was diagnosed with bronchiectasis of unknown etiology 6 years ago and notes a worsening of their cough and dyspnea over the past few months. A recent computed tomography scan of the chest revealed mild bronchiectasis and ground glass inflammation (Figure, left), and recent pulmonary function tests showed combined obstructive and restrictive defects. Their medications include albuterol inhaler, fluticasone-salmeterol inhaler, guaifenesin, and loratadine.Left, Axial computed tomography scan of the chest revealing mild bronchiectasis and ground glass inflammation. Right, Purpuric plaque on the right medial ankle and dorsal foot, with central vesicles.On examination, the Arab patient[right single quotation mark]s vital signs are normal. They has a purpuric plaque on the right medial ankle and dorsal foot, with central vesicles (Figure, right). The rash is tender to palpation, and there is associated nonpitting edema of the right foot and ankle. Laboratory values are notable for a leukocyte count of 15[thin space]700 cells/[micro sign]L, with 38% eosinophils (absolute count, 5950 cells/[micro sign]L; normal, <350). Their platelet count was 272[thin space]000, and their hemoglobin level was 14.7 g/dL. A skin punch biopsy of the rash on the right ankle was performed and results are pending.Obtain blood cultures and empirically treat with intravenous vancomycinPerform a herpes simplex virus/varicella zoster virus direct fluorescent antibody test and empirically treat with valacyclovir\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain antineutrophilic cytoplasmic antibodies (ANCA) titers\nB. Start a high-potency topical steroid\nC. Obtain blood cultures and empirically treat with intravenous vancomycin\nD. Perform a herpes simplex virus/varicella zoster virus direct fluorescent antibody test and empirically treat with valacyclovir\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 71-year-old Asian man with a history of bronchiectasis presents with a painful rash and swelling of his right foot for 1 day. He has had no fevers, joint pain, recent trauma, or new exposures to the area. He was diagnosed with bronchiectasis of unknown etiology 6 years ago and notes a worsening of his cough and dyspnea over the past few months. A recent computed tomography scan of the chest revealed mild bronchiectasis and ground glass inflammation (Figure, left), and recent pulmonary function tests showed combined obstructive and restrictive defects. His medications include albuterol inhaler, fluticasone-salmeterol inhaler, guaifenesin, and loratadine.Left, Axial computed tomography scan of the chest revealing mild bronchiectasis and ground glass inflammation. Right, Purpuric plaque on the right medial ankle and dorsal foot, with central vesicles.On examination, the Asian patient[right single quotation mark]s vital signs are normal. He has a purpuric plaque on the right medial ankle and dorsal foot, with central vesicles (Figure, right). The rash is tender to palpation, and there is associated nonpitting edema of the right foot and ankle. Laboratory values are notable for a leukocyte count of 15[thin space]700 cells/[micro sign]L, with 38% eosinophils (absolute count, 5950 cells/[micro sign]L; normal, <350). His platelet count was 272[thin space]000, and his hemoglobin level was 14.7 g/dL. A skin punch biopsy of the rash on the right ankle was performed and results are pending.Obtain blood cultures and empirically treat with intravenous vancomycinPerform a herpes simplex virus/varicella zoster virus direct fluorescent antibody test and empirically treat with valacyclovir\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain antineutrophilic cytoplasmic antibodies (ANCA) titers\nB. Start a high-potency topical steroid\nC. Obtain blood cultures and empirically treat with intravenous vancomycin\nD. Perform a herpes simplex virus/varicella zoster virus direct fluorescent antibody test and empirically treat with valacyclovir\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 70s with a history of T2N2 melanoma, locally metastatic squamous cell carcinoma, and non-Hodgkin follicular lymphoma presented with weakness, a blistering erythematous eruption, and painful oral lesions of 1 month[right single quotation mark]s duration. On physical examination, the patient was in severe discomfort with limited movement owing to cutaneous pain. He was cachectic and had widespread erosions and tense and flaccid bullae with overlying crust affecting his trunk and extremities (including the palms and soles) but sparing his scalp (Figure, A). He had severe stomatitis with localized hemorrhagic lesions, shaggy erosions on the buccal and gingival mucosa, and erythematous macules on his hard and soft palates (Figure, B). Findings from laboratory tests, including a complete blood cell count and a comprehensive metabolic panel, were unremarkable except for mild anemia. Results from a computed tomographic scan of the chest and neck showed adenopathy suspicious for lymphoproliferative disorder or potentially metastatic disease. A punch biopsy for histopathologic examination (Figure, C) and direct immunofluorescence (DIF) was performed, and serum was tested for indirect immunofluorescence (IIF) on rodent epithelium (Figure, D).A, Erosions, tense and flaccid bullae, and overlying crust over the dorsal side of the foot. B, Severe stomatitis and hemorrhagic crust. C, Histopathologic image of a biopsy specimen showing suprabasal acantholysis and a dermal infiltrate of lymphocytes, histiocytes, and scattered eosinophils (hematoxylin-eosin, original magnification [multiplication sign]20). D, Positive indirect immunofluorescence test of rat urinary bladder epithelium.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Stevens-Johnson syndrome\nB. Pemphigus vulgaris\nC. Bullous pemphigoid\nD. Paraneoplastic pemphigus\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 patient in their 70s with a history of T2N2 melanoma, locally metastatic squamous cell carcinoma, and non-Hodgkin follicular lymphoma presented with weakness, a blistering erythematous eruption, and painful oral lesions of 1 month[right single quotation mark]s duration. On physical examination, the Black patient was in severe discomfort with limited movement owing to cutaneous pain. They was cachectic and had widespread erosions and tense and flaccid bullae with overlying crust affecting their trunk and extremities (including the palms and soles) but sparing their scalp (Figure, A). They had severe stomatitis with localized hemorrhagic lesions, shaggy erosions on the buccal and gingival mucosa, and erythematous macules on their hard and soft palates (Figure, B). Findings from laboratory tests, including a complete blood cell count and a comprehensive metabolic panel, were unremarkable except for mild anemia. Results from a computed tomographic scan of the chest and neck showed adenopathy suspicious for lymphoproliferative disorder or potentially metastatic disease. A punch biopsy for histopathologic examination (Figure, C) and direct immunofluorescence (DIF) was performed, and serum was tested for indirect immunofluorescence (IIF) on rodent epithelium (Figure, D).A, Erosions, tense and flaccid bullae, and overlying crust over the dorsal side of the foot. B, Severe stomatitis and hemorrhagic crust. C, Histopathologic image of a biopsy specimen showing suprabasal acantholysis and a dermal infiltrate of lymphocytes, histiocytes, and scattered eosinophils (hematoxylin-eosin, original magnification [multiplication sign]20). D, Positive indirect immunofluorescence test of rat urinary bladder epithelium.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Stevens-Johnson syndrome\nB. Pemphigus vulgaris\nC. Bullous pemphigoid\nD. Paraneoplastic pemphigus\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 with a history of T2N2 melanoma, locally metastatic squamous cell carcinoma, and non-Hodgkin follicular lymphoma presented with weakness, a blistering erythematous eruption, and painful oral lesions of 1 month[right single quotation mark]s duration. On physical examination, the Hispanic woman was in severe discomfort with limited movement owing to cutaneous pain. She was cachectic and had widespread erosions and tense and flaccid bullae with overlying crust affecting her trunk and extremities (including the palms and soles) but sparing her scalp (Figure, A). She had severe stomatitis with localized hemorrhagic lesions, shaggy erosions on the buccal and gingival mucosa, and erythematous macules on her hard and soft palates (Figure, B). Findings from laboratory tests, including a complete blood cell count and a comprehensive metabolic panel, were unremarkable except for mild anemia. Results from a computed tomographic scan of the chest and neck showed adenopathy suspicious for lymphoproliferative disorder or potentially metastatic disease. A punch biopsy for histopathologic examination (Figure, C) and direct immunofluorescence (DIF) was performed, and serum was tested for indirect immunofluorescence (IIF) on rodent epithelium (Figure, D).A, Erosions, tense and flaccid bullae, and overlying crust over the dorsal side of the foot. B, Severe stomatitis and hemorrhagic crust. C, Histopathologic image of a biopsy specimen showing suprabasal acantholysis and a dermal infiltrate of lymphocytes, histiocytes, and scattered eosinophils (hematoxylin-eosin, original magnification [multiplication sign]20). D, Positive indirect immunofluorescence test of rat urinary bladder epithelium.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Stevens-Johnson syndrome\nB. Pemphigus vulgaris\nC. Bullous pemphigoid\nD. Paraneoplastic pemphigus\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 70s with a history of T2N2 melanoma, locally metastatic squamous cell carcinoma, and non-Hodgkin follicular lymphoma presented with weakness, a blistering erythematous eruption, and painful oral lesions of 1 month[right single quotation mark]s duration. On physical examination, the White patient was in severe discomfort with limited movement owing to cutaneous pain. He was cachectic and had widespread erosions and tense and flaccid bullae with overlying crust affecting his trunk and extremities (including the palms and soles) but sparing his scalp (Figure, A). He had severe stomatitis with localized hemorrhagic lesions, shaggy erosions on the buccal and gingival mucosa, and erythematous macules on his hard and soft palates (Figure, B). Findings from laboratory tests, including a complete blood cell count and a comprehensive metabolic panel, were unremarkable except for mild anemia. Results from a computed tomographic scan of the chest and neck showed adenopathy suspicious for lymphoproliferative disorder or potentially metastatic disease. A punch biopsy for histopathologic examination (Figure, C) and direct immunofluorescence (DIF) was performed, and serum was tested for indirect immunofluorescence (IIF) on rodent epithelium (Figure, D).A, Erosions, tense and flaccid bullae, and overlying crust over the dorsal side of the foot. B, Severe stomatitis and hemorrhagic crust. C, Histopathologic image of a biopsy specimen showing suprabasal acantholysis and a dermal infiltrate of lymphocytes, histiocytes, and scattered eosinophils (hematoxylin-eosin, original magnification [multiplication sign]20). D, Positive indirect immunofluorescence test of rat urinary bladder epithelium.