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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 91-year-old Black patient with a history of hypertension, hypercholesterolemia, and stage 3 renal insufficiency presented for a routine office visit. They 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 Black patient has functional mitral regurgitation secondary to a dilated cardiomyopathy.The Black patient has moderate aortic valve stenosis with the severity overestimated by Doppler measurements.The Black 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 Hispanic 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 Hispanic patient has functional mitral regurgitation secondary to a dilated cardiomyopathy.The Hispanic patient has moderate aortic valve stenosis with the severity overestimated by Doppler measurements.The Hispanic 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 55-year-old man presenting to the emergency department reported blurry vision in his right eye during the past week. He also noticed rhythmic pulsing sounds in both ears during the past month. Past medical history was significant only for well-controlled hypertension treated with irbesartan (300 mg daily) and poor vision in the left eye for many years attributable to presumed inactive ocular histoplasmosis.On presentation, the patient appeared well, with blood pressure of 140/70 mm Hg and a regular heart rate of 75/min. Best corrected visual acuity was 20/200 (right eye) and counting fingers at 1 foot (left eye). Direct ophthalmoscopy revealed severe bilateral optic disc edema, peripapillary hemorrhages, and absent spontaneous venous pulsations (Figure 1). Findings from a full neurologic examination were otherwise normal. Findings from a plain computed tomography (CT) scan of the head were normal apart from multiple bony sclerotic lesions seen in the calvarium, skull base, and C1 vertebra.Optic nerve photographs demonstrating severe bilateral optic disc edema with peripapillary hemorrhages.Perform lumbar puncture with patient in upright position to measure opening pressure and examine cerebrospinal fluid (CSF) componentsOrder magnetic resonance imaging (MRI) or magnetic resonance venography (MRV) of the brain and orbits\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Order magnetic resonance imaging (MRI) or magnetic resonance venography (MRV) of the brain and orbits\nB. Perform lumbar puncture with patient in upright position to measure opening pressure and examine cerebrospinal fluid (CSF) components\nC. Perform serum and urine protein electrophoresis\nD. Perform skeletal survey\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 55-year-old White patient presenting to the emergency department reported blurry vision in their right eye during the past week. They also noticed rhythmic pulsing sounds in both ears during the past month. Past medical history was significant only for well-controlled hypertension treated with irbesartan (300 mg daily) and poor vision in the left eye for many years attributable to presumed inactive ocular histoplasmosis.On presentation, the White patient appeared well, with blood pressure of 140/70 mm Hg and a regular heart rate of 75/min. Best corrected visual acuity was 20/200 (right eye) and counting fingers at 1 foot (left eye). Direct ophthalmoscopy revealed severe bilateral optic disc edema, peripapillary hemorrhages, and absent spontaneous venous pulsations (Figure 1). Findings from a full neurologic examination were otherwise normal. Findings from a plain computed tomography (CT) scan of the head were normal apart from multiple bony sclerotic lesions seen in the calvarium, skull base, and C1 vertebra.Optic nerve photographs demonstrating severe bilateral optic disc edema with peripapillary hemorrhages.Perform lumbar puncture with White patient in upright position to measure opening pressure and examine cerebrospinal fluid (CSF) componentsOrder magnetic resonance imaging (MRI) or magnetic resonance venography (MRV) of the brain and orbits\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Order magnetic resonance imaging (MRI) or magnetic resonance venography (MRV) of the brain and orbits\nB. Perform lumbar puncture with patient in upright position to measure opening pressure and examine cerebrospinal fluid (CSF) components\nC. Perform serum and urine protein electrophoresis\nD. Perform skeletal survey\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 55-year-old Arab woman presenting to the emergency department reported blurry vision in her right eye during the past week. She also noticed rhythmic pulsing sounds in both ears during the past month. Past medical history was significant only for well-controlled hypertension treated with irbesartan (300 mg daily) and poor vision in the left eye for many years attributable to presumed inactive ocular histoplasmosis.On presentation, the Arab woman appeared well, with blood pressure of 140/70 mm Hg and a regular heart rate of 75/min. Best corrected visual acuity was 20/200 (right eye) and counting fingers at 1 foot (left eye). Direct ophthalmoscopy revealed severe bilateral optic disc edema, peripapillary hemorrhages, and absent spontaneous venous pulsations (Figure 1). Findings from a full neurologic examination were otherwise normal. Findings from a plain computed tomography (CT) scan of the head were normal apart from multiple bony sclerotic lesions seen in the calvarium, skull base, and C1 vertebra.Optic nerve photographs demonstrating severe bilateral optic disc edema with peripapillary hemorrhages.Perform lumbar puncture with Arab woman in upright position to measure opening pressure and examine cerebrospinal fluid (CSF) componentsOrder magnetic resonance imaging (MRI) or magnetic resonance venography (MRV) of the brain and orbits\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Order magnetic resonance imaging (MRI) or magnetic resonance venography (MRV) of the brain and orbits\nB. Perform lumbar puncture with patient in upright position to measure opening pressure and examine cerebrospinal fluid (CSF) components\nC. Perform serum and urine protein electrophoresis\nD. Perform skeletal survey\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 55-year-old Asian man presenting to the emergency department reported blurry vision in his right eye during the past week. He also noticed rhythmic pulsing sounds in both ears during the past month. Past medical history was significant only for well-controlled hypertension treated with irbesartan (300 mg daily) and poor vision in the left eye for many years attributable to presumed inactive ocular histoplasmosis.On presentation, the Asian patient appeared well, with blood pressure of 140/70 mm Hg and a regular heart rate of 75/min. Best corrected visual acuity was 20/200 (right eye) and counting fingers at 1 foot (left eye). Direct ophthalmoscopy revealed severe bilateral optic disc edema, peripapillary hemorrhages, and absent spontaneous venous pulsations (Figure 1). Findings from a full neurologic examination were otherwise normal. Findings from a plain computed tomography (CT) scan of the head were normal apart from multiple bony sclerotic lesions seen in the calvarium, skull base, and C1 vertebra.Optic nerve photographs demonstrating severe bilateral optic disc edema with peripapillary hemorrhages.Perform lumbar puncture with Asian patient in upright position to measure opening pressure and examine cerebrospinal fluid (CSF) componentsOrder magnetic resonance imaging (MRI) or magnetic resonance venography (MRV) of the brain and orbits\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Order magnetic resonance imaging (MRI) or magnetic resonance venography (MRV) of the brain and orbits\nB. Perform lumbar puncture with patient in upright position to measure opening pressure and examine cerebrospinal fluid (CSF) components\nC. Perform serum and urine protein electrophoresis\nD. Perform skeletal survey\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 60s presented with a slowly enlarging, painful mass on his buttock. He recalled that a small lesion had appeared approximately 8 months prior, and over the past several months he had noted significant growth and pain. A nonpruritic rash had also become apparent on his forearms and thighs. Physical examination showed a 2-cm macerated pedunculated growth on the left buttock within the intergluteal cleft (Figure, A). An erythematous rash was noted on the forearms and thighs with fine scale present at the wrists.A, Photograph of a 2-cm macerated pedunculated growth on the left buttock. B, Histopathologic image of an exophytic growth on the buttock with marked epidermal hyperplasia (hematoxylin-eosin, original magnification [multiplication sign]40). C, Histopathologic image of immunohistochemical staining for spirochetes (original magnification [multiplication sign]400).A shave biopsy specimen of the exophytic growth on the buttock revealed marked epidermal hyperplasia (Figure, B) with a dense dermal infiltrate containing lymphocytes and plasma cells.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Granuloma inguinale\nB. Condyloma acuminata\nC. Condyloma lata\nD. Verrucous herpes simplex virus\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 60s presented with a slowly enlarging, painful mass on her buttock. She recalled that a small lesion had appeared approximately 8 months prior, and over the past several months she had noted significant growth and pain. A nonpruritic rash had also become apparent on her forearms and thighs. Physical examination showed a 2-cm macerated pedunculated growth on the left buttock within the intergluteal cleft (Figure, A). An erythematous rash was noted on the forearms and thighs with fine scale present at the wrists.A, Photograph of a 2-cm macerated pedunculated growth on the left buttock. B, Histopathologic image of an exophytic growth on the buttock with marked epidermal hyperplasia (hematoxylin-eosin, original magnification [multiplication sign]40). C, Histopathologic image of immunohistochemical staining for spirochetes (original magnification [multiplication sign]400).A shave biopsy specimen of the exophytic growth on the buttock revealed marked epidermal hyperplasia (Figure, B) with a dense dermal infiltrate containing lymphocytes and plasma cells.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Granuloma inguinale\nB. Condyloma acuminata\nC. Condyloma lata\nD. Verrucous herpes simplex virus\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Hispanic man in his 60s presented with a slowly enlarging, painful mass on his buttock. He recalled that a small lesion had appeared approximately 8 months prior, and over the past several months he had noted significant growth and pain. A nonpruritic rash had also become apparent on his forearms and thighs. Physical examination showed a 2-cm macerated pedunculated growth on the left buttock within the intergluteal cleft (Figure, A). An erythematous rash was noted on the forearms and thighs with fine scale present at the wrists.A, Photograph of a 2-cm macerated pedunculated growth on the left buttock. B, Histopathologic image of an exophytic growth on the buttock with marked epidermal hyperplasia (hematoxylin-eosin, original magnification [multiplication sign]40). C, Histopathologic image of immunohistochemical staining for spirochetes (original magnification [multiplication sign]400).A shave biopsy specimen of the exophytic growth on the buttock revealed marked epidermal hyperplasia (Figure, B) with a dense dermal infiltrate containing lymphocytes and plasma cells.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Granuloma inguinale\nB. Condyloma acuminata\nC. Condyloma lata\nD. Verrucous herpes simplex virus\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 60s presented with a slowly enlarging, painful mass on their buttock. They recalled that a small lesion had appeared approximately 8 months prior, and over the past several months they had noted significant growth and pain. A nonpruritic rash had also become apparent on their forearms and thighs. Physical examination showed a 2-cm macerated pedunculated growth on the left buttock within the intergluteal cleft (Figure, A). An erythematous rash was noted on the forearms and thighs with fine scale present at the wrists.A, Photograph of a 2-cm macerated pedunculated growth on the left buttock. B, Histopathologic image of an exophytic growth on the buttock with marked epidermal hyperplasia (hematoxylin-eosin, original magnification [multiplication sign]40). C, Histopathologic image of immunohistochemical staining for spirochetes (original magnification [multiplication sign]400).A shave biopsy specimen of the exophytic growth on the buttock revealed marked epidermal hyperplasia (Figure, B) with a dense dermal infiltrate containing lymphocytes and plasma cells.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Granuloma inguinale\nB. Condyloma acuminata\nC. Condyloma lata\nD. Verrucous herpes simplex virus\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 40-year-old man, who resided in the eastern part of India, was referred to us from the department of otorhinolaryngology for evaluation of a nonhealing ulcer on the tongue present for the last 4 months. The lesion had started as a small painless mass on the right lateral aspect of the tongue, which gradually grew and subsequently ulcerated. It was asymptomatic except for causing mild difficulty in eating. The patient could not recall any history of trauma or tongue bite preceding the lesion. He denied consuming tobacco or alcohol regularly. He had type 2 diabetes mellitus for 2 years, which was well controlled with oral hypoglycemic agents. The patient had no systemic complaints. There was no history of high-risk behavior for human immunodeficiency virus (HIV) acquisition. On physical examination, there was a single well-defined ulcer measuring 2[thin space][multiplication sign][thin space]2 cm on the right lateral aspect of tongue with a clean base and irregular and elevated heaped-up margins (Figure 1A). There was no underlying induration, friability, or bleeding on manipulation. The rest of the oral cavity was normal. A 3-mm punch biopsy from the edge of the ulcer was taken and sent for histopathological examination (Figure 1B and C).A, Tongue ulcer. B, Biopsy from the ulcer showing a mixed cell infiltrate (hematoxylin-eosin, original magnification [multiplication sign]40). C, Intracellular yeast forms within the histiocytes (original magnification [multiplication sign]100).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Mucosal leishmaniasis\nB. Primary oral histoplasmosis\nC. Squamous cell carcinoma\nD. Tubercular chancre\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 40-year-old Arab woman, who resided in the eastern part of India, was referred to us from the department of otorhinolaryngology for evaluation of a nonhealing ulcer on the tongue present for the last 4 months. The lesion had started as a small painless mass on the right lateral aspect of the tongue, which gradually grew and subsequently ulcerated. It was asymptomatic except for causing mild difficulty in eating. The Arab woman could not recall any history of trauma or tongue bite preceding the lesion. She denied consuming tobacco or alcohol regularly. She had type 2 diabetes mellitus for 2 years, which was well controlled with oral hypoglycemic agents. The Arab woman had no systemic complaints. There was no history of high-risk behavior for human immunodeficiency virus (HIV) acquisition. On physical examination, there was a single well-defined ulcer measuring 2[thin space][multiplication sign][thin space]2 cm on the right lateral aspect of tongue with a clean base and irregular and elevated heaped-up margins (Figure 1A). There was no underlying induration, friability, or bleeding on manipulation. The rest of the oral cavity was normal. A 3-mm punch biopsy from the edge of the ulcer was taken and sent for histopathological examination (Figure 1B and C).A, Tongue ulcer. B, Biopsy from the ulcer showing a mixed cell infiltrate (hematoxylin-eosin, original magnification [multiplication sign]40). C, Intracellular yeast forms within the histiocytes (original magnification [multiplication sign]100).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Mucosal leishmaniasis\nB. Primary oral histoplasmosis\nC. Squamous cell carcinoma\nD. Tubercular chancre\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 40-year-old Asian patient, who resided in the eastern part of India, was referred to us from the department of otorhinolaryngology for evaluation of a nonhealing ulcer on the tongue present for the last 4 months. The lesion had started as a small painless mass on the right lateral aspect of the tongue, which gradually grew and subsequently ulcerated. It was asymptomatic except for causing mild difficulty in eating. The Asian patient could not recall any history of trauma or tongue bite preceding the lesion. They denied consuming tobacco or alcohol regularly. They had type 2 diabetes mellitus for 2 years, which was well controlled with oral hypoglycemic agents. The Asian patient had no systemic complaints. There was no history of high-risk behavior for human immunodeficiency virus (HIV) acquisition. On physical examination, there was a single well-defined ulcer measuring 2[thin space][multiplication sign][thin space]2 cm on the right lateral aspect of tongue with a clean base and irregular and elevated heaped-up margins (Figure 1A). There was no underlying induration, friability, or bleeding on manipulation. The rest of the oral cavity was normal. A 3-mm punch biopsy from the edge of the ulcer was taken and sent for histopathological examination (Figure 1B and C).A, Tongue ulcer. B, Biopsy from the ulcer showing a mixed cell infiltrate (hematoxylin-eosin, original magnification [multiplication sign]40). C, Intracellular yeast forms within the histiocytes (original magnification [multiplication sign]100).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Mucosal leishmaniasis\nB. Primary oral histoplasmosis\nC. Squamous cell carcinoma\nD. Tubercular chancre\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 40-year-old Black man, who resided in the eastern part of India, was referred to us from the department of otorhinolaryngology for evaluation of a nonhealing ulcer on the tongue present for the last 4 months. The lesion had started as a small painless mass on the right lateral aspect of the tongue, which gradually grew and subsequently ulcerated. It was asymptomatic except for causing mild difficulty in eating. The Black patient could not recall any history of trauma or tongue bite preceding the lesion. He denied consuming tobacco or alcohol regularly. He had type 2 diabetes mellitus for 2 years, which was well controlled with oral hypoglycemic agents. The Black patient had no systemic complaints. There was no history of high-risk behavior for human immunodeficiency virus (HIV) acquisition. On physical examination, there was a single well-defined ulcer measuring 2[thin space][multiplication sign][thin space]2 cm on the right lateral aspect of tongue with a clean base and irregular and elevated heaped-up margins (Figure 1A). There was no underlying induration, friability, or bleeding on manipulation. The rest of the oral cavity was normal. A 3-mm punch biopsy from the edge of the ulcer was taken and sent for histopathological examination (Figure 1B and C).A, Tongue ulcer. B, Biopsy from the ulcer showing a mixed cell infiltrate (hematoxylin-eosin, original magnification [multiplication sign]40). C, Intracellular yeast forms within the histiocytes (original magnification [multiplication sign]100).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Mucosal leishmaniasis\nB. Primary oral histoplasmosis\nC. Squamous cell carcinoma\nD. Tubercular chancre\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA woman in her 30s presented to the hospital with decreased vision in both eyes, confusion, and ataxia for 3 weeks. She had undergone gastric bypass surgery 3 months before presentation, which was complicated by a gastric ulcer and stricture. She had lost 34.5 kg since the procedure. Other medical history included hypothyroidism and thyroidectomy for thyroid cancer diagnosed 10 years ago. Her medication regimen included levothyroxine sodium and occasional bariatric chewable vitamins. She denied alcohol or tobacco use or drug abuse. Her best-corrected visual acuity was 20/200 OD and 20/400 OS. Her pupils were equally reactive, with no relative afferent pupillary defect. There was a mild abduction deficit in both eyes as well as prominent upbeating nystagmus. The amplitude of the nystagmus increased in upgaze and dampened with downgaze. She was unable to read the control plate of the Ishihara test. Findings from an anterior segment examination were unremarkable. Findings from a dilated fundus examination revealed disc edema in both eyes with peripapillary nerve fiber layer thickening and large intraretinal hemorrhages (Figure).A and B, Initial presentation of large intraretinal hemorrhages and disc edema in the left and right eye, respectively.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Intravenous vitamin therapy\nB. Lumbar puncture\nC. Intravenous corticosteroids\nD. Magnetic resonance imaging and/or venography\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 patient in them 30s presented to the hospital with decreased vision in both eyes, confusion, and ataxia for 3 weeks. They had undergone gastric bypass surgery 3 months before presentation, which was complicated by a gastric ulcer and stricture. They had lost 34.5 kg since the procedure. Other medical history included hypothyroidism and thyroidectomy for thyroid cancer diagnosed 10 years ago. Them medication regimen included levothyroxine sodium and occasional bariatric chewable vitamins. They denied alcohol or tobacco use or drug abuse. Them best-corrected visual acuity was 20/200 OD and 20/400 OS. Them pupils were equally reactive, with no relative afferent pupillary defect. There was a mild abduction deficit in both eyes as well as prominent upbeating nystagmus. The amplitude of the nystagmus increased in upgaze and dampened with downgaze. They was unable to read the control plate of the Ishihara test. Findings from an anterior segment examination were unremarkable. Findings from a dilated fundus examination revealed disc edema in both eyes with peripapillary nerve fiber layer thickening and large intraretinal hemorrhages (Figure).A and B, Initial presentation of large intraretinal hemorrhages and disc edema in the left and right eye, respectively.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Intravenous vitamin therapy\nB. Lumbar puncture\nC. Intravenous corticosteroids\nD. Magnetic resonance imaging and/or venography\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA White man in him 30s presented to the hospital with decreased vision in both eyes, confusion, and ataxia for 3 weeks. He had undergone gastric bypass surgery 3 months before presentation, which was complicated by a gastric ulcer and stricture. He had lost 34.5 kg since the procedure. Other medical history included hypothyroidism and thyroidectomy for thyroid cancer diagnosed 10 years ago. Him medication regimen included levothyroxine sodium and occasional bariatric chewable vitamins. He denied alcohol or tobacco use or drug abuse. Him best-corrected visual acuity was 20/200 OD and 20/400 OS. Him pupils were equally reactive, with no relative afferent pupillary defect. There was a mild abduction deficit in both eyes as well as prominent upbeating nystagmus. The amplitude of the nystagmus increased in upgaze and dampened with downgaze. He was unable to read the control plate of the Ishihara test. Findings from an anterior segment examination were unremarkable. Findings from a dilated fundus examination revealed disc edema in both eyes with peripapillary nerve fiber layer thickening and large intraretinal hemorrhages (Figure).A and B, Initial presentation of large intraretinal hemorrhages and disc edema in the left and right eye, respectively.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Intravenous vitamin therapy\nB. Lumbar puncture\nC. Intravenous corticosteroids\nD. Magnetic resonance imaging and/or venography\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Arab woman in her 30s presented to the hospital with decreased vision in both eyes, confusion, and ataxia for 3 weeks. She had undergone gastric bypass surgery 3 months before presentation, which was complicated by a gastric ulcer and stricture. She had lost 34.5 kg since the procedure. Other medical history included hypothyroidism and thyroidectomy for thyroid cancer diagnosed 10 years ago. Her medication regimen included levothyroxine sodium and occasional bariatric chewable vitamins. She denied alcohol or tobacco use or drug abuse. Her best-corrected visual acuity was 20/200 OD and 20/400 OS. Her pupils were equally reactive, with no relative afferent pupillary defect. There was a mild abduction deficit in both eyes as well as prominent upbeating nystagmus. The amplitude of the nystagmus increased in upgaze and dampened with downgaze. She was unable to read the control plate of the Ishihara test. Findings from an anterior segment examination were unremarkable. Findings from a dilated fundus examination revealed disc edema in both eyes with peripapillary nerve fiber layer thickening and large intraretinal hemorrhages (Figure).A and B, Initial presentation of large intraretinal hemorrhages and disc edema in the left and right eye, respectively.