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Stevens-Johnson syndrome\nB. Pemphigus vulgaris\nC. Bullous pemphigoid\nD. Paraneoplastic pemphigus\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 20s with a medical history significant for systemic lupus erythematosus (SLE) presented with tender erythematous nodules after undergoing right knee arthroscopy (Figure, A). SLE had been diagnosed ten years previously after she presented with a positive antinuclear antibody titer (most recent titer, 1:1280), arthralgias, leukopenia, oral ulcers, and a malar erythematous eruption. There was no history of discoid or tumid lupus lesions. Initially, the lesions were thought secondary to soft-tissue infection and were treated with courses of clindamycin, vancomycin, and doxycycline. Physical examination revealed poorly demarcated erythematous plaques and nodules, tender to palpation, ranging from the distal thigh to the lower leg, adjacent to arthroscopy sites. Lesions around the suture sites appeared more violaceous. A punch biopsy of the lesion was performed (Figure, B and C).A, Clinical photograph of right knee demonstrating ill-defined erythematous plaques and nodules adjacent to 2 small incisional scars from previous arthroscopy. B and C, Photomicrographs of punch biopsy specimen. B, Hematoxylin-eosin, original magnification [multiplication sign]4. C, Hematoxylin-eosin, original magnification [multiplication sign]10.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Tumid lupus erythematosus\nB. Gyrate erythema\nC. Cellulitis\nD. Erythema nodosum\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Arab man in him 20s with a medical history significant for systemic lupus erythematosus (SLE) presented with tender erythematous nodules after undergoing right knee arthroscopy (Figure, A). SLE had been diagnosed ten years previously after he presented with a positive antinuclear antibody titer (most recent titer, 1:1280), arthralgias, leukopenia, oral ulcers, and a malar erythematous eruption. There was no history of discoid or tumid lupus lesions. Initially, the lesions were thought secondary to soft-tissue infection and were treated with courses of clindamycin, vancomycin, and doxycycline. Physical examination revealed poorly demarcated erythematous plaques and nodules, tender to palpation, ranging from the distal thigh to the lower leg, adjacent to arthroscopy sites. Lesions around the suture sites appeared more violaceous. A punch biopsy of the lesion was performed (Figure, B and C).A, Clinical photograph of right knee demonstrating ill-defined erythematous plaques and nodules adjacent to 2 small incisional scars from previous arthroscopy. B and C, Photomicrographs of punch biopsy specimen. B, Hematoxylin-eosin, original magnification [multiplication sign]4. C, Hematoxylin-eosin, original magnification [multiplication sign]10.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Tumid lupus erythematosus\nB. Gyrate erythema\nC. Cellulitis\nD. Erythema nodosum\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Asian woman in her 20s with a medical history significant for systemic lupus erythematosus (SLE) presented with tender erythematous nodules after undergoing right knee arthroscopy (Figure, A). SLE had been diagnosed ten years previously after she presented with a positive antinuclear antibody titer (most recent titer, 1:1280), arthralgias, leukopenia, oral ulcers, and a malar erythematous eruption. There was no history of discoid or tumid lupus lesions. Initially, the lesions were thought secondary to soft-tissue infection and were treated with courses of clindamycin, vancomycin, and doxycycline. Physical examination revealed poorly demarcated erythematous plaques and nodules, tender to palpation, ranging from the distal thigh to the lower leg, adjacent to arthroscopy sites. Lesions around the suture sites appeared more violaceous. A punch biopsy of the lesion was performed (Figure, B and C).A, Clinical photograph of right knee demonstrating ill-defined erythematous plaques and nodules adjacent to 2 small incisional scars from previous arthroscopy. B and C, Photomicrographs of punch biopsy specimen. B, Hematoxylin-eosin, original magnification [multiplication sign]4. C, Hematoxylin-eosin, original magnification [multiplication sign]10.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Tumid lupus erythematosus\nB. Gyrate erythema\nC. Cellulitis\nD. Erythema nodosum\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 20s with a medical history significant for systemic lupus erythematosus (SLE) presented with tender erythematous nodules after undergoing right knee arthroscopy (Figure, A). SLE had been diagnosed ten years previously after they presented with a positive antinuclear antibody titer (most recent titer, 1:1280), arthralgias, leukopenia, oral ulcers, and a malar erythematous eruption. There was no history of discoid or tumid lupus lesions. Initially, the lesions were thought secondary to soft-tissue infection and were treated with courses of clindamycin, vancomycin, and doxycycline. Physical examination revealed poorly demarcated erythematous plaques and nodules, tender to palpation, ranging from the distal thigh to the lower leg, adjacent to arthroscopy sites. Lesions around the suture sites appeared more violaceous. A punch biopsy of the lesion was performed (Figure, B and C).A, Clinical photograph of right knee demonstrating ill-defined erythematous plaques and nodules adjacent to 2 small incisional scars from previous arthroscopy. B and C, Photomicrographs of punch biopsy specimen. B, Hematoxylin-eosin, original magnification [multiplication sign]4. C, Hematoxylin-eosin, original magnification [multiplication sign]10.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Tumid lupus erythematosus\nB. Gyrate erythema\nC. Cellulitis\nD. Erythema nodosum\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 50s presented with an 8-week history of increasing headache, hyposmia, hypogeusia, and nasal congestion. Endoscopic nasopharyngoscopy revealed a large polypoid nasal mass occupying the left nasal roof and completely obstructing the nasal passage. Contrast-enhanced T1-weighted magnetic resonance imaging (MRI) revealed a 1.7[thin space][multiplication sign][thin space]3.5[thin space][multiplication sign][thin space]2.6-cm soft-tissue mass within the left ethmoid cavity, eroding through the cribriform plate with adjacent dural enhancement (Figure, A). Intraoperative pathologic examination showed polypoid spindle cell proliferation. Histopathologic findings showed respiratory epithelium with submucosal vascular proliferation with no atypia among the lining endothelial cells. The Figure, B, shows a central vessel surrounded by lobules of endothelial lined capillaries. The Figure, C, highlights the endothelial cells of the numerous capillaries and the central vessel.A, Contrast-enhanced T1-weighted magnetic resonance imaging of a soft-tissue mass within the left ethmoid cavity. B, Central vessel surrounded by lobules of endothelial-lined capillaries (hematoxylin-eosin, original magnification [multiplication sign]20). C, Endothelial cells of the numerous capillaries and the central vessel on CD34 staining (original magnification [multiplication sign]20).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Inverting papilloma\nB. Respiratory epithelial adenomatoid hamartoma\nC. Juvenile nasopharyngeal angiofibroma\nD. Lobular capillary hemangioma\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Hispanic patient in them 50s presented with an 8-week history of increasing headache, hyposmia, hypogeusia, and nasal congestion. Endoscopic nasopharyngoscopy revealed a large polypoid nasal mass occupying the left nasal roof and completely obstructing the nasal passage. Contrast-enhanced T1-weighted magnetic resonance imaging (MRI) revealed a 1.7[thin space][multiplication sign][thin space]3.5[thin space][multiplication sign][thin space]2.6-cm soft-tissue mass within the left ethmoid cavity, eroding through the cribriform plate with adjacent dural enhancement (Figure, A). Intraoperative pathologic examination showed polypoid spindle cell proliferation. Histopathologic findings showed respiratory epithelium with submucosal vascular proliferation with no atypia among the lining endothelial cells. The Figure, B, shows a central vessel surrounded by lobules of endothelial lined capillaries. The Figure, C, highlights the endothelial cells of the numerous capillaries and the central vessel.A, Contrast-enhanced T1-weighted magnetic resonance imaging of a soft-tissue mass within the left ethmoid cavity. B, Central vessel surrounded by lobules of endothelial-lined capillaries (hematoxylin-eosin, original magnification [multiplication sign]20). C, Endothelial cells of the numerous capillaries and the central vessel on CD34 staining (original magnification [multiplication sign]20).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Inverting papilloma\nB. Respiratory epithelial adenomatoid hamartoma\nC. Juvenile nasopharyngeal angiofibroma\nD. Lobular capillary hemangioma\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 him 50s presented with an 8-week history of increasing headache, hyposmia, hypogeusia, and nasal congestion. Endoscopic nasopharyngoscopy revealed a large polypoid nasal mass occupying the left nasal roof and completely obstructing the nasal passage. Contrast-enhanced T1-weighted magnetic resonance imaging (MRI) revealed a 1.7[thin space][multiplication sign][thin space]3.5[thin space][multiplication sign][thin space]2.6-cm soft-tissue mass within the left ethmoid cavity, eroding through the cribriform plate with adjacent dural enhancement (Figure, A). Intraoperative pathologic examination showed polypoid spindle cell proliferation. Histopathologic findings showed respiratory epithelium with submucosal vascular proliferation with no atypia among the lining endothelial cells. The Figure, B, shows a central vessel surrounded by lobules of endothelial lined capillaries. The Figure, C, highlights the endothelial cells of the numerous capillaries and the central vessel.A, Contrast-enhanced T1-weighted magnetic resonance imaging of a soft-tissue mass within the left ethmoid cavity. B, Central vessel surrounded by lobules of endothelial-lined capillaries (hematoxylin-eosin, original magnification [multiplication sign]20). C, Endothelial cells of the numerous capillaries and the central vessel on CD34 staining (original magnification [multiplication sign]20).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Inverting papilloma\nB. Respiratory epithelial adenomatoid hamartoma\nC. Juvenile nasopharyngeal angiofibroma\nD. Lobular capillary hemangioma\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 presented with an 8-week history of increasing headache, hyposmia, hypogeusia, and nasal congestion. Endoscopic nasopharyngoscopy revealed a large polypoid nasal mass occupying the left nasal roof and completely obstructing the nasal passage. Contrast-enhanced T1-weighted magnetic resonance imaging (MRI) revealed a 1.7[thin space][multiplication sign][thin space]3.5[thin space][multiplication sign][thin space]2.6-cm soft-tissue mass within the left ethmoid cavity, eroding through the cribriform plate with adjacent dural enhancement (Figure, A). Intraoperative pathologic examination showed polypoid spindle cell proliferation. Histopathologic findings showed respiratory epithelium with submucosal vascular proliferation with no atypia among the lining endothelial cells. The Figure, B, shows a central vessel surrounded by lobules of endothelial lined capillaries. The Figure, C, highlights the endothelial cells of the numerous capillaries and the central vessel.A, Contrast-enhanced T1-weighted magnetic resonance imaging of a soft-tissue mass within the left ethmoid cavity. B, Central vessel surrounded by lobules of endothelial-lined capillaries (hematoxylin-eosin, original magnification [multiplication sign]20). C, Endothelial cells of the numerous capillaries and the central vessel on CD34 staining (original magnification [multiplication sign]20).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Inverting papilloma\nB. Respiratory epithelial adenomatoid hamartoma\nC. Juvenile nasopharyngeal angiofibroma\nD. Lobular capillary hemangioma\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 60s presented with a 10-year history of oropharyngeal discomfort and recent episodes of snoring and obstructive sleep disturbance. Although she had been experiencing a gradually increasing lumpy feeling on swallowing for at least 6 months, she did not experience of dysphagia, dyspnea, or pain. Physical examination revealed a mass measuring approximately 4[thin space][multiplication sign][thin space]3 cm and covered with normal mucosa on the posterior oropharyngeal wall. This tumor was firm, nontender, and firmly adherent (Figure, A). Computed tomography (CT) showed a segmented bony lesion located at the odontoid process and the body of the C2 vertebra (Figure, B). This mass showed high signal intensity with a hypointense rim in both T1- and T2-weighted magnetic resonance images (MRI) (Figure, C and D, respectively). Polysomnography was performed and showed an apnea-hypopnea index of 58.7/h and a minimal oxygen saturation of 76%, which led to a diagnosis of obstructive sleep apnea. The mass was considered causative of obstructive sleep apnea. Hence, we performed total excision of the mass using a per-oral approach.A, Photograph of an oropharyngeal mass. B, Computed tomographic image showing a segmented bony lesion located at the odontoid process and the body of the C2 vertebra. C, T1-weighted magnetic resonance image (MRI) of an oropharyngeal mass. D, T2-weighted MRI of an oropharyngeal mass.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Osteochondroma\nB. Exuberant osteophytes\nC. Diffuse idiopathic skeletal hyperostosis\nD. Osteoid osteoma\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Asian woman in her 60s presented with a 10-year history of oropharyngeal discomfort and recent episodes of snoring and obstructive sleep disturbance. Although she had been experiencing a gradually increasing lumpy feeling on swallowing for at least 6 months, she did not experience of dysphagia, dyspnea, or pain. Physical examination revealed a mass measuring approximately 4[thin space][multiplication sign][thin space]3 cm and covered with normal mucosa on the posterior oropharyngeal wall. This tumor was firm, nontender, and firmly adherent (Figure, A). Computed tomography (CT) showed a segmented bony lesion located at the odontoid process and the body of the C2 vertebra (Figure, B). This mass showed high signal intensity with a hypointense rim in both T1- and T2-weighted magnetic resonance images (MRI) (Figure, C and D, respectively). Polysomnography was performed and showed an apnea-hypopnea index of 58.7/h and a minimal oxygen saturation of 76%, which led to a diagnosis of obstructive sleep apnea. The mass was considered causative of obstructive sleep apnea. Hence, we performed total excision of the mass using a per-oral approach.A, Photograph of an oropharyngeal mass. B, Computed tomographic image showing a segmented bony lesion located at the odontoid process and the body of the C2 vertebra. C, T1-weighted magnetic resonance image (MRI) of an oropharyngeal mass. D, T2-weighted MRI of an oropharyngeal mass.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Osteochondroma\nB. Exuberant osteophytes\nC. Diffuse idiopathic skeletal hyperostosis\nD. Osteoid osteoma\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 60s presented with a 10-year history of oropharyngeal discomfort and recent episodes of snoring and obstructive sleep disturbance. Although they had been experiencing a gradually increasing lumpy feeling on swallowing for at least 6 months, they did not experience of dysphagia, dyspnea, or pain. Physical examination revealed a mass measuring approximately 4[thin space][multiplication sign][thin space]3 cm and covered with normal mucosa on the posterior oropharyngeal wall. This tumor was firm, nontender, and firmly adherent (Figure, A). Computed tomography (CT) showed a segmented bony lesion located at the odontoid process and the body of the C2 vertebra (Figure, B). This mass showed high signal intensity with a hypointense rim in both T1- and T2-weighted magnetic resonance images (MRI) (Figure, C and D, respectively). Polysomnography was performed and showed an apnea-hypopnea index of 58.7/h and a minimal oxygen saturation of 76%, which led to a diagnosis of obstructive sleep apnea. The mass was considered causative of obstructive sleep apnea. Hence, we performed total excision of the mass using a per-oral approach.A, Photograph of an oropharyngeal mass. B, Computed tomographic image showing a segmented bony lesion located at the odontoid process and the body of the C2 vertebra. C, T1-weighted magnetic resonance image (MRI) of an oropharyngeal mass. D, T2-weighted MRI of an oropharyngeal mass.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Osteochondroma\nB. Exuberant osteophytes\nC. Diffuse idiopathic skeletal hyperostosis\nD. Osteoid osteoma\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 him 60s presented with a 10-year history of oropharyngeal discomfort and recent episodes of snoring and obstructive sleep disturbance. Although he had been experiencing a gradually increasing lumpy feeling on swallowing for at least 6 months, he did not experience of dysphagia, dyspnea, or pain. Physical examination revealed a mass measuring approximately 4[thin space][multiplication sign][thin space]3 cm and covered with normal mucosa on the posterior oropharyngeal wall. This tumor was firm, nontender, and firmly adherent (Figure, A). Computed tomography (CT) showed a segmented bony lesion located at the odontoid process and the body of the C2 vertebra (Figure, B). This mass showed high signal intensity with a hypointense rim in both T1- and T2-weighted magnetic resonance images (MRI) (Figure, C and D, respectively). Polysomnography was performed and showed an apnea-hypopnea index of 58.7/h and a minimal oxygen saturation of 76%, which led to a diagnosis of obstructive sleep apnea. The mass was considered causative of obstructive sleep apnea. Hence, we performed total excision of the mass using a per-oral approach.A, Photograph of an oropharyngeal mass. B, Computed tomographic image showing a segmented bony lesion located at the odontoid process and the body of the C2 vertebra. C, T1-weighted magnetic resonance image (MRI) of an oropharyngeal mass. D, T2-weighted MRI of an oropharyngeal mass.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Osteochondroma\nB. Exuberant osteophytes\nC. Diffuse idiopathic skeletal hyperostosis\nD. Osteoid osteoma\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 a 3-month history of a gradually enlarging soft palate mass associated with a change in her voice. She had no associated pain, difficulty swallowing, or difficulty breathing. She was otherwise healthy, with no medical or surgical history. Findings from her physical examination were unremarkable with the exception of a 2[thin space][multiplication sign][thin space]2-cm firm, nontender, submucosal posterior soft palate mass just left of the uvula. There was no overlying ulceration or discoloration. Flexible nasopharyngoscopy was normal. Prior to presentation, a computed tomographic scan and biopsy had been performed at an outside hospital. Magnetic resonance imaging (MRI) of the face with contrast was also performed (Figure, A-C). Imaging showed a well-circumscribed solid lesion with no evidence of infiltration of soft-tissue structures, the pterygopalatine fossa, or palatine nerve foramina. There was no cervical lymphadenopathy. The lesion was resected via a transoral approach and was easily dissected from the surrounding tissue (Figure, D). The overlying mucosa was spared.