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Intravenous vitamin therapy\nB. Lumbar puncture\nC. Intravenous corticosteroids\nD. Magnetic resonance imaging and/or venography\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 2-day-old girl (weight, 3.7 kg) developed abdominal distention and vomiting after feeding. Her Apgar scores at 1 and 5 minutes were 7 and 9, respectively. The infant[right single quotation mark]s postnatal course was remarkable for a febrile episode that was presumed to be due to chorioamnionitis in the mother and for which antibiotic treatment was initiated. Findings from the prenatal ultrasound, most recently conducted at 33 weeks[right single quotation mark] gestation, were normal. The infant was active and well perfused, with a soft but distended abdomen and right-sided labial swelling. Findings from the remainder of her examination were unremarkable.An abdominal radiograph revealed dilated small-bowel loops (Figure 1A). Radiography of the upper gastrointestinal tract with water-soluble contrast showed a normal pattern of rotation. Results of a suction rectal biopsy revealed ganglion cells to be present. Serial abdominal radiographic images showed retained contrast in the terminal ileum 6 days following the gastrointestinal series (Figure 1B).A, Abdominal radiograph showing distended small-bowel loops with absent gas in the colon and rectum. B, Delayed radiography of the upper gastrointestinal tract with water-soluble contrast demonstrating retained contrast in the terminal ileum 6 days after initial radiography.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Ovarian cyst with torsion\nB. Small-bowel volvulus\nC. Cecal duplication\nD. Infantile leiomyosarcoma\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 2-day-old Asian boy (weight, 3.7 kg) developed abdominal distention and vomiting after feeding. Him Apgar scores at 1 and 5 minutes were 7 and 9, respectively. The infant[right single quotation mark]s postnatal course was remarkable for a febrile episode that was presumed to be due to chorioamnionitis in the mother and for which antibiotic treatment was initiated. Findings from the prenatal ultrasound, most recently conducted at 33 weeks[right single quotation mark] gestation, were normal. The infant was active and well perfused, with a soft but distended abdomen and right-sided labial swelling. Findings from the remainder of him examination were unremarkable.An abdominal radiograph revealed dilated small-bowel loops (Figure 1A). Radiography of the upper gastrointestinal tract with water-soluble contrast showed a normal pattern of rotation. Results of a suction rectal biopsy revealed ganglion cells to be present. Serial abdominal radiographic images showed retained contrast in the terminal ileum 6 days following the gastrointestinal series (Figure 1B).A, Abdominal radiograph showing distended small-bowel loops with absent gas in the colon and rectum. B, Delayed radiography of the upper gastrointestinal tract with water-soluble contrast demonstrating retained contrast in the terminal ileum 6 days after initial radiography.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Ovarian cyst with torsion\nB. Small-bowel volvulus\nC. Cecal duplication\nD. Infantile leiomyosarcoma\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 2-day-old Black girl (weight, 3.7 kg) developed abdominal distention and vomiting after feeding. Her Apgar scores at 1 and 5 minutes were 7 and 9, respectively. The infant[right single quotation mark]s postnatal course was remarkable for a febrile episode that was presumed to be due to chorioamnionitis in the mother and for which antibiotic treatment was initiated. Findings from the prenatal ultrasound, most recently conducted at 33 weeks[right single quotation mark] gestation, were normal. The infant was active and well perfused, with a soft but distended abdomen and right-sided labial swelling. Findings from the remainder of her examination were unremarkable.An abdominal radiograph revealed dilated small-bowel loops (Figure 1A). Radiography of the upper gastrointestinal tract with water-soluble contrast showed a normal pattern of rotation. Results of a suction rectal biopsy revealed ganglion cells to be present. Serial abdominal radiographic images showed retained contrast in the terminal ileum 6 days following the gastrointestinal series (Figure 1B).A, Abdominal radiograph showing distended small-bowel loops with absent gas in the colon and rectum. B, Delayed radiography of the upper gastrointestinal tract with water-soluble contrast demonstrating retained contrast in the terminal ileum 6 days after initial radiography.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Ovarian cyst with torsion\nB. Small-bowel volvulus\nC. Cecal duplication\nD. Infantile leiomyosarcoma\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 2-day-old Hispanic child (weight, 3.7 kg) developed abdominal distention and vomiting after feeding. Them Apgar scores at 1 and 5 minutes were 7 and 9, respectively. The infant[right single quotation mark]s postnatal course was remarkable for a febrile episode that was presumed to be due to chorioamnionitis in the mother and for which antibiotic treatment was initiated. Findings from the prenatal ultrasound, most recently conducted at 33 weeks[right single quotation mark] gestation, were normal. The infant was active and well perfused, with a soft but distended abdomen and right-sided labial swelling. Findings from the remainder of them examination were unremarkable.An abdominal radiograph revealed dilated small-bowel loops (Figure 1A). Radiography of the upper gastrointestinal tract with water-soluble contrast showed a normal pattern of rotation. Results of a suction rectal biopsy revealed ganglion cells to be present. Serial abdominal radiographic images showed retained contrast in the terminal ileum 6 days following the gastrointestinal series (Figure 1B).A, Abdominal radiograph showing distended small-bowel loops with absent gas in the colon and rectum. B, Delayed radiography of the upper gastrointestinal tract with water-soluble contrast demonstrating retained contrast in the terminal ileum 6 days after initial radiography.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Ovarian cyst with torsion\nB. Small-bowel volvulus\nC. Cecal duplication\nD. Infantile leiomyosarcoma\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 30s presented with a fishhook injury to his left eye and lower eyelid after fishing in Everglades National Park. His visual acuity was hand motions, and intraocular pressure measurement was deferred in that eye. Findings from examination of the left eye showed a penetrating injury with a 3-pronged barbed fishhook, with 1 prong lodged in the anterior chamber and another lodged in the lower eyelid (Figure 1). The status of the crystalline lens was unclear owing to corneal edema. No hypopyon was visualized. The patient was brought to the operating room for removal of the fishhook, closure of the cornea and eyelid lacerations, and injection of intracameral antibiotic drugs.External photograph showing a 3-pronged treble hook lodged in the cornea and lower eyelid; visual acuity is hand motions.Back-out technique: remove the fishhook in a retrograde manner through its entry woundAdvance-and-cut technique: rotate the hook anterogradely, clip the barb, and back out the hook retrogradely through the entry woundNeedle-cover technique: use the bevel of a large bore needle through the entry wound to engage and [left double quotation mark]cover[right double quotation mark] the barb, then withdraw togetherCut-and-push-through technique: cut the lure, make a corneal exit wound next to the distal end of the hook, and rotate the hook through the exit wound\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Needle-cover technique: use the bevel of a large bore needle through the entry wound to engage and [left double quotation mark]cover[right double quotation mark] the barb, then withdraw together\nB. Back-out technique: remove the fishhook in a retrograde manner through its entry wound\nC. Cut-and-push-through technique: cut the lure, make a corneal exit wound next to the distal end of the hook, and rotate the hook through the exit wound\nD. Advance-and-cut technique: rotate the hook anterogradely, clip the barb, and back out the hook retrogradely through the entry wound\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 30s presented with a fishhook injury to his left eye and lower eyelid after fishing in Everglades National Park. His visual acuity was hand motions, and intraocular pressure measurement was deferred in that eye. Findings from examination of the left eye showed a penetrating injury with a 3-pronged barbed fishhook, with 1 prong lodged in the anterior chamber and another lodged in the lower eyelid (Figure 1). The status of the crystalline lens was unclear owing to corneal edema. No hypopyon was visualized. The White patient was brought to the operating room for removal of the fishhook, closure of the cornea and eyelid lacerations, and injection of intracameral antibiotic drugs.External photograph showing a 3-pronged treble hook lodged in the cornea and lower eyelid; visual acuity is hand motions.Back-out technique: remove the fishhook in a retrograde manner through its entry woundAdvance-and-cut technique: rotate the hook anterogradely, clip the barb, and back out the hook retrogradely through the entry woundNeedle-cover technique: use the bevel of a large bore needle through the entry wound to engage and [left double quotation mark]cover[right double quotation mark] the barb, then withdraw togetherCut-and-push-through technique: cut the lure, make a corneal exit wound next to the distal end of the hook, and rotate the hook through the exit wound\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Needle-cover technique: use the bevel of a large bore needle through the entry wound to engage and [left double quotation mark]cover[right double quotation mark] the barb, then withdraw together\nB. Back-out technique: remove the fishhook in a retrograde manner through its entry wound\nC. Cut-and-push-through technique: cut the lure, make a corneal exit wound next to the distal end of the hook, and rotate the hook through the exit wound\nD. Advance-and-cut technique: rotate the hook anterogradely, clip the barb, and back out the hook retrogradely through the entry wound\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Arab woman in her 30s presented with a fishhook injury to her left eye and lower eyelid after fishing in Everglades National Park. Her visual acuity was hand motions, and intraocular pressure measurement was deferred in that eye. Findings from examination of the left eye showed a penetrating injury with a 3-pronged barbed fishhook, with 1 prong lodged in the anterior chamber and another lodged in the lower eyelid (Figure 1). The status of the crystalline lens was unclear owing to corneal edema. No hypopyon was visualized. The Arab woman was brought to the operating room for removal of the fishhook, closure of the cornea and eyelid lacerations, and injection of intracameral antibiotic drugs.External photograph showing a 3-pronged treble hook lodged in the cornea and lower eyelid; visual acuity is hand motions.Back-out technique: remove the fishhook in a retrograde manner through its entry woundAdvance-and-cut technique: rotate the hook anterogradely, clip the barb, and back out the hook retrogradely through the entry woundNeedle-cover technique: use the bevel of a large bore needle through the entry wound to engage and [left double quotation mark]cover[right double quotation mark] the barb, then withdraw togetherCut-and-push-through technique: cut the lure, make a corneal exit wound next to the distal end of the hook, and rotate the hook through the exit wound\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Needle-cover technique: use the bevel of a large bore needle through the entry wound to engage and [left double quotation mark]cover[right double quotation mark] the barb, then withdraw together\nB. Back-out technique: remove the fishhook in a retrograde manner through its entry wound\nC. Cut-and-push-through technique: cut the lure, make a corneal exit wound next to the distal end of the hook, and rotate the hook through the exit wound\nD. Advance-and-cut technique: rotate the hook anterogradely, clip the barb, and back out the hook retrogradely through the entry wound\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 patient in their 30s presented with a fishhook injury to their left eye and lower eyelid after fishing in Everglades National Park. Their visual acuity was hand motions, and intraocular pressure measurement was deferred in that eye. Findings from examination of the left eye showed a penetrating injury with a 3-pronged barbed fishhook, with 1 prong lodged in the anterior chamber and another lodged in the lower eyelid (Figure 1). The status of the crystalline lens was unclear owing to corneal edema. No hypopyon was visualized. The Asian patient was brought to the operating room for removal of the fishhook, closure of the cornea and eyelid lacerations, and injection of intracameral antibiotic drugs.External photograph showing a 3-pronged treble hook lodged in the cornea and lower eyelid; visual acuity is hand motions.Back-out technique: remove the fishhook in a retrograde manner