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Hemangioma\nB. Pleomorphic adenoma\nC. Granular cell tumor\nD. Mucoepidermoid carcinoma\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 White boy presented with a 3-month history of a gradually enlarging soft palate mass associated with a change in him voice. He had no associated pain, difficulty swallowing, or difficulty breathing. He was otherwise healthy, with no medical or surgical history. Findings from him physical examination were unremarkable with the exception of a 2[thin space][multiplication sign][thin space]2-cm firm, nontender, submucosal posterior soft palate mass just left of the uvula. There was no overlying ulceration or discoloration. Flexible nasopharyngoscopy was normal. Prior to presentation, a computed tomographic scan and biopsy had been performed at an outside hospital. Magnetic resonance imaging (MRI) of the face with contrast was also performed (Figure, A-C). Imaging showed a well-circumscribed solid lesion with no evidence of infiltration of soft-tissue structures, the pterygopalatine fossa, or palatine nerve foramina. There was no cervical lymphadenopathy. The lesion was resected via a transoral approach and was easily dissected from the surrounding tissue (Figure, D). The overlying mucosa was spared.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Hemangioma\nB. Pleomorphic adenoma\nC. Granular cell tumor\nD. Mucoepidermoid carcinoma\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 girl presented with a 3-month history of a gradually enlarging soft palate mass associated with a change in her voice. She had no associated pain, difficulty swallowing, or difficulty breathing. She was otherwise healthy, with no medical or surgical history. Findings from her physical examination were unremarkable with the exception of a 2[thin space][multiplication sign][thin space]2-cm firm, nontender, submucosal posterior soft palate mass just left of the uvula. There was no overlying ulceration or discoloration. Flexible nasopharyngoscopy was normal. Prior to presentation, a computed tomographic scan and biopsy had been performed at an outside hospital. Magnetic resonance imaging (MRI) of the face with contrast was also performed (Figure, A-C). Imaging showed a well-circumscribed solid lesion with no evidence of infiltration of soft-tissue structures, the pterygopalatine fossa, or palatine nerve foramina. There was no cervical lymphadenopathy. The lesion was resected via a transoral approach and was easily dissected from the surrounding tissue (Figure, D). The overlying mucosa was spared.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Hemangioma\nB. Pleomorphic adenoma\nC. Granular cell tumor\nD. Mucoepidermoid carcinoma\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 child presented with a 3-month history of a gradually enlarging soft palate mass associated with a change in them voice. They had no associated pain, difficulty swallowing, or difficulty breathing. They was otherwise healthy, with no medical or surgical history. Findings from them physical examination were unremarkable with the exception of a 2[thin space][multiplication sign][thin space]2-cm firm, nontender, submucosal posterior soft palate mass just left of the uvula. There was no overlying ulceration or discoloration. Flexible nasopharyngoscopy was normal. Prior to presentation, a computed tomographic scan and biopsy had been performed at an outside hospital. Magnetic resonance imaging (MRI) of the face with contrast was also performed (Figure, A-C). Imaging showed a well-circumscribed solid lesion with no evidence of infiltration of soft-tissue structures, the pterygopalatine fossa, or palatine nerve foramina. There was no cervical lymphadenopathy. The lesion was resected via a transoral approach and was easily dissected from the surrounding tissue (Figure, D). The overlying mucosa was spared.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Hemangioma\nB. Pleomorphic adenoma\nC. Granular cell tumor\nD. Mucoepidermoid carcinoma\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 50s presented with a 7-month history of worsening, primarily left-sided, sinus obstruction and congestion with associated hyposmia, facial pressure, and headaches. He had no history of sinus disease or surgery and had no epistaxis, weight loss, or visual symptoms. Computed tomography showed a 3.1-cm mass in the left ethmoid sinus and nasal cavity (Figure, A). Positron emission tomographic scanning showed no evidence of metastasis. Nasal endoscopy revealed a friable, polypoid mass in the ethmoid sinus with extension into the nasal cavity and superiorly to the skull base. A biopsy specimen showed a heterogeneous tumor with small, angulated, blue cells with hyperchromatic nuclei, apoptosis, and mitosis, malignant glands lined by cuboidal cells with round nuclei, prominent nucleoli, and eosinophilic cytoplasm. The glands had luminal mucin production (Figure, B). Focally, there were also scattered round cells with abundant eosinophilic, refractile cytoplasm, features of rhabdomyoblasts (Figure, C). These latter cells were strongly positive for desmin (Figure, D) and myogenin. Ethmoid sinus mass. A, Computed tomographic scan. The arrowhead indicates the mass. B, Blastema as indicated by the asterisk and malignant glands as indicated by the arrowhead. C, Rhabdomyoblasts as indicated by the arrowheads (hematoxylin-eosin, original magnification [multiplication sign]40). D, Desmin immunohistochemistry with strong positive staining in the rhabdomyoblasts (original magnification [multiplication sign]20).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Small cell carcinoma\nB. Olfactory neuroblastoma\nC. Sinonasal teratocarcinosarcoma\nD. Alveolar rhabdomyosarcoma\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Black man in his 50s presented with a 7-month history of worsening, primarily left-sided, sinus obstruction and congestion with associated hyposmia, facial pressure, and headaches. He had no history of sinus disease or surgery and had no epistaxis, weight loss, or visual symptoms. Computed tomography showed a 3.1-cm mass in the left ethmoid sinus and nasal cavity (Figure, A). Positron emission tomographic scanning showed no evidence of metastasis. Nasal endoscopy revealed a friable, polypoid mass in the ethmoid sinus with extension into the nasal cavity and superiorly to the skull base. A biopsy specimen showed a heterogeneous tumor with small, angulated, blue cells with hyperchromatic nuclei, apoptosis, and mitosis, malignant glands lined by cuboidal cells with round nuclei, prominent nucleoli, and eosinophilic cytoplasm. The glands had luminal mucin production (Figure, B). Focally, there were also scattered round cells with abundant eosinophilic, refractile cytoplasm, features of rhabdomyoblasts (Figure, C). These latter cells were strongly positive for desmin (Figure, D) and myogenin. Ethmoid sinus mass. A, Computed tomographic scan. The arrowhead indicates the mass. B, Blastema as indicated by the asterisk and malignant glands as indicated by the arrowhead. C, Rhabdomyoblasts as indicated by the arrowheads (hematoxylin-eosin, original magnification [multiplication sign]40). D, Desmin immunohistochemistry with strong positive staining in the rhabdomyoblasts (original magnification [multiplication sign]20).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Small cell carcinoma\nB. Olfactory neuroblastoma\nC. Sinonasal teratocarcinosarcoma\nD. Alveolar rhabdomyosarcoma\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 woman in her 50s presented with a 7-month history of worsening, primarily left-sided, sinus obstruction and congestion with associated hyposmia, facial pressure, and headaches. She had no history of sinus disease or surgery and had no epistaxis, weight loss, or visual symptoms. Computed tomography showed a 3.1-cm mass in the left ethmoid sinus and nasal cavity (Figure, A). Positron emission tomographic scanning showed no evidence of metastasis. Nasal endoscopy revealed a friable, polypoid mass in the ethmoid sinus with extension into the nasal cavity and superiorly to the skull base. A biopsy specimen showed a heterogeneous tumor with small, angulated, blue cells with hyperchromatic nuclei, apoptosis, and mitosis, malignant glands lined by cuboidal cells with round nuclei, prominent nucleoli, and eosinophilic cytoplasm. The glands had luminal mucin production (Figure, B). Focally, there were also scattered round cells with abundant eosinophilic, refractile cytoplasm, features of rhabdomyoblasts (Figure, C). These latter cells were strongly positive for desmin (Figure, D) and myogenin. Ethmoid sinus mass. A, Computed tomographic scan. The arrowhead indicates the mass. B, Blastema as indicated by the asterisk and malignant glands as indicated by the arrowhead. C, Rhabdomyoblasts as indicated by the arrowheads (hematoxylin-eosin, original magnification [multiplication sign]40). D, Desmin immunohistochemistry with strong positive staining in the rhabdomyoblasts (original magnification [multiplication sign]20).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Small cell carcinoma\nB. Olfactory neuroblastoma\nC. Sinonasal teratocarcinosarcoma\nD. Alveolar rhabdomyosarcoma\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 50s presented with a 7-month history of worsening, primarily left-sided, sinus obstruction and congestion with associated hyposmia, facial pressure, and headaches. They had no history of sinus disease or surgery and had no epistaxis, weight loss, or visual symptoms. Computed tomography showed a 3.1-cm mass in the left ethmoid sinus and nasal cavity (Figure, A). Positron emission tomographic scanning showed no evidence of metastasis. Nasal endoscopy revealed a friable, polypoid mass in the ethmoid sinus with extension into the nasal cavity and superiorly to the skull base. A biopsy specimen showed a heterogeneous tumor with small, angulated, blue cells with hyperchromatic nuclei, apoptosis, and mitosis, malignant glands lined by cuboidal cells with round nuclei, prominent nucleoli, and eosinophilic cytoplasm. The glands had luminal mucin production (Figure, B). Focally, there were also scattered round cells with abundant eosinophilic, refractile cytoplasm, features of rhabdomyoblasts (Figure, C). These latter cells were strongly positive for desmin (Figure, D) and myogenin. Ethmoid sinus mass. A, Computed tomographic scan. The arrowhead indicates the mass. B, Blastema as indicated by the asterisk and malignant glands as indicated by the arrowhead. C, Rhabdomyoblasts as indicated by the arrowheads (hematoxylin-eosin, original magnification [multiplication sign]40). D, Desmin immunohistochemistry with strong positive staining in the rhabdomyoblasts (original magnification [multiplication sign]20).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Small cell carcinoma\nB. Olfactory neuroblastoma\nC. Sinonasal teratocarcinosarcoma\nD. Alveolar rhabdomyosarcoma\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 late 30s presented to the emergency department for a left eye mass impairing his vision. He reported that he first noticed a small lesion on the nasal conjunctiva of his left eye 6 months earlier; there was rapid growth during the last 2 months. The mass became painful 4 weeks earlier and started to affect his vision 2 weeks earlier. His ocular history included enucleation of his right eye secondary to a traumatic ruptured globe 6 years previously. He denied any systemic medical problems and was not taking any medications. On examination, his visual acuity was no light perception OD (prosthesis) and light perception OS. External examination revealed a well-fitting prosthesis in the right eye with a healthy upper and lower eyelid fornix. The left eye is shown in Figure 1. An incisional biopsy was performed.Clinical photograph at presentation demonstrating a large, hemorrhagic, necrotic mass obscuring the entire globe and eyelids of the left eye.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Enucleation\nB. Testing for human immunodeficiency virus (HIV)\nC. Computed tomographic scan of the orbit\nD. Exenteration\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 their late 30s presented to the emergency department for a left eye mass impairing their vision. They reported that they first noticed a small lesion on the nasal conjunctiva of their left eye 6 months earlier; there was rapid growth during the last 2 months. The mass became painful 4 weeks earlier and started to affect their vision 2 weeks earlier. Their ocular history included enucleation of their right eye secondary to a traumatic ruptured globe 6 years previously. They denied any systemic medical problems and was not taking any medications. On examination, their visual acuity was no light perception OD (prosthesis) and light perception OS. External examination revealed a well-fitting prosthesis in the right eye with a healthy upper and lower eyelid fornix. The left eye is shown in Figure 1. An incisional biopsy was performed.Clinical photograph at presentation demonstrating a large, hemorrhagic, necrotic mass obscuring the entire globe and eyelids of the left eye.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Enucleation\nB. Testing for human immunodeficiency virus (HIV)\nC. Computed tomographic scan of the orbit\nD. Exenteration\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Asian woman in her late 30s presented to the emergency department for a left eye mass impairing her vision. She reported that she first noticed a small lesion on the nasal conjunctiva of her left eye 6 months earlier; there was rapid growth during the last 2 months. The mass became painful 4 weeks earlier and started to affect her vision 2 weeks earlier. Her ocular history included enucleation of her right eye secondary to a traumatic ruptured globe 6 years previously. She denied any systemic medical problems and was not taking any medications. On examination, her visual acuity was no light perception OD (prosthesis) and light perception OS. External examination revealed a well-fitting prosthesis in the right eye with a healthy upper and lower eyelid fornix. The left eye is shown in Figure 1. An incisional biopsy was performed.Clinical photograph at presentation demonstrating a large, hemorrhagic, necrotic mass obscuring the entire globe and eyelids of the left eye.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Enucleation\nB. Testing for human immunodeficiency virus (HIV)\nC. Computed tomographic scan of the orbit\nD. Exenteration\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Black man in his late 30s presented to the emergency department for a left eye mass impairing his vision. He reported that he first noticed a small lesion on the nasal conjunctiva of his left eye 6 months earlier; there was rapid growth during the last 2 months. The mass became painful 4 weeks earlier and started to affect his vision 2 weeks earlier. His ocular history included enucleation of his right eye secondary to a traumatic ruptured globe 6 years previously. He denied any systemic medical problems and was not taking any medications. On examination, his visual acuity was no light perception OD (prosthesis) and light perception OS. External examination revealed a well-fitting prosthesis in the right eye with a healthy upper and lower eyelid fornix. The left eye is shown in Figure 1. An incisional biopsy was performed.Clinical photograph at presentation demonstrating a large, hemorrhagic, necrotic mass obscuring the entire globe and eyelids of the left eye.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Enucleation\nB. Testing for human immunodeficiency virus (HIV)\nC. Computed tomographic scan of the orbit\nD. Exenteration\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 38-year-old woman developed acute painless blurred vision in her right eye 3 weeks after receiving a single injection of corticosteroid in her deltoid for stenosing tenosynovitis. Her medical history was significant for stage II breast carcinoma with positive lymph nodes, which was diagnosed and treated 5 years prior. Subsequent annual metastatic surveillance test results had been negative for recurrence. Visual acuity was 20/60 OD and 20/20 OS. Ophthalmoscopy of the right eye revealed a 6[thin space][multiplication sign][thin space]6-mm circumscribed serous macular detachment with turbid subretinal fluid. Similar lesions were present in the nasal and inferior midperiphery (Figure, A and B). The left eye was unremarkable. Fluorescein angiography (FA) showed hyperfluorescent pinpoint hot spots with interspersed hypofluorescent patches in the areas of the lesions (Figure, C-F). Notably absent on FA were retinal pigment epithelium (RPE) leakage, a smokestack pattern of subretinal leakage, or RPE gutter defects. B-scan ultrasonography demonstrated choroidal thickening nasal to the optic disc (Figure, G); vascularity could not be assessed. Optical coherence tomography (OCT) showed a localized serous macular detachment with a focal area of choriocapillaris infiltration and thickening near the nasal edge of the detachment (Figure, H).Fundus photograph (A-B) of the right eye demonstrates a serous macular detachment with yellowish choroidal discoloration. A, Similar yellowish choroidal lesions (arrowheads) were present in the nasal and inferior midperiphery. B, The enlarged image demonstrates the extent of serous macular detachment (arrowheads). C, Wide-angle fluorescein angiography in the late venous phase of the right eye shows an area between the disc and fovea with scattered hyperfluorescent hotspots. Magnified views of the macular lesion (D), nasal lesion (E), and inferior lesion (F). G, B-scan ultrasonography of the right eye shows a subtle nonspecific choroidal thickening with medium internal reflectivity. The arrowhead points to the choroidal infiltration by the metastatic tumor. H, Spectral-domain optical coherence tomography of the right eye demonstrates serous macular detachment with localized subtle choroidal vascular attenuation, infiltration, and thickening (arrowheads).Blood tests to consider diagnosis of syphilitic chorioretinitis\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Consider managing as multifocal central serous chorioretinopathy\nB. Consider a diagnosis of choroidal metastasis\nC. Blood tests to consider diagnosis of syphilitic chorioretinitis\nD. Obtain workup for Vogt-Koyanagi-Harada syndrome\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 38-year-old Hispanic patient developed acute painless blurred vision in them right eye 3 weeks after receiving a single injection of corticosteroid in them deltoid for stenosing tenosynovitis. Them medical history was significant for stage II breast carcinoma with positive lymph nodes, which was diagnosed and treated 5 years prior. Subsequent annual metastatic surveillance test results had been negative for recurrence. Visual acuity was 20/60 OD and 20/20 OS. Ophthalmoscopy of the right eye revealed a 6[thin space][multiplication sign][thin space]6-mm circumscribed serous macular detachment with turbid subretinal fluid. Similar lesions were present in the nasal and inferior midperiphery (Figure, A and B). The left eye was unremarkable. Fluorescein angiography (FA) showed hyperfluorescent pinpoint hot spots with interspersed hypofluorescent patches in the areas of the lesions (Figure, C-F). Notably absent on FA were retinal pigment epithelium (RPE) leakage, a smokestack pattern of subretinal leakage, or RPE gutter defects. B-scan ultrasonography demonstrated choroidal thickening nasal to the optic disc (Figure, G); vascularity could not be assessed. Optical coherence tomography (OCT) showed a localized serous macular detachment with a focal area of choriocapillaris infiltration and thickening near the nasal edge of the detachment (Figure, H).Fundus photograph (A-B) of the right eye demonstrates a serous macular detachment with yellowish choroidal discoloration. A, Similar yellowish choroidal lesions (arrowheads) were present in the nasal and inferior midperiphery. B, The enlarged image demonstrates the extent of serous macular detachment (arrowheads). C, Wide-angle fluorescein angiography in the late venous phase of the right eye shows an area between the disc and fovea with scattered hyperfluorescent hotspots. Magnified views of the macular lesion (D), nasal lesion (E), and inferior lesion (F). G, B-scan ultrasonography of the right eye shows a subtle nonspecific choroidal thickening with medium internal reflectivity. The arrowhead points to the choroidal infiltration by the metastatic tumor. H, Spectral-domain optical coherence tomography of the right eye demonstrates serous macular detachment with localized subtle choroidal vascular attenuation, infiltration, and thickening (arrowheads).Blood tests to consider diagnosis of syphilitic chorioretinitis\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Consider managing as multifocal central serous chorioretinopathy\nB. Consider a diagnosis of choroidal metastasis\nC. Blood tests to consider diagnosis of syphilitic chorioretinitis\nD. Obtain workup for Vogt-Koyanagi-Harada syndrome\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 38-year-old White man developed acute painless blurred vision in him right eye 3 weeks after receiving a single injection of corticosteroid in him deltoid for stenosing tenosynovitis. Him medical history was significant for stage II breast carcinoma with positive lymph nodes, which was diagnosed and treated 5 years prior. Subsequent annual metastatic surveillance test results had been negative for recurrence. Visual acuity was 20/60 OD and 20/20 OS. Ophthalmoscopy of the right eye revealed a 6[thin space][multiplication sign][thin space]6-mm circumscribed serous macular detachment with turbid subretinal fluid. Similar lesions were present in the nasal and inferior midperiphery (Figure, A and B). The left eye was