through its entry woundAdvance-and-cut technique: rotate the hook anterogradely, clip the barb, and back out the hook retrogradely through the entry woundNeedle-cover technique: use the bevel of a large bore needle through the entry wound to engage and [left double quotation mark]cover[right double quotation mark] the barb, then withdraw togetherCut-and-push-through technique: cut the lure, make a corneal exit wound next to the distal end of the hook, and rotate the hook through the exit wound\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Needle-cover technique: use the bevel of a large bore needle through the entry wound to engage and [left double quotation mark]cover[right double quotation mark] the barb, then withdraw together\nB. Back-out technique: remove the fishhook in a retrograde manner through its entry wound\nC. Cut-and-push-through technique: cut the lure, make a corneal exit wound next to the distal end of the hook, and rotate the hook through the exit wound\nD. Advance-and-cut technique: rotate the hook anterogradely, clip the barb, and back out the hook retrogradely through the entry wound\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>\nAfter 5 days of nausea and vomiting, a man in his 60s with advanced, refractory diffuse large B-cell lymphoma involving the abdomen presented to the emergency department. The patient noted chronic, left-sided abdominal pain related to his lymphoma and normal passage of stool and flatus. He reported no other illnesses and was taking only esomeprazole. He was afebrile and normotensive with a pulse rate of 104/minute. A large, firm, tender mass located near the umbilicus was palpable in his abdomen, but there was no rigidity or rebound tenderness. Laboratory studies (Table) showed an elevated lactate level of 6.3 mmol/L (reference range, 0.7-2.2 mmol/L) (56.8 mg/dL; reference range, 6.3-19.8 mg/dL).A computed tomographic scan of the abdomen showed diffuse lymphadenopathy and a large mesenteric mass abutting multiple segments of the small intestine and encasing the mesenteric vasculature. He received 3 L of intravenous normal saline in the first 24 hours because of concern about volume depletion and sepsis. His tachycardia improved, but blood lactate remained elevated between 4.7-7.2 mmol/L (42.3-64.9 mg/dL). Serial abdominal examination results remained unchanged from the initial presentation.The patient has lactic acidosis from hypovolemic shock.The patient has lactic acidosis from mesenteric ischemia.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. The patient has lactic acidosis from sepsis.\nB. The patient has lactic acidosis from hypovolemic shock.\nC. The patient has lactic acidosis from lymphoma.\nD. The patient has lactic acidosis from mesenteric ischemia.\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>\nAfter 5 days of nausea and vomiting, a Black patient in their 60s with advanced, refractory diffuse large B-cell lymphoma involving the abdomen presented to the emergency department. The Black patient noted chronic, left-sided abdominal pain related to their lymphoma and normal passage of stool and flatus. They reported no other illnesses and was taking only esomeprazole. They was afebrile and normotensive with a pulse rate of 104/minute. A large, firm, tender mass located near the umbilicus was palpable in their abdomen, but there was no rigidity or rebound tenderness. Laboratory studies (Table) showed an elevated lactate level of 6.3 mmol/L (reference range, 0.7-2.2 mmol/L) (56.8 mg/dL; reference range, 6.3-19.8 mg/dL).A computed tomographic scan of the abdomen showed diffuse lymphadenopathy and a large mesenteric mass abutting multiple segments of the small intestine and encasing the mesenteric vasculature. They received 3 L of intravenous normal saline in the first 24 hours because of concern about volume depletion and sepsis. Their tachycardia improved, but blood lactate remained elevated between 4.7-7.2 mmol/L (42.3-64.9 mg/dL). Serial abdominal examination results remained unchanged from the initial presentation.The Black patient has lactic acidosis from hypovolemic shock.The Black patient has lactic acidosis from mesenteric ischemia.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. The patient has lactic acidosis from sepsis.\nB. The patient has lactic acidosis from hypovolemic shock.\nC. The patient has lactic acidosis from lymphoma.\nD. The patient has lactic acidosis from mesenteric ischemia.\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>\nAfter 5 days of nausea and vomiting, a Hispanic man in his 60s with advanced, refractory diffuse large B-cell lymphoma involving the abdomen presented to the emergency department. The Hispanic patient noted chronic, left-sided abdominal pain related to his lymphoma and normal passage of stool and flatus. He reported no other illnesses and was taking only esomeprazole. He was afebrile and normotensive with a pulse rate of 104/minute. A large, firm, tender mass located near the umbilicus was palpable in his abdomen, but there was no rigidity or rebound tenderness. Laboratory studies (Table) showed an elevated lactate level of 6.3 mmol/L (reference range, 0.7-2.2 mmol/L) (56.8 mg/dL; reference range, 6.3-19.8 mg/dL).A computed tomographic scan of the abdomen showed diffuse lymphadenopathy and a large mesenteric mass abutting multiple segments of the small intestine and encasing the mesenteric vasculature. He received 3 L of intravenous normal saline in the first 24 hours because of concern about volume depletion and sepsis. His tachycardia improved, but blood lactate remained elevated between 4.7-7.2 mmol/L (42.3-64.9 mg/dL). Serial abdominal examination results remained unchanged from the initial presentation.The Hispanic patient has lactic acidosis from hypovolemic shock.The Hispanic patient has lactic acidosis from mesenteric ischemia.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. The patient has lactic acidosis from sepsis.\nB. The patient has lactic acidosis from hypovolemic shock.\nC. The patient has lactic acidosis from lymphoma.\nD. The patient has lactic acidosis from mesenteric ischemia.\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>\nAfter 5 days of nausea and vomiting, a White woman in her 60s with advanced, refractory diffuse large B-cell lymphoma involving the abdomen presented to the emergency department. The White woman noted chronic, left-sided abdominal pain related to her lymphoma and normal passage of stool and flatus. She reported no other illnesses and was taking only esomeprazole. She was afebrile and normotensive with a pulse rate of 104/minute. A large, firm, tender mass located near the umbilicus was palpable in her abdomen, but there was no rigidity or rebound tenderness. Laboratory studies (Table) showed an elevated lactate level of 6.3 mmol/L (reference range, 0.7-2.2 mmol/L) (56.8 mg/dL; reference range, 6.3-19.8 mg/dL).A computed tomographic scan of the abdomen showed diffuse lymphadenopathy and a large mesenteric mass abutting multiple segments of the small intestine and encasing the mesenteric vasculature. She received 3 L of intravenous normal saline in the first 24 hours because of concern about volume depletion and sepsis. Her tachycardia improved, but blood lactate remained elevated between 4.7-7.2 mmol/L (42.3-64.9 mg/dL). Serial abdominal examination results remained unchanged from the initial presentation.The White woman has lactic acidosis from hypovolemic shock.The White woman has lactic acidosis from mesenteric ischemia.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. The patient has lactic acidosis from sepsis.\nB. The patient has lactic acidosis from hypovolemic shock.\nC. The patient has lactic acidosis from lymphoma.\nD. The patient has lactic acidosis from mesenteric ischemia.\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 67-year-old woman presented to the emergency department with increasing dyspnea and chest wall tenderness. Two hours prior to presentation, she choked on her food while at dinner and received repeated attempts at the Heimlich maneuver with successful dislodgement of a piece of ham. The choking episode lasted for approximately 10 seconds, during which the patient was unable to speak. She has a history of hypertension and gastroesophageal reflux disease but no history of smoking. On arrival, she was dyspneic and in respiratory distress. Oxygen saturation was 80% with ambient air and improved to 99% with supplemental oxygen delivered via nasal cannula. A 12-lead electrocardiogram showed normal sinus rhythm without acute ST or T-wave changes. Brain natriuretic peptide level was 84 pg/mL. The patient received a chest radiograph and a computed tomographic scan of the chest (Figure). Transthoracic echocardiography demonstrated preserved systolic function, with no evidence of valve disease.Top left, Chest radiograph, posteroanterior view. Top right, Chest radiograph, left lateral view. Bottom, Computed tomography scan of the chest, axial view.Start intravenous antibiotics, intravenous fluid resuscitation, and obtain serum lactate level and blood and sputum culturesStart oxygen, [greek small letter beta]2-agonist nebulizer treatments, steroids, and oral azithromycin\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Observe and provide supplemental oxygen\nB. Start oxygen, [greek small letter beta]2-agonist nebulizer treatments, steroids, and oral azithromycin\nC. Start aspirin, [greek small letter beta]-blocker, and consider cardiac catheterization\nD. Start intravenous antibiotics, intravenous fluid resuscitation, and obtain serum lactate level and blood and sputum cultures\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 67-year-old Arab woman presented to the emergency department with increasing dyspnea and chest wall tenderness. Two hours prior to presentation, she choked on her food while at dinner and received repeated attempts at the Heimlich maneuver with successful dislodgement of a piece of ham. The choking episode lasted for approximately 10 seconds, during which the Arab patient was unable to speak. She has a history of hypertension and gastroesophageal reflux disease but no history of smoking. On arrival, she was dyspneic and in respiratory distress. Oxygen saturation was 80% with ambient air and improved to 99% with supplemental oxygen delivered via nasal cannula. A 12-lead electrocardiogram showed normal sinus rhythm without acute ST or T-wave changes. Brain natriuretic peptide level was 84 pg/mL. The Arab patient received a chest radiograph and a computed tomographic scan of the chest (Figure). Transthoracic echocardiography demonstrated preserved systolic function, with no evidence of valve disease.Top left, Chest radiograph, posteroanterior view. Top right, Chest radiograph, left lateral view. Bottom, Computed tomography scan of the chest, axial view.Start intravenous antibiotics, intravenous fluid resuscitation, and obtain serum lactate level and blood and sputum culturesStart oxygen, [greek small letter beta]2-agonist nebulizer treatments, steroids, and oral azithromycin\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Observe and provide supplemental oxygen\nB. Start oxygen, [greek small letter beta]2-agonist nebulizer treatments, steroids, and oral azithromycin\nC. Start aspirin, [greek small letter beta]-blocker, and consider cardiac catheterization\nD. Start intravenous antibiotics, intravenous fluid resuscitation, and obtain serum lactate level and blood and sputum cultures\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 67-year-old Asian patient presented to the emergency department with increasing dyspnea and chest wall tenderness. Two hours prior to presentation, they choked on them food while at dinner and received repeated attempts at the Heimlich maneuver with successful dislodgement of a piece of ham. The choking episode lasted for approximately 10 seconds, during which the Asian patient was unable to speak. They has a history of hypertension and gastroesophageal reflux disease but no history of smoking. On arrival, they was dyspneic and in respiratory distress. Oxygen saturation was 80% with ambient air and improved to 99% with supplemental oxygen delivered via nasal cannula. A 12-lead electrocardiogram showed normal sinus rhythm without acute ST or T-wave changes. Brain natriuretic peptide level was 84 pg/mL. The Asian patient received a chest radiograph and a computed tomographic scan of the chest (Figure). Transthoracic echocardiography demonstrated preserved systolic function, with no evidence of valve disease.Top left, Chest radiograph, posteroanterior view. Top right, Chest radiograph, left lateral view. Bottom, Computed tomography scan of the chest, axial view.Start intravenous antibiotics, intravenous fluid resuscitation, and obtain serum lactate level and blood and sputum culturesStart oxygen, [greek small letter beta]2-agonist nebulizer treatments, steroids, and oral azithromycin\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Observe and provide supplemental oxygen\nB. Start oxygen, [greek small letter beta]2-agonist nebulizer treatments, steroids, and oral azithromycin\nC. Start aspirin, [greek small letter beta]-blocker, and consider cardiac catheterization\nD. Start intravenous antibiotics, intravenous fluid resuscitation, and obtain serum lactate level and blood and sputum cultures\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 67-year-old Black man presented to the emergency department with increasing dyspnea and chest wall tenderness. Two hours prior to presentation, he choked on him food while at dinner and received repeated attempts at the Heimlich maneuver with successful dislodgement of a piece of ham. The choking episode lasted for approximately 10 seconds, during which the Black man was unable to speak. He has a history of hypertension and gastroesophageal reflux disease but no history of smoking. On arrival, he was dyspneic and in respiratory distress. Oxygen saturation was 80% with ambient air and improved to 99% with supplemental oxygen delivered via nasal cannula. A 12-lead electrocardiogram showed normal sinus rhythm without acute ST or T-wave changes. Brain natriuretic peptide level was 84 pg/mL. The Black man received a chest radiograph and a computed tomographic scan of the chest (Figure). Transthoracic echocardiography demonstrated preserved systolic function, with no evidence of valve disease.Top left, Chest radiograph, posteroanterior view. Top right, Chest radiograph, left lateral view. Bottom, Computed tomography scan of the chest, axial view.Start intravenous antibiotics, intravenous fluid resuscitation, and obtain serum lactate level and blood and sputum culturesStart oxygen, [greek small letter beta]2-agonist nebulizer treatments, steroids, and oral azithromycin\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Observe and provide supplemental oxygen\nB. Start oxygen, [greek small letter beta]2-agonist nebulizer treatments, steroids, and oral azithromycin\nC. Start aspirin, [greek small letter beta]-blocker, and consider cardiac catheterization\nD. Start intravenous antibiotics, intravenous fluid resuscitation, and obtain serum lactate level and blood and sputum cultures\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 2-year-old girl was referred to our department for skin fragility since early infancy. She had 2 older brothers, and the family had no medical history of note. Physical examination revealed mild xerosis with superficial skin erosions and erythematous residual macules from previous erosions. Some of the lesions had an unusual linear geographic contour and were predominantly located at areas of friction (Figure, A and B). Hair, nails, and mucous membranes were normal. There was no history of blistering. The mother explained that she often found the child peeling off skin with marked facility. Symptoms improved in winter and worsened in summer. Physical and mental developments were normal. Serological markers for celiac disease were negative. A skin biopsy was performed (Figure, C).A, Clinical photograph of a disease outbreak. Skin fragility can be seen as superficial erosions distributed predominantly around the trunk, some with geometric shape. B, Photograph showing localized affectation of the disease. Erythemato-desquamative well-demarcated plaque with peeling borders on right foot. C, Hematoxylin-eosin staining (original magnification [multiplication sign]40) of healthy skin. Remarkable detachment of the entire stratum corneum and mild psoriasiform epidermis hyperplasia with no other significant findings.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Peeling skin disease\nB. Kindler syndrome\nC. Epidermolysis bullosa simplex superficialis\nD. Dermatitis artefacta\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 2-year-old Hispanic boy was referred to our department for skin fragility since early infancy. He had 2 older brothers, and the family had no medical history of note. Physical examination revealed mild xerosis with superficial skin erosions and erythematous residual macules from previous erosions. Some of the lesions had an unusual linear geographic contour and were predominantly located at areas of friction (Figure, A and B). Hair, nails, and mucous membranes were normal. There was no history of blistering. The mother explained that he often found the Hispanic child peeling off skin with marked facility. Symptoms improved in winter and worsened in summer. Physical and mental developments were normal. Serological markers for celiac disease were negative. A skin biopsy was performed (Figure, C).A, Clinical photograph of a disease outbreak. Skin fragility can be seen as superficial erosions distributed predominantly around the trunk, some with geometric shape. B, Photograph showing localized affectation of the disease. Erythemato-desquamative well-demarcated plaque with peeling borders on right foot. C, Hematoxylin-eosin staining (original magnification [multiplication sign]40) of healthy skin. Remarkable detachment of the entire stratum corneum and mild psoriasiform epidermis hyperplasia with no other significant findings.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Peeling skin disease\nB. Kindler syndrome\nC. Epidermolysis bullosa simplex superficialis\nD. Dermatitis artefacta\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 2-year-old White child was referred to our department for skin fragility since early infancy. They had 2 older brothers, and the family had no medical history of note. Physical examination revealed mild xerosis with superficial skin erosions and erythematous residual macules from previous erosions. Some of the lesions had an unusual linear geographic contour and were predominantly located at areas of friction (Figure, A and B). Hair, nails, and mucous membranes were normal. There was no history of blistering. The mother explained that they often found the White child peeling off skin with marked facility. Symptoms improved in winter and worsened in summer. Physical and mental developments were normal. Serological markers for celiac disease were negative. A skin biopsy was performed (Figure, C).A, Clinical photograph of a disease outbreak. Skin fragility can be seen as superficial erosions distributed predominantly around the trunk, some with geometric shape. B, Photograph showing localized affectation of the disease. Erythemato-desquamative well-demarcated plaque with peeling borders on right foot. C, Hematoxylin-eosin staining (original magnification [multiplication sign]40) of healthy skin. Remarkable detachment of the entire stratum corneum and mild psoriasiform epidermis hyperplasia with no other significant findings.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Peeling skin disease\nB. Kindler syndrome\nC. Epidermolysis bullosa simplex superficialis\nD. Dermatitis artefacta\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 2-year-old Arab girl was referred to our department for skin fragility since early infancy. She had 2 older brothers, and the family had no medical history of note. Physical examination revealed mild xerosis with superficial skin erosions and erythematous residual macules from previous erosions. Some of the lesions had an unusual linear geographic contour and were predominantly located at areas of friction (Figure, A and B). Hair, nails, and mucous membranes were normal. There was no history of blistering. The mother explained that she often found the Arab child peeling off skin with marked facility. Symptoms improved in winter and worsened in summer. Physical and mental developments were normal. Serological markers for celiac disease were negative. A skin biopsy was performed (Figure, C).A, Clinical photograph of a disease outbreak. Skin fragility can be seen as superficial erosions distributed predominantly around the trunk, some with geometric shape. B, Photograph showing localized affectation of the disease. Erythemato-desquamative well-demarcated plaque with peeling borders on right foot. C, Hematoxylin-eosin staining (original magnification [multiplication sign]40) of healthy skin. Remarkable detachment of the entire stratum corneum and mild psoriasiform epidermis hyperplasia with no other significant findings.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Peeling skin disease\nB. Kindler syndrome\nC. Epidermolysis bullosa simplex superficialis\nD. Dermatitis artefacta\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 60-year-old woman presented with a painless subareolar nodule of her left nipple measuring 2 cm in diameter (Figure, A) that had been present for several months. Screening mammography (Figure, B) performed 4 weeks prior revealed a large grouping of left breast subareolar calcifications extending into the skin and nipple. Follow-up ultrasonography demonstrated no discrete abnormal mass or shadowing but did show multiple echogenic foci consistent with findings on mammography. An incisional biopsy specimen of the mass was obtained and sent for histopathologic evaluation (Figure, C).A, Firm, irregular, subareolar nodule of left nipple measuring 2 cm in diameter. B, Mammography of the left breast. C, Biopsy specimen of the subareolar nodule (hematoxylin-eosin, original magnification [multiplication sign]20).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Low-grade adenosquamous carcinoma\nB. Florid papillomatosis of the nipple\nC. Tubular carcinoma\nD. Syringomatous adenoma of the nipple\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 60-year-old Asian patient presented with a painless subareolar nodule of them left nipple measuring 2 cm in diameter (Figure, A) that had been present for several months. Screening mammography (Figure, B) performed 4 weeks prior revealed a large grouping of left breast subareolar calcifications extending into the skin and nipple. Follow-up ultrasonography demonstrated no discrete abnormal mass or shadowing but did show multiple echogenic foci consistent with findings on mammography. An incisional biopsy specimen of the mass was obtained and sent for histopathologic evaluation (Figure, C).A, Firm, irregular, subareolar nodule of left nipple measuring 2 cm in diameter. B, Mammography of the left breast. C, Biopsy specimen of the subareolar nodule (hematoxylin-eosin, original magnification [multiplication sign]20).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Low-grade adenosquamous carcinoma\nB. Florid papillomatosis of the nipple\nC. Tubular carcinoma\nD. Syringomatous adenoma of the nipple\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 60-year-old Black man presented with a painless subareolar nodule of him left nipple measuring 2 cm in diameter (Figure, A) that had been present for several months. Screening mammography (Figure, B) performed 4 weeks prior revealed a large grouping of left breast subareolar calcifications extending into the skin and nipple. Follow-up ultrasonography demonstrated no discrete abnormal mass or shadowing but did show multiple echogenic foci consistent with findings on mammography. An incisional biopsy specimen of the mass was obtained and sent for histopathologic evaluation (Figure, C).A, Firm, irregular, subareolar nodule of left nipple measuring 2 cm in diameter. B, Mammography of the left breast. C, Biopsy specimen of the subareolar nodule (hematoxylin-eosin, original magnification [multiplication sign]20).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Low-grade adenosquamous carcinoma\nB. Florid papillomatosis of the nipple\nC. Tubular carcinoma\nD. Syringomatous adenoma of the nipple\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 60-year-old Hispanic woman presented with a painless subareolar nodule of her left nipple measuring 2 cm in diameter (Figure, A) that had been present for several months. Screening mammography (Figure, B) performed 4 weeks prior revealed a large grouping of left breast subareolar calcifications extending into the skin and nipple. Follow-up ultrasonography demonstrated no discrete abnormal mass or shadowing but did show multiple echogenic foci consistent with findings on mammography. An incisional biopsy specimen of the mass was obtained and sent for histopathologic evaluation (Figure, C).A, Firm, irregular, subareolar nodule of left nipple measuring 2 cm in diameter. B, Mammography of the left breast. C, Biopsy specimen of the subareolar nodule (hematoxylin-eosin, original magnification [multiplication sign]20).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Low-grade adenosquamous carcinoma\nB. Florid papillomatosis of the nipple\nC. Tubular carcinoma\nD. Syringomatous adenoma of the nipple\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA previously healthy 8-year-old boy presented to the emergency department for evaluation of a large, tender scalp nodule. One month prior to presentation, the patient[right single quotation mark]s mother noticed multiple annular, scaly patches on the patient[right single quotation mark]s scalp and upper back. Both of the patient[right single quotation mark]s brothers developed similar patches. Two weeks before presentation, the area on the scalp grew in size, becoming a tender nodule with yellow suppurative discharge.Results of the physical examination were notable for a somewhat tired-appearing boy with a 6-cm tender, red nodule on the right frontal scalp (Figure 1). The nodule had a boggy consistency and thick yellow crust and was draining yellow material. There was no hair within this area on the scalp. On the patient[right single quotation mark]s right upper back was an annular scaly patch; significant posterior auricular and cervical lymphadenopathy was noted bilaterally.View on presentation of a boggy, erythematous nodule with suppurative discharge and loss of hair.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Abscess\nB. Mycobacterial infection\nC. Dissecting cellulitis\nD. Kerion celsi\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA previously healthy 8-year-old White boy presented to the emergency department for evaluation of a large, tender scalp nodule. One month prior to presentation, the White patient[right single quotation mark]s mother noticed multiple annular, scaly patches on the White patient[right single quotation mark]s scalp and upper back. Both of the White patient[right single quotation mark]s brothers developed similar patches. Two weeks before presentation, the area on the scalp grew in size, becoming a tender nodule with yellow suppurative discharge.Results of the physical examination were notable for a somewhat tired-appearing White boy with a 6-cm tender, red nodule on the right frontal scalp (Figure 1). The nodule had a boggy consistency and thick yellow crust and was draining yellow material. There was no hair within this area on the scalp. On the White patient[right single quotation mark]s right upper back was an annular scaly patch; significant posterior auricular and cervical lymphadenopathy was noted bilaterally.View on presentation of a boggy, erythematous nodule with suppurative discharge and loss of hair.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Abscess\nB. Mycobacterial infection\nC. Dissecting cellulitis\nD. Kerion celsi\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA previously healthy 8-year-old Arab girl presented to the emergency department for evaluation of a large, tender scalp nodule. One month prior to presentation, the Arab woman[right single quotation mark]s mother noticed multiple annular, scaly patches on the Arab woman[right single quotation mark]s scalp and upper back. Both of the Arab woman[right single quotation mark]s brothers developed similar patches. Two weeks before presentation, the area on the scalp grew in size, becoming a tender nodule with yellow suppurative discharge.Results of the physical examination were notable for a somewhat tired-appearing Arab girl with a 6-cm tender, red nodule on the right frontal scalp (Figure 1). The nodule had a boggy consistency and thick yellow crust and was draining yellow material. There was no hair within this area on the scalp. On the Arab woman[right single quotation mark]s right upper back was an annular scaly patch; significant posterior auricular and cervical lymphadenopathy was noted bilaterally.View on presentation of a boggy, erythematous nodule with suppurative discharge and loss of hair.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Abscess\nB. Mycobacterial infection\nC. Dissecting cellulitis\nD. Kerion celsi\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA previously healthy 8-year-old Asian child presented to the emergency department for evaluation of a large, tender scalp nodule. One month prior to presentation, the Asian patient[right single quotation mark]s mother noticed multiple annular, scaly patches on the Asian patient[right single quotation mark]s scalp and upper back. Both of the Asian patient[right single quotation mark]s brothers developed similar patches. Two weeks before presentation, the area on the scalp grew in size, becoming a tender nodule with yellow suppurative discharge.Results of the physical examination were notable for a somewhat tired-appearing Asian child with a 6-cm tender, red nodule on the right frontal scalp (Figure 1). The nodule had a boggy consistency and thick yellow crust and was draining yellow material. There was no hair within this area on the scalp. On the Asian patient[right single quotation mark]s right upper back was an annular scaly patch; significant posterior auricular and cervical lymphadenopathy was noted bilaterally.View on presentation of a boggy, erythematous nodule with suppurative discharge and loss of hair.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Abscess\nB. Mycobacterial infection\nC. Dissecting cellulitis\nD. Kerion celsi\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>\nAt birth, a full-term newborn was noted to have numerous hypopigmented skin macules on the trunk, scalp, neck, face, back, and limbs after an uncomplicated pregnancy (Figure 1A). The family history was negative for any dermatologic or genetic diseases. A shave biopsy specimen of the right leg was interpreted as papillomatous epidermal hyperplasia consistent with an epidermal nevus. Because of the constellation of findings, an initial diagnosis of linear epidermal nevus syndrome was made. At age 3 months, the patient was referred for ophthalmologic examination owing to a flat, hypopigmented lesion in the left temporal iris noted by the patient[right single quotation mark]s father. On examination, the patient fixed and followed with both eyes. Pupils, motility, and binocular alignment were normal. Dilated ophthalmoscopic examination revealed a well-demarcated hypopigmented lesion originating from the retinal nerve fiber layer and protruding into the vitreous cavity of the right eye (Figure 1B). A similar lesion was seen along the left inferotemporal arcade (Figure 1C). B-scan ultrasonography revealed a 4.0[thin space][multiplication sign][thin space]2.9[thin space][multiplication sign][thin space]2.2-mm lesion with no calcification, no retinal detachment, and no choroidal involvement (Figure 1D). Given the suspected iris hamartoma and retinal astrocytic hamartoma, a systemic workup was commenced.A, Dermatologic manifestations. The patient had multiple hypopigmented macules on his scalp, face, neck, back, limbs, and torso (arrowheads). B, A lesion was discovered in the right eye consistent with a retinal astrocytic hamartoma. C, A similar smaller lesion was seen in the left eye. D, B-scan ultrasonography revealed an elevated lesion emanating from the retina with no calcification or choroidal involvement.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Brain imaging and echocardiography\nB. Renal ultrasonography and lumbar puncture\nC. Metastatic workup\nD. Fine-needle aspiration biopsy of ocular lesion\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>\nAt birth, a full-term newborn was noted to have numerous hypopigmented skin macules on the trunk, scalp, neck, face, back, and limbs after an uncomplicated pregnancy (Figure 1A). The family history was negative for any dermatologic or genetic diseases. A shave biopsy specimen of the right leg was interpreted as papillomatous epidermal hyperplasia consistent with an epidermal nevus. Because of the constellation of findings, an initial diagnosis of linear epidermal nevus syndrome was made. At age 3 months, the Black patient was referred for ophthalmologic examination owing to a flat, hypopigmented lesion in the left temporal iris noted by the Black patient[right single quotation mark]s father. On examination, the Black patient fixed and followed with both eyes. Pupils, motility, and binocular alignment were normal. Dilated ophthalmoscopic examination revealed a well-demarcated hypopigmented lesion originating from the retinal nerve fiber layer and protruding into the vitreous cavity of the right eye (Figure 1B). A similar lesion was seen along the left inferotemporal arcade (Figure 1C). B-scan ultrasonography revealed a 4.0[thin space][multiplication sign][thin space]2.9[thin space][multiplication sign][thin space]2.2-mm lesion with no calcification, no retinal detachment, and no choroidal involvement (Figure 1D). Given the suspected iris hamartoma and retinal astrocytic hamartoma, a systemic workup was commenced.A, Dermatologic manifestations. The Black patient had multiple hypopigmented macules on their scalp, face, neck, back, limbs, and torso (arrowheads). B, A lesion was discovered in the right eye consistent with a retinal astrocytic hamartoma. C, A similar smaller lesion was seen in the left eye. D, B-scan ultrasonography revealed an elevated lesion emanating from the retina with no calcification or choroidal involvement.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Brain imaging and echocardiography\nB. Renal ultrasonography and lumbar puncture\nC. Metastatic workup\nD. Fine-needle aspiration biopsy of ocular lesion\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>\nAt birth, a full-term newborn was noted to have numerous hypopigmented skin macules on the trunk, scalp, neck, face, back, and limbs after an uncomplicated pregnancy (Figure 1A). The family history was negative for any dermatologic or genetic diseases. A shave biopsy specimen of the right leg was interpreted as papillomatous epidermal hyperplasia consistent with an epidermal nevus. Because of the constellation of findings, an initial diagnosis of linear epidermal nevus syndrome was made. At age 3 months, the Hispanic patient was referred for ophthalmologic examination owing to a flat, hypopigmented lesion in the left temporal iris noted by the Hispanic patient[right single quotation mark]s father. On examination, the Hispanic patient fixed and followed with both eyes. Pupils, motility, and binocular alignment were normal. Dilated ophthalmoscopic examination revealed a well-demarcated hypopigmented lesion originating from the retinal nerve fiber layer and protruding into the vitreous cavity of the right eye (Figure 1B). A similar lesion was seen along the left inferotemporal arcade (Figure 1C). B-scan ultrasonography revealed a 4.0[thin space][multiplication sign][thin space]2.9[thin space][multiplication sign][thin space]2.2-mm lesion with no calcification, no retinal detachment, and no choroidal involvement (Figure 1D). Given the suspected iris hamartoma and retinal astrocytic hamartoma, a systemic workup was commenced.A, Dermatologic manifestations. The Hispanic patient had multiple hypopigmented macules on his scalp, face, neck, back, limbs, and torso (arrowheads). B, A lesion was discovered in the right eye consistent with a retinal astrocytic hamartoma. C, A similar smaller lesion was seen in the left eye. D, B-scan ultrasonography revealed an elevated lesion emanating from the retina with no calcification or choroidal involvement.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Brain imaging and echocardiography\nB. Renal ultrasonography and lumbar puncture\nC. Metastatic workup\nD. Fine-needle aspiration biopsy of ocular lesion\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>\nAt birth, a full-term newborn was noted to have numerous hypopigmented skin macules on the trunk, scalp, neck, face, back, and limbs after an uncomplicated pregnancy (Figure 1A). The family history was negative for any dermatologic or genetic diseases. A shave biopsy specimen of the right leg was interpreted as papillomatous epidermal hyperplasia consistent with an epidermal nevus. Because of the constellation of findings, an initial diagnosis of linear epidermal nevus syndrome was made. At age 3 months, the White woman was referred for ophthalmologic examination owing to a flat, hypopigmented lesion in the left temporal iris noted by the White woman[right single quotation mark]s father. On examination, the White woman fixed and followed with both eyes. Pupils, motility, and binocular alignment were normal. Dilated ophthalmoscopic examination revealed a well-demarcated hypopigmented lesion originating from the retinal nerve fiber layer and protruding into the vitreous cavity of the right eye (Figure 1B). A similar lesion was seen along the left inferotemporal arcade (Figure 1C). B-scan ultrasonography revealed a 4.0[thin space][multiplication sign][thin space]2.9[thin space][multiplication sign][thin space]2.2-mm lesion with no calcification, no retinal detachment, and no choroidal involvement (Figure 1D). Given the suspected iris hamartoma and retinal astrocytic hamartoma, a systemic workup was commenced.A, Dermatologic manifestations. The White woman had multiple hypopigmented macules on her scalp, face, neck, back, limbs, and torso (arrowheads). B, A lesion was discovered in the right eye consistent with a retinal astrocytic hamartoma. C, A similar smaller lesion was seen in the left eye. D, B-scan ultrasonography revealed an elevated lesion emanating from the retina with no calcification or choroidal involvement.