unremarkable. Fluorescein angiography (FA) showed hyperfluorescent pinpoint hot spots with interspersed hypofluorescent patches in the areas of the lesions (Figure, C-F). Notably absent on FA were retinal pigment epithelium (RPE) leakage, a smokestack pattern of subretinal leakage, or RPE gutter defects. B-scan ultrasonography demonstrated choroidal thickening nasal to the optic disc (Figure, G); vascularity could not be assessed. Optical coherence tomography (OCT) showed a localized serous macular detachment with a focal area of choriocapillaris infiltration and thickening near the nasal edge of the detachment (Figure, H).Fundus photograph (A-B) of the right eye demonstrates a serous macular detachment with yellowish choroidal discoloration. A, Similar yellowish choroidal lesions (arrowheads) were present in the nasal and inferior midperiphery. B, The enlarged image demonstrates the extent of serous macular detachment (arrowheads). C, Wide-angle fluorescein angiography in the late venous phase of the right eye shows an area between the disc and fovea with scattered hyperfluorescent hotspots. Magnified views of the macular lesion (D), nasal lesion (E), and inferior lesion (F). G, B-scan ultrasonography of the right eye shows a subtle nonspecific choroidal thickening with medium internal reflectivity. The arrowhead points to the choroidal infiltration by the metastatic tumor. H, Spectral-domain optical coherence tomography of the right eye demonstrates serous macular detachment with localized subtle choroidal vascular attenuation, infiltration, and thickening (arrowheads).Blood tests to consider diagnosis of syphilitic chorioretinitis\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Consider managing as multifocal central serous chorioretinopathy\nB. Consider a diagnosis of choroidal metastasis\nC. Blood tests to consider diagnosis of syphilitic chorioretinitis\nD. Obtain workup for Vogt-Koyanagi-Harada syndrome\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 38-year-old Arab woman developed acute painless blurred vision in her right eye 3 weeks after receiving a single injection of corticosteroid in her deltoid for stenosing tenosynovitis. Her medical history was significant for stage II breast carcinoma with positive lymph nodes, which was diagnosed and treated 5 years prior. Subsequent annual metastatic surveillance test results had been negative for recurrence. Visual acuity was 20/60 OD and 20/20 OS. Ophthalmoscopy of the right eye revealed a 6[thin space][multiplication sign][thin space]6-mm circumscribed serous macular detachment with turbid subretinal fluid. Similar lesions were present in the nasal and inferior midperiphery (Figure, A and B). The left eye was unremarkable. Fluorescein angiography (FA) showed hyperfluorescent pinpoint hot spots with interspersed hypofluorescent patches in the areas of the lesions (Figure, C-F). Notably absent on FA were retinal pigment epithelium (RPE) leakage, a smokestack pattern of subretinal leakage, or RPE gutter defects. B-scan ultrasonography demonstrated choroidal thickening nasal to the optic disc (Figure, G); vascularity could not be assessed. Optical coherence tomography (OCT) showed a localized serous macular detachment with a focal area of choriocapillaris infiltration and thickening near the nasal edge of the detachment (Figure, H).Fundus photograph (A-B) of the right eye demonstrates a serous macular detachment with yellowish choroidal discoloration. A, Similar yellowish choroidal lesions (arrowheads) were present in the nasal and inferior midperiphery. B, The enlarged image demonstrates the extent of serous macular detachment (arrowheads). C, Wide-angle fluorescein angiography in the late venous phase of the right eye shows an area between the disc and fovea with scattered hyperfluorescent hotspots. Magnified views of the macular lesion (D), nasal lesion (E), and inferior lesion (F). G, B-scan ultrasonography of the right eye shows a subtle nonspecific choroidal thickening with medium internal reflectivity. The arrowhead points to the choroidal infiltration by the metastatic tumor. H, Spectral-domain optical coherence tomography of the right eye demonstrates serous macular detachment with localized subtle choroidal vascular attenuation, infiltration, and thickening (arrowheads).Blood tests to consider diagnosis of syphilitic chorioretinitis\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Consider managing as multifocal central serous chorioretinopathy\nB. Consider a diagnosis of choroidal metastasis\nC. Blood tests to consider diagnosis of syphilitic chorioretinitis\nD. Obtain workup for Vogt-Koyanagi-Harada syndrome\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 7-year-old girl presented to the dermatology clinic with a 4-week history of progressive nail changes. Her mother reported a sudden onset of brittle nails with cracks followed by painless sloughing of nails. Initially only the fingernails had been affected, but the toenails soon showed the same pathology. The family was concerned and suspected an internal disease or vitamin deficiency. The child was otherwise well and no previous skin or nail conditions were known. On clinical examination, most fingernails showed semilunar whitish grooves in the middle of the nail plate (Figure, A). The toenails had transverse partial cracks of the proximal nail plate with distal onycholysis but normal proximal nail growth (Figure, B).Findings on clinical examination. A, Fingernails showed semilunar whitish grooves in the middle of the nail plate. B, Toenails had transverse partial cracks of the proximal nail plate with distal onycholysis.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Vaccination reaction\nB. Kawasaki syndrome\nC. Drug intake\nD. Hand-foot-and-mouth 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 7-year-old Asian boy presented to the dermatology clinic with a 4-week history of progressive nail changes. Him mother reported a sudden onset of brittle nails with cracks followed by painless sloughing of nails. Initially only the fingernails had been affected, but the toenails soon showed the same pathology. The family was concerned and suspected an internal disease or vitamin deficiency. The Asian child was otherwise well and no previous skin or nail conditions were known. On clinical examination, most fingernails showed semilunar whitish grooves in the middle of the nail plate (Figure, A). The toenails had transverse partial cracks of the proximal nail plate with distal onycholysis but normal proximal nail growth (Figure, B).Findings on clinical examination. A, Fingernails showed semilunar whitish grooves in the middle of the nail plate. B, Toenails had transverse partial cracks of the proximal nail plate with distal onycholysis.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Vaccination reaction\nB. Kawasaki syndrome\nC. Drug intake\nD. Hand-foot-and-mouth 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 7-year-old Black child presented to the dermatology clinic with a 4-week history of progressive nail changes. Them mother reported a sudden onset of brittle nails with cracks followed by painless sloughing of nails. Initially only the fingernails had been affected, but the toenails soon showed the same pathology. The family was concerned and suspected an internal disease or vitamin deficiency. The Black child was otherwise well and no previous skin or nail conditions were known. On clinical examination, most fingernails showed semilunar whitish grooves in the middle of the nail plate (Figure, A). The toenails had transverse partial cracks of the proximal nail plate with distal onycholysis but normal proximal nail growth (Figure, B).Findings on clinical examination. A, Fingernails showed semilunar whitish grooves in the middle of the nail plate. B, Toenails had transverse partial cracks of the proximal nail plate with distal onycholysis.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Vaccination reaction\nB. Kawasaki syndrome\nC. Drug intake\nD. Hand-foot-and-mouth 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 7-year-old Hispanic girl presented to the dermatology clinic with a 4-week history of progressive nail changes. Her mother reported a sudden onset of brittle nails with cracks followed by painless sloughing of nails. Initially only the fingernails had been affected, but the toenails soon showed the same pathology. The family was concerned and suspected an internal disease or vitamin deficiency. The Hispanic child was otherwise well and no previous skin or nail conditions were known. On clinical examination, most fingernails showed semilunar whitish grooves in the middle of the nail plate (Figure, A). The toenails had transverse partial cracks of the proximal nail plate with distal onycholysis but normal proximal nail growth (Figure, B).Findings on clinical examination. A, Fingernails showed semilunar whitish grooves in the middle of the nail plate. B, Toenails had transverse partial cracks of the proximal nail plate with distal onycholysis.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Vaccination reaction\nB. Kawasaki syndrome\nC. Drug intake\nD. Hand-foot-and-mouth 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 man in his 60s presented for further evaluation of a right inguinal and scrotal lesion (Figure 1). The rash initially started 4 years prior as a dime-sized, pink, scaly area in the right inguinal crease and was pruritic. Results of a biopsy at the time were consistent with lichen simplex chronicus, and treatment with topical steroids was initiated. Since then, the rash had failed to resolve and the affected area had increased in size to its present dimensions. The patient had a history of prostate cancer treated with prostatectomy 4 years previously without evidence of recurrence and melanoma of the posterior neck treated with wide local excision, in addition to non[en dash]insulin-dependent diabetes mellitus and hyperlipidemia controlled with oral medications. He does not smoke and has been in a monogamous marriage for more than 30 years. Examination revealed a multifocal scaly, pink-red beefy plaque in the right inguinal crease extending from the superior aspect of the scrotum to the gluteal crease measuring approximately 6[thin space][multiplication sign][thin space]7 cm in total area with some areas of excoriation and superficial open wounds. An additional area of macular erythema extended superiorly along the inguinal crease toward the medial thigh. No lymphadenopathy of the inguinal region was noted.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Fungal infection\nB. Extramammary Paget disease\nC. Lichen sclerosis\nD. Bowen disease\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 60s presented for further evaluation of a right inguinal and scrotal lesion (Figure 1). The rash initially started 4 years prior as a dime-sized, pink, scaly area in the right inguinal crease and was pruritic. Results of a biopsy at the time were consistent with lichen simplex chronicus, and treatment with topical steroids was initiated. Since then, the rash had failed to resolve and the affected area had increased in size to its present dimensions. The White patient had a history of prostate cancer treated with prostatectomy 4 years previously without evidence of recurrence and melanoma of the posterior neck treated with wide local excision, in addition to non[en dash]insulin-dependent diabetes mellitus and hyperlipidemia controlled with oral medications. He does not smoke and has been in a monogamous marriage for more than 30 years. Examination revealed a multifocal scaly, pink-red beefy plaque in the right inguinal crease extending from the superior aspect of the scrotum to the gluteal crease measuring approximately 6[thin space][multiplication sign][thin space]7 cm in total area with some areas of excoriation and superficial open wounds. An additional area of macular erythema extended superiorly along the inguinal crease toward the medial thigh. No lymphadenopathy of the inguinal region was noted.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Fungal infection\nB. Extramammary Paget disease\nC. Lichen sclerosis\nD. Bowen disease\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 60s presented for further evaluation of a right inguinal and scrotal lesion (Figure 1). The rash initially started 4 years prior as a dime-sized, pink, scaly area in the right inguinal crease and was pruritic. Results of a biopsy at the time were consistent with lichen simplex chronicus, and treatment with topical steroids was initiated. Since then, the rash had failed to resolve and the affected area had increased in size to its present dimensions. The Arab woman had a history of prostate cancer treated with prostatectomy 4 years previously without evidence of recurrence and melanoma of the posterior neck treated with wide local excision, in addition to non[en dash]insulin-dependent diabetes mellitus and hyperlipidemia controlled with oral medications. She does not smoke and has been in a monogamous marriage for more than 30 years. Examination revealed a multifocal scaly, pink-red beefy plaque in the right inguinal crease extending from the superior aspect of the scrotum to the gluteal crease measuring approximately 6[thin space][multiplication sign][thin space]7 cm in total area with some areas of excoriation and superficial open wounds. An additional area of macular erythema extended superiorly along the inguinal crease toward the medial thigh. No lymphadenopathy of the inguinal region was noted.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Fungal infection\nB. Extramammary Paget disease\nC. Lichen sclerosis\nD. Bowen disease\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 60s presented for further evaluation of a right inguinal and scrotal lesion (Figure 1). The rash initially started 4 years prior as a dime-sized, pink, scaly area in the right inguinal crease and was pruritic. Results of a biopsy at the time were consistent with lichen simplex chronicus, and treatment with topical steroids was initiated. Since then, the rash had failed to resolve and the affected area had increased in size to its present dimensions. The Asian patient had a history of prostate cancer treated with prostatectomy 4 years previously without evidence of recurrence and melanoma of the posterior neck treated with wide local excision, in addition to non[en dash]insulin-dependent diabetes mellitus and hyperlipidemia controlled with oral medications. They does not smoke and has been in a monogamous marriage for more than 30 years. Examination revealed a multifocal scaly, pink-red beefy plaque in the right inguinal crease extending from the superior aspect of the scrotum to the gluteal crease measuring approximately 6[thin space][multiplication sign][thin space]7 cm in total area with some areas of excoriation and superficial open wounds. An additional area of macular erythema extended superiorly along the inguinal crease toward the medial thigh. No lymphadenopathy of the inguinal region was noted.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Fungal infection\nB. Extramammary Paget disease\nC. Lichen sclerosis\nD. Bowen disease\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 50s who previously underwent renal transplantation for polycystic kidney disease presented with worsening chronic malaise, fatigue, dyspnea, early satiety, and abdominal distention with extreme discomfort. An abdominal magnetic resonance image is shown in Figure 1A. Given the symptoms and magnetic resonance imaging findings, the patient was eventually taken to the operating room. Laparotomy exposed a giant multinodular mass (Figure 1B).A, Abdominal magnetic resonance image. B,Intraoperative photograph of the giant multinodular mass occupying most of the upper abdomen.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Caroli disease\nB. Recurrence of polycystic kidney disease\nC. Polycystic liver disease\nD. De novo kidney graft tumor\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Black woman in her 50s who previously underwent renal transplantation for polycystic kidney disease presented with worsening chronic malaise, fatigue, dyspnea, early satiety, and abdominal distention with extreme discomfort. An abdominal magnetic resonance image is shown in Figure 1A. Given the symptoms and magnetic resonance imaging findings, the Black woman was eventually taken to the operating room. Laparotomy exposed a giant multinodular mass (Figure 1B).A, Abdominal magnetic resonance image. B,Intraoperative photograph of the giant multinodular mass occupying most of the upper abdomen.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Caroli disease\nB. Recurrence of polycystic kidney disease\nC. Polycystic liver disease\nD. De novo kidney graft tumor\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 patient in their 50s who previously underwent renal transplantation for polycystic kidney disease presented with worsening chronic malaise, fatigue, dyspnea, early satiety, and abdominal distention with extreme discomfort. An abdominal magnetic resonance image is shown in Figure 1A. Given the symptoms and magnetic resonance imaging findings, the Hispanic patient was eventually taken to the operating room. Laparotomy exposed a giant multinodular mass (Figure 1B).A, Abdominal magnetic resonance image. B,Intraoperative photograph of the giant multinodular mass occupying most of the upper abdomen.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Caroli disease\nB. Recurrence of polycystic kidney disease\nC. Polycystic liver disease\nD. De novo kidney graft tumor\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 man in his 50s who previously underwent renal transplantation for polycystic kidney disease presented with worsening chronic malaise, fatigue, dyspnea, early satiety, and abdominal distention with extreme discomfort. An abdominal magnetic resonance image is shown in Figure 1A. Given the symptoms and magnetic resonance imaging findings, the White patient was eventually taken to the operating room. Laparotomy exposed a giant multinodular mass (Figure 1B).A, Abdominal magnetic resonance image. B,Intraoperative photograph of the giant multinodular mass occupying most of the upper abdomen.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Caroli disease\nB. Recurrence of polycystic kidney disease\nC. Polycystic liver disease\nD. De novo kidney graft tumor\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 30s presented with gradually worsening abdominal pain and was found to have hyponatremia. A glioma of the optic chiasm was treated 20 years prior with chemotherapy and radiation. Sequelae included chronic headaches, anterior hypopituitarism, and hydrocephalus necessitating a ventriculoperitoneal shunt. Medications included analgesics, cyclobenzaprine, sumatriptan, ondansetron, divalproex sodium, gabapentin, furosemide, somatotropin, potassium chloride, vitamin D, and estrogen. Haloperidol was recently added. Blood pressure was 125/87 mm Hg. Mucosae were moist and jugular venous pressure was not well seen. Her cardiopulmonary and abdominal examinations were normal, peripheral edema was absent, and sensorium was clear. Table 1 shows initial laboratory data.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. The patient has hypervolemic hypotonic hyponatremia.\nB. The patient has euvolemic hypotonic hyponatremia.\nC. The patient has hypovolemic hypotonic hyponatremia.\nD. The patient has hypervolemic hypertonic hyponatremia.\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 30s presented with gradually worsening abdominal pain and was found to have hyponatremia. A glioma of the optic chiasm was treated 20 years prior with chemotherapy and radiation. Sequelae included chronic headaches, anterior hypopituitarism, and hydrocephalus necessitating a ventriculoperitoneal shunt. Medications included analgesics, cyclobenzaprine, sumatriptan, ondansetron, divalproex sodium, gabapentin, furosemide, somatotropin, potassium chloride, vitamin D, and estrogen. Haloperidol was recently added. Blood pressure was 125/87 mm Hg. Mucosae were moist and jugular venous pressure was not well seen. Her cardiopulmonary and abdominal examinations were normal, peripheral edema was absent, and sensorium was clear. Table 1 shows initial laboratory data.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. The patient has hypervolemic hypotonic hyponatremia.\nB. The patient has euvolemic hypotonic hyponatremia.\nC. The patient has hypovolemic hypotonic hyponatremia.\nD. The patient has hypervolemic hypertonic hyponatremia.\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 30s presented with gradually worsening abdominal pain and was found to have hyponatremia. A glioma of the optic chiasm was treated 20 years prior with chemotherapy and radiation. Sequelae included chronic headaches, anterior hypopituitarism, and hydrocephalus necessitating a ventriculoperitoneal shunt. Medications included analgesics, cyclobenzaprine, sumatriptan, ondansetron, divalproex sodium, gabapentin, furosemide, somatotropin, potassium chloride, vitamin D, and estrogen. Haloperidol was recently added. Blood pressure was 125/87 mm Hg. Mucosae were moist and jugular venous pressure was not well seen. Him cardiopulmonary and abdominal examinations were normal, peripheral edema was absent, and sensorium was clear. Table 1 shows initial laboratory data.