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Brain imaging and echocardiography\nB. Renal ultrasonography and lumbar puncture\nC. Metastatic workup\nD. Fine-needle aspiration biopsy of ocular lesion\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 mid-50s with a history of hyperlipidemia and arthritis presented with recurrent subconjunctival hemorrhages and retinal vascular abnormalities as noted by her general ophthalmologist. Best-corrected visual acuity was 20/20 OU. Results of the pupillary examination, intraocular pressure measurements, motility, and confrontatiol visual field testing were normal in each eye. Findings on the anterior slitlamp examination demonstrated rare anterior chamber cells and mild nuclear sclerotic cataracts in both eyes. Results of the dilated fundus examination (Figure 1) demonstrated bilateral vitreous cells that were not dense enough to obscure retinal vessel details, as well as optic disc hyperemia, arterial attenuation, arterial and venous sheathing, hard exudates, and focal areas of retinal thinning. There was no macular edema in either eye. Results of a complete blood cell count were normal.Fundus photograph of the patient[right single quotation mark]s left eye at presentation.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Check hemoglobin A1c level\nB. Check blood pressure\nC. Check antinuclear antibody level\nD. Check erythrocyte sedimentation rate\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Arab woman in her mid-50s with a history of hyperlipidemia and arthritis presented with recurrent subconjunctival hemorrhages and retinal vascular abnormalities as noted by her general ophthalmologist. Best-corrected visual acuity was 20/20 OU. Results of the pupillary examination, intraocular pressure measurements, motility, and confrontatiol visual field testing were normal in each eye. Findings on the anterior slitlamp examination demonstrated rare anterior chamber cells and mild nuclear sclerotic cataracts in both eyes. Results of the dilated fundus examination (Figure 1) demonstrated bilateral vitreous cells that were not dense enough to obscure retinal vessel details, as well as optic disc hyperemia, arterial attenuation, arterial and venous sheathing, hard exudates, and focal areas of retinal thinning. There was no macular edema in either eye. Results of a complete blood cell count were normal.Fundus photograph of the Arab patient[right single quotation mark]s left eye at presentation.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Check hemoglobin A1c level\nB. Check blood pressure\nC. Check antinuclear antibody level\nD. Check erythrocyte sedimentation rate\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 patient in them mid-50s with a history of hyperlipidemia and arthritis presented with recurrent subconjunctival hemorrhages and retinal vascular abnormalities as noted by them general ophthalmologist. Best-corrected visual acuity was 20/20 OU. Results of the pupillary examination, intraocular pressure measurements, motility, and confrontatiol visual field testing were normal in each eye. Findings on the anterior slitlamp examination demonstrated rare anterior chamber cells and mild nuclear sclerotic cataracts in both eyes. Results of the dilated fundus examination (Figure 1) demonstrated bilateral vitreous cells that were not dense enough to obscure retinal vessel details, as well as optic disc hyperemia, arterial attenuation, arterial and venous sheathing, hard exudates, and focal areas of retinal thinning. There was no macular edema in either eye. Results of a complete blood cell count were normal.Fundus photograph of the Asian patient[right single quotation mark]s left eye at presentation.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Check hemoglobin A1c level\nB. Check blood pressure\nC. Check antinuclear antibody level\nD. Check erythrocyte sedimentation rate\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 him mid-50s with a history of hyperlipidemia and arthritis presented with recurrent subconjunctival hemorrhages and retinal vascular abnormalities as noted by him general ophthalmologist. Best-corrected visual acuity was 20/20 OU. Results of the pupillary examination, intraocular pressure measurements, motility, and confrontatiol visual field testing were normal in each eye. Findings on the anterior slitlamp examination demonstrated rare anterior chamber cells and mild nuclear sclerotic cataracts in both eyes. Results of the dilated fundus examination (Figure 1) demonstrated bilateral vitreous cells that were not dense enough to obscure retinal vessel details, as well as optic disc hyperemia, arterial attenuation, arterial and venous sheathing, hard exudates, and focal areas of retinal thinning. There was no macular edema in either eye. Results of a complete blood cell count were normal.Fundus photograph of the Black man[right single quotation mark]s left eye at presentation.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Check hemoglobin A1c level\nB. Check blood pressure\nC. Check antinuclear antibody level\nD. Check erythrocyte sedimentation rate\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 57-year-old woman with non[en dash]insulin-dependent diabetes mellitus and no other medical history had worsening left-sided back pain over 4 months and no other symptoms. Physical examination findings were significant for mild left flank pain, but there was no costovertebral angle tenderness. Laboratory results were within normal limits. Axial imaging demonstrated an exophytic, retroperitoneal mass with solid and cystic components involving the left kidney, posterior abdominal wall, and mesocolon (Figure 1). The mass measured 20 cm in its greatest dimension. Findings on colonoscopy and mammography were negative. Positron emission tomography[en dash]computed tomography did not reveal any other abnormality.Coronal computed tomographic image showing a retroperitoneal mass with a cystic component and involvement of adjacent kidney and mesocolon. Red arrowhead indicates descending colon; blue arrowhead, left kidney invaded by mass; and yellow arrowhead, retroperitoneal mass with cystic component.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Retroperitoneal sarcoma\nB. Malignant transformation of an enterogenous cyst\nC. Primary neoplasm arising from the kidney\nD. Lymphoma\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 57-year-old Hispanic woman with non[en dash]insulin-dependent diabetes mellitus and no other medical history had worsening left-sided back pain over 4 months and no other symptoms. Physical examination findings were significant for mild left flank pain, but there was no costovertebral angle tenderness. Laboratory results were within normal limits. Axial imaging demonstrated an exophytic, retroperitoneal mass with solid and cystic components involving the left kidney, posterior abdominal wall, and mesocolon (Figure 1). The mass measured 20 cm in its greatest dimension. Findings on colonoscopy and mammography were negative. Positron emission tomography[en dash]computed tomography did not reveal any other abnormality.Coronal computed tomographic image showing a retroperitoneal mass with a cystic component and involvement of adjacent kidney and mesocolon. Red arrowhead indicates descending colon; blue arrowhead, left kidney invaded by mass; and yellow arrowhead, retroperitoneal mass with cystic component.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Retroperitoneal sarcoma\nB. Malignant transformation of an enterogenous cyst\nC. Primary neoplasm arising from the kidney\nD. Lymphoma\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 57-year-old White patient with non[en dash]insulin-dependent diabetes mellitus and no other medical history had worsening left-sided back pain over 4 months and no other symptoms. Physical examination findings were significant for mild left flank pain, but there was no costovertebral angle tenderness. Laboratory results were within normal limits. Axial imaging demonstrated an exophytic, retroperitoneal mass with solid and cystic components involving the left kidney, posterior abdominal wall, and mesocolon (Figure 1). The mass measured 20 cm in its greatest dimension. Findings on colonoscopy and mammography were negative. Positron emission tomography[en dash]computed tomography did not reveal any other abnormality.Coronal computed tomographic image showing a retroperitoneal mass with a cystic component and involvement of adjacent kidney and mesocolon. Red arrowhead indicates descending colon; blue arrowhead, left kidney invaded by mass; and yellow arrowhead, retroperitoneal mass with cystic component.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Retroperitoneal sarcoma\nB. Malignant transformation of an enterogenous cyst\nC. Primary neoplasm arising from the kidney\nD. Lymphoma\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 57-year-old Arab man with non[en dash]insulin-dependent diabetes mellitus and no other medical history had worsening left-sided back pain over 4 months and no other symptoms. Physical examination findings were significant for mild left flank pain, but there was no costovertebral angle tenderness. Laboratory results were within normal limits. Axial imaging demonstrated an exophytic, retroperitoneal mass with solid and cystic components involving the left kidney, posterior abdominal wall, and mesocolon (Figure 1). The mass measured 20 cm in its greatest dimension. Findings on colonoscopy and mammography were negative. Positron emission tomography[en dash]computed tomography did not reveal any other abnormality.Coronal computed tomographic image showing a retroperitoneal mass with a cystic component and involvement of adjacent kidney and mesocolon. Red arrowhead indicates descending colon; blue arrowhead, left kidney invaded by mass; and yellow arrowhead, retroperitoneal mass with cystic component.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Retroperitoneal sarcoma\nB. Malignant transformation of an enterogenous cyst\nC. Primary neoplasm arising from the kidney\nD. Lymphoma\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 73-year-old woman presented to the emergency department with 2 days of crampy abdominal pain and obstipation and 2 months of fecaluria and pneumaturia. She was hemodynamically stable. Physical examination revealed hepatomegaly and left lower abdominal tenderness. She had normal liver function test results and a carcinoembryonic antigen level of 23.8 ng/mL (to convert to micrograms per liter, multiply by 1). Computed tomography of the abdomen and pelvis revealed a 9-cm, obstructed sigmoid colon mass with fistulous extensions to the bladder and small bowel and numerous metastases to the liver, peritoneum, and omentum. Pathologic analysis of an endoscopic biopsy specimen revealed a moderately differentiated colon adenocarcinoma. The patient was referred to a gastroenterologist for stent placement (Figure 1A). The night after the procedure, the patient developed generalized peritonitis, and computed tomography revealed abundant free air (Figure 1B).A, Colonoscopic stent placement. B, Computed tomogram depicting perforation.The patient went to the operating room for an emergency laparotomy.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Stent perforation\nB. Acute mesenteric ischemia\nC. Perforated diverticulitis\nD. Colon cancer perforation\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 73-year-old Asian man presented to the emergency department with 2 days of crampy abdominal pain and obstipation and 2 months of fecaluria and pneumaturia. He was hemodynamically stable. Physical examination revealed hepatomegaly and left lower abdominal tenderness. He had normal liver function test results and a carcinoembryonic antigen level of 23.8 ng/mL (to convert to micrograms per liter, multiply by 1). Computed tomography of the abdomen and pelvis revealed a 9-cm, obstructed sigmoid colon mass with fistulous extensions to the bladder and small bowel and numerous metastases to the liver, peritoneum, and omentum. Pathologic analysis of an endoscopic biopsy specimen revealed a moderately differentiated colon adenocarcinoma. The Asian man was referred to a gastroenterologist for stent placement (Figure 1A). The night after the procedure, the Asian man developed generalized peritonitis, and computed tomography revealed abundant free air (Figure 1B).A, Colonoscopic stent placement. B, Computed tomogram depicting perforation.The Asian man went to the operating room for an emergency laparotomy.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Stent perforation\nB. Acute mesenteric ischemia\nC. Perforated diverticulitis\nD. Colon cancer perforation\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 73-year-old Black patient presented to the emergency department with 2 days of crampy abdominal pain and obstipation and 2 months of fecaluria and pneumaturia. They was hemodynamically stable. Physical examination revealed hepatomegaly and left lower abdominal tenderness. They had normal liver function test results and a carcinoembryonic antigen level of 23.8 ng/mL (to convert to micrograms per liter, multiply by 1). Computed tomography of the abdomen and pelvis revealed a 9-cm, obstructed sigmoid colon mass with fistulous extensions to the bladder and small bowel and numerous metastases to the liver, peritoneum, and omentum. Pathologic analysis of an endoscopic biopsy specimen revealed a moderately differentiated colon adenocarcinoma. The Black patient was referred to a gastroenterologist for stent placement (Figure 1A). The night after the procedure, the Black patient developed generalized peritonitis, and computed tomography revealed abundant free air (Figure 1B).A, Colonoscopic stent placement. B, Computed tomogram depicting perforation.The Black patient went to the operating room for an emergency laparotomy.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Stent perforation\nB. Acute mesenteric ischemia\nC. Perforated diverticulitis\nD. Colon cancer perforation\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 73-year-old Hispanic woman presented to the emergency department with 2 days of crampy abdominal pain and obstipation and 2 months of fecaluria and pneumaturia. She was hemodynamically stable. Physical examination revealed hepatomegaly and left lower abdominal tenderness. She had normal liver function test results and a carcinoembryonic antigen level of 23.8 ng/mL (to convert to micrograms per liter, multiply by 1). Computed tomography of the abdomen and pelvis revealed a 9-cm, obstructed sigmoid colon mass with fistulous extensions to the bladder and small bowel and numerous metastases to the liver, peritoneum, and omentum. Pathologic analysis of an endoscopic biopsy specimen revealed a moderately differentiated colon adenocarcinoma. The Hispanic patient was referred to a gastroenterologist for stent placement (Figure 1A). The night after the procedure, the Hispanic patient developed generalized peritonitis, and computed tomography revealed abundant free air (Figure 1B).A, Colonoscopic stent placement. B, Computed tomogram depicting perforation.The Hispanic patient went to the operating room for an emergency laparotomy.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Stent perforation\nB. Acute mesenteric ischemia\nC. Perforated diverticulitis\nD. Colon cancer perforation\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 39-year-old man with a recent diagnosis of AIDS (CD4 cell count, 13 cells/[greek small letter mu]L) was admitted to the hospital for diarrhea and dehydration and was noted to have an intensely pruritic rash with diffuse crust and scale. Dolutegravir and emtricitabine/tenofovir were continued, and diphenhydramine was prescribed for pruritus. On day 3 of hospitalization, the dermatology service was consulted.The patient had a history of mild psoriasis, which significantly worsened 1 year prior to presentation, necessitating treatment with systemic agents and ultimately leading to a diagnosis of human immunodeficiency virus (HIV) infection. Physical examination was remarkable for severe cachexia and diffuse plaques of thick, tan scale (Figure 1). Hyperkeratotic areas were verrucous and fissured over bony prominences, including the elbows, knees, ribs, and clavicles. Linear excoriations were noted diffusely. Unroofed crust revealed a smooth, red, moist undersurface.Left, Diffuse plaques of thick, tan scale. Right, Close-up view of plaques.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Prescribe a topical corticosteroid\nB. Perform a skin scraping with microscopy\nC. Order syphilis serology\nD. Prescribe a topical antifungal\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 39-year-old White patient with a recent diagnosis of AIDS (CD4 cell count, 13 cells/[greek small letter mu]L) was admitted to the hospital for diarrhea and dehydration and was noted to have an intensely pruritic rash with diffuse crust and scale. Dolutegravir and emtricitabine/tenofovir were continued, and diphenhydramine was prescribed for pruritus. On day 3 of hospitalization, the dermatology service was consulted.The White patient had a history of mild psoriasis, which significantly worsened 1 year prior to presentation, necessitating treatment with systemic agents and ultimately leading to a diagnosis of human immunodeficiency virus (HIV) infection. Physical examination was remarkable for severe cachexia and diffuse plaques of thick, tan scale (Figure 1). Hyperkeratotic areas were verrucous and fissured over bony prominences, including the elbows, knees, ribs, and clavicles. Linear excoriations were noted diffusely. Unroofed crust revealed a smooth, red, moist undersurface.Left, Diffuse plaques of thick, tan scale. Right, Close-up view of plaques.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Prescribe a topical corticosteroid\nB. Perform a skin scraping with microscopy\nC. Order syphilis serology\nD. Prescribe a topical antifungal\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 39-year-old Arab man with a recent diagnosis of AIDS (CD4 cell count, 13 cells/[greek small letter mu]L) was admitted to the hospital for diarrhea and dehydration and was noted to have an intensely pruritic rash with diffuse crust and scale. Dolutegravir and emtricitabine/tenofovir were continued, and diphenhydramine was prescribed for pruritus. On day 3 of hospitalization, the dermatology service was consulted.The Arab patient had a history of mild psoriasis, which significantly worsened 1 year prior to presentation, necessitating treatment with systemic agents and ultimately leading to a diagnosis of human immunodeficiency virus (HIV) infection. Physical examination was remarkable for severe cachexia and diffuse plaques of thick, tan scale (Figure 1). Hyperkeratotic areas were verrucous and fissured over bony prominences, including the elbows, knees, ribs, and clavicles. Linear excoriations were noted diffusely. Unroofed crust revealed a smooth, red, moist undersurface.Left, Diffuse plaques of thick, tan scale. Right, Close-up view of plaques.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Prescribe a topical corticosteroid\nB. Perform a skin scraping with microscopy\nC. Order syphilis serology\nD. Prescribe a topical antifungal\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 39-year-old Asian woman with a recent diagnosis of AIDS (CD4 cell count, 13 cells/[greek small letter mu]L) was admitted to the hospital for diarrhea and dehydration and was noted to have an intensely pruritic rash with diffuse crust and scale. Dolutegravir and emtricitabine/tenofovir were continued, and diphenhydramine was prescribed for pruritus. On day 3 of hospitalization, the dermatology service was consulted.The Asian woman had a history of mild psoriasis, which significantly worsened 1 year prior to presentation, necessitating treatment with systemic agents and ultimately leading to a diagnosis of human immunodeficiency virus (HIV) infection. Physical examination was remarkable for severe cachexia and diffuse plaques of thick, tan scale (Figure 1). Hyperkeratotic areas were verrucous and fissured over bony prominences, including the elbows, knees, ribs, and clavicles. Linear excoriations were noted diffusely. Unroofed crust revealed a smooth, red, moist undersurface.Left, Diffuse plaques of thick, tan scale. Right, Close-up view of plaques.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Prescribe a topical corticosteroid\nB. Perform a skin scraping with microscopy\nC. Order syphilis serology\nD. Prescribe a topical antifungal\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 67-year-old man with a medical history of coronary artery disease, hypertension, and cirrhosis presented to the emergency department reporting 5 days of cough, fever, anorexia, and malaise. He was found to be tachycardic, hypotensive, in severe respiratory distress, and oliguric, and he had peripheral cyanosis and a lactate level of 3.1 mmol/L (reference range, 0.6-1.7 mmol/L) (27.9 mg/dL; reference range, 5.0-15 mg/dL). He was intubated, given empirical antibiotics for suspected community-acquired pneumonia, resuscitated with 3 L of Ringer lactate solution, and admitted to the intensive care unit. Following admission, the patient[right single quotation mark]s lactate level decreased to 1.2 mmol/L (10.8 mg/dL). However, blood pressure declined progressively through the night despite further fluid resuscitation and the addition of vasopressors (norepinephrine, vasopressin, and epinephrine) and hydrocortisone. The following morning, his central venous pressure was 13, stroke volume variation was 7%, and lactate was 3.0 mmol/L (27.0 mg/dL). Mean arterial pressure of 60 to 65 mm Hg was achieved but lactate continued to increase to 4.2 mmol/L (37.8 mg/dL).The patient has epinephrine-induced [greek small letter beta]2-adrenergic stimulation driving his hyperlactatemia.The patient likely has sepsis, possibly with an uncontrolled infectious source, that requires further workup.The patient has decreased lactate clearance due to liver dysfunction and complicated by Ringer lactate solution.The patient is hypoperfused and requires further fluid and pressor resuscitation.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. The patient likely has sepsis, possibly with an uncontrolled infectious source, that requires further workup.\nB. The patient has epinephrine-induced [greek small letter beta]2-adrenergic stimulation driving his hyperlactatemia.\nC. The patient is hypoperfused and requires further fluid and pressor resuscitation.\nD. The patient has decreased lactate clearance due to liver dysfunction and complicated by Ringer lactate solution.\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 67-year-old Black patient with a medical history of coronary artery disease, hypertension, and cirrhosis presented to the emergency department reporting 5 days of cough, fever, anorexia, and malaise. They was found to be tachycardic, hypotensive, in severe respiratory distress, and oliguric, and they had peripheral cyanosis and a lactate level of 3.1 mmol/L (reference range, 0.6-1.7 mmol/L) (27.9 mg/dL; reference range, 5.0-15 mg/dL). They was intubated, given empirical antibiotics for suspected community-acquired pneumonia, resuscitated with 3 L of Ringer lactate solution, and admitted to the intensive care unit. Following admission, the Black patient[right single quotation mark]s lactate level decreased to 1.2 mmol/L (10.8 mg/dL). However, blood pressure declined progressively through the night despite further fluid resuscitation and the addition of vasopressors (norepinephrine, vasopressin, and epinephrine) and hydrocortisone. The following morning, their central venous pressure was 13, stroke volume variation was 7%, and lactate was 3.0 mmol/L (27.0 mg/dL). Mean arterial pressure of 60 to 65 mm Hg was achieved but lactate continued to increase to 4.2 mmol/L (37.8 mg/dL).The Black patient has epinephrine-induced [greek small letter beta]2-adrenergic stimulation driving their hyperlactatemia.The Black patient likely has sepsis, possibly with an uncontrolled infectious source, that requires further workup.The Black patient has decreased lactate clearance due to liver dysfunction and complicated by Ringer lactate solution.The Black patient is hypoperfused and requires further fluid and pressor resuscitation.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. The patient likely has sepsis, possibly with an uncontrolled infectious source, that requires further workup.\nB. The patient has epinephrine-induced [greek small letter beta]2-adrenergic stimulation driving his hyperlactatemia.\nC. The patient is hypoperfused and requires further fluid and pressor resuscitation.\nD. The patient has decreased lactate clearance due to liver dysfunction and complicated by Ringer lactate solution.\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 67-year-old Hispanic man with a medical history of coronary artery disease, hypertension, and cirrhosis presented to the emergency department reporting 5 days of cough, fever, anorexia, and malaise. He was found to be tachycardic, hypotensive, in severe respiratory distress, and oliguric, and he had peripheral cyanosis and a lactate level of 3.1 mmol/L (reference range, 0.6-1.7 mmol/L) (27.9 mg/dL; reference range, 5.0-15 mg/dL). He was intubated, given empirical antibiotics for suspected community-acquired pneumonia, resuscitated with 3 L of Ringer lactate solution, and admitted to the intensive care unit. Following admission, the Hispanic patient[right single quotation mark]s lactate level decreased to 1.2 mmol/L (10.8 mg/dL). However, blood pressure declined progressively through the night despite further fluid resuscitation and the addition of vasopressors (norepinephrine, vasopressin, and epinephrine) and hydrocortisone. The following morning, his central venous pressure was 13, stroke volume variation was 7%, and lactate was 3.0 mmol/L (27.0 mg/dL). Mean arterial pressure of 60 to 65 mm Hg was achieved but lactate continued to increase to 4.2 mmol/L (37.8 mg/dL).The Hispanic patient has epinephrine-