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. The patient has hypervolemic hypotonic hyponatremia.\nB. The patient has euvolemic hypotonic hyponatremia.\nC. The patient has hypovolemic hypotonic hyponatremia.\nD. The patient has hypervolemic hypertonic hyponatremia.\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 patient in them 30s presented with gradually worsening abdominal pain and was found to have hyponatremia. A glioma of the optic chiasm was treated 20 years prior with chemotherapy and radiation. Sequelae included chronic headaches, anterior hypopituitarism, and hydrocephalus necessitating a ventriculoperitoneal shunt. Medications included analgesics, cyclobenzaprine, sumatriptan, ondansetron, divalproex sodium, gabapentin, furosemide, somatotropin, potassium chloride, vitamin D, and estrogen. Haloperidol was recently added. Blood pressure was 125/87 mm Hg. Mucosae were moist and jugular venous pressure was not well seen. Them cardiopulmonary and abdominal examinations were normal, peripheral edema was absent, and sensorium was clear. Table 1 shows initial laboratory data.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. The patient has hypervolemic hypotonic hyponatremia.\nB. The patient has euvolemic hypotonic hyponatremia.\nC. The patient has hypovolemic hypotonic hyponatremia.\nD. The patient has hypervolemic hypertonic hyponatremia.\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 82-year-old man presented with intractable pruritus of several months[right single quotation mark] duration and a skin eruption. He reported being diagnosed with dermatitis herpetiformis more than 20 years ago and receiving sulfapyridine and dapsone for treatment. He stopped taking these medications because of limited benefit and concern about nephrotoxicity. Since then, he was treated with periodic courses of oral antibiotics and oral corticosteroids. Recently, extensive skin disease and pruritus developed. He noted 20 years of chronic diarrhea, which improved with a gluten-free diet, in addition to chronic renal insufficiency, hypothyroidism, and aortic stenosis. Physical examination revealed diffuse erosions with grouped papules and vesicles on his bilateral extremities, elbow and knee extensors, chest, back, buttocks, face, and scalp (Figure 1). Examination also revealed extensive excoriations, as well as superficial honey-colored crusts. A few possible burrows were noted on his wrists.Grouped papules, vesicles, and erosions of chest and elbow extensors (left) and back (right; inset is a close-up view).Obtain complete blood cell count and creatinine level\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain complete blood cell count and creatinine level\nB. Examine for infestation with scabies\nC. Obtain a chest radiograph\nD. Perform skin biopsy and direct immunofluorescence\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 82-year-old Hispanic man presented with intractable pruritus of several months[right single quotation mark] duration and a skin eruption. He reported being diagnosed with dermatitis herpetiformis more than 20 years ago and receiving sulfapyridine and dapsone for treatment. He stopped taking these medications because of limited benefit and concern about nephrotoxicity. Since then, he was treated with periodic courses of oral antibiotics and oral corticosteroids. Recently, extensive skin disease and pruritus developed. He noted 20 years of chronic diarrhea, which improved with a gluten-free diet, in addition to chronic renal insufficiency, hypothyroidism, and aortic stenosis. Physical examination revealed diffuse erosions with grouped papules and vesicles on his bilateral extremities, elbow and knee extensors, chest, back, buttocks, face, and scalp (Figure 1). Examination also revealed extensive excoriations, as well as superficial honey-colored crusts. A few possible burrows were noted on his wrists.Grouped papules, vesicles, and erosions of chest and elbow extensors (left) and back (right; inset is a close-up view).Obtain complete blood cell count and creatinine level\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain complete blood cell count and creatinine level\nB. Examine for infestation with scabies\nC. Obtain a chest radiograph\nD. Perform skin biopsy and direct immunofluorescence\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 82-year-old White woman presented with intractable pruritus of several months[right single quotation mark] duration and a skin eruption. She reported being diagnosed with dermatitis herpetiformis more than 20 years ago and receiving sulfapyridine and dapsone for treatment. She stopped taking these medications because of limited benefit and concern about nephrotoxicity. Since then, she was treated with periodic courses of oral antibiotics and oral corticosteroids. Recently, extensive skin disease and pruritus developed. She noted 20 years of chronic diarrhea, which improved with a gluten-free diet, in addition to chronic renal insufficiency, hypothyroidism, and aortic stenosis. Physical examination revealed diffuse erosions with grouped papules and vesicles on her bilateral extremities, elbow and knee extensors, chest, back, buttocks, face, and scalp (Figure 1). Examination also revealed extensive excoriations, as well as superficial honey-colored crusts. A few possible burrows were noted on her wrists.Grouped papules, vesicles, and erosions of chest and elbow extensors (left) and back (right; inset is a close-up view).Obtain complete blood cell count and creatinine level\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain complete blood cell count and creatinine level\nB. Examine for infestation with scabies\nC. Obtain a chest radiograph\nD. Perform skin biopsy and direct immunofluorescence\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 82-year-old Arab patient presented with intractable pruritus of several months[right single quotation mark] duration and a skin eruption. They reported being diagnosed with dermatitis herpetiformis more than 20 years ago and receiving sulfapyridine and dapsone for treatment. They stopped taking these medications because of limited benefit and concern about nephrotoxicity. Since then, they was treated with periodic courses of oral antibiotics and oral corticosteroids. Recently, extensive skin disease and pruritus developed. They noted 20 years of chronic diarrhea, which improved with a gluten-free diet, in addition to chronic renal insufficiency, hypothyroidism, and aortic stenosis. Physical examination revealed diffuse erosions with grouped papules and vesicles on their bilateral extremities, elbow and knee extensors, chest, back, buttocks, face, and scalp (Figure 1). Examination also revealed extensive excoriations, as well as superficial honey-colored crusts. A few possible burrows were noted on their wrists.Grouped papules, vesicles, and erosions of chest and elbow extensors (left) and back (right; inset is a close-up view).Obtain complete blood cell count and creatinine level\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain complete blood cell count and creatinine level\nB. Examine for infestation with scabies\nC. Obtain a chest radiograph\nD. Perform skin biopsy and direct immunofluorescence\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 91-year-old woman with a history of hypertension, hypercholesterolemia, and stage 3 renal insufficiency presented for a routine office visit. She reported no chest pain, dyspnea on exertion, presyncope, orthopnea, paroxysmal nocturnal dyspnea, or pedal edema.Physical examination demonstrated blood pressure of 140/76 mm Hg and a heart rate of 72/min. Carotid upstrokes were slightly delayed with a transmitted murmur. Lungs were clear bilaterally. Cardiac examination demonstrated a regular rate and rhythm, normal S1, 3/6 harsh, late-peaking systolic murmur that radiated to the carotids with soft A2, 2/4 diastolic decrescendo murmur at the left lower sternal border, and 2/6 holosystolic murmur at the apex. Distal pulses were 2+ bilaterally. There was no edema.A 2-D and Doppler transthoracic echocardiogram (TTE) was performed to assess valvular function (Table; Interactive).The patient has functional mitral regurgitation secondary to a dilated cardiomyopathy.The patient has moderate aortic valve stenosis with the severity overestimated by Doppler measurements.The patient has severe aortic valve stenosis with preserved left ventricular systolic function.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. The patient has functional mitral regurgitation secondary to a dilated cardiomyopathy.\nB. The patient has moderate aortic valve stenosis with the severity overestimated by Doppler measurements.\nC. The patient has obstructive hypertrophic cardiomyopathy.\nD. The patient has severe aortic valve stenosis with preserved left ventricular systolic function.\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 91-year-old Asian man with a history of hypertension, hypercholesterolemia, and stage 3 renal insufficiency presented for a routine office visit. He reported no chest pain, dyspnea on exertion, presyncope, orthopnea, paroxysmal nocturnal dyspnea, or pedal edema.Physical examination demonstrated blood pressure of 140/76 mm Hg and a heart rate of 72/min. Carotid upstrokes were slightly delayed with a transmitted murmur. Lungs were clear bilaterally. Cardiac examination demonstrated a regular rate and rhythm, normal S1, 3/6 harsh, late-peaking systolic murmur that radiated to the carotids with soft A2, 2/4 diastolic decrescendo murmur at the left lower sternal border, and 2/6 holosystolic murmur at the apex. Distal pulses were 2+ bilaterally. There was no edema.A 2-D and Doppler transthoracic echocardiogram (TTE) was performed to assess valvular function (Table; Interactive).The Asian man has functional mitral regurgitation secondary to a dilated cardiomyopathy.The Asian man has moderate aortic valve stenosis with the severity overestimated by Doppler measurements.The Asian man has severe aortic valve stenosis with preserved left ventricular systolic function.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. The patient has functional mitral regurgitation secondary to a dilated cardiomyopathy.\nB. The patient has moderate aortic valve stenosis with the severity overestimated by Doppler measurements.\nC. The patient has obstructive hypertrophic cardiomyopathy.\nD. The patient has severe aortic valve stenosis with preserved left ventricular systolic function.\n</options>" }, { "role": "assistant", "content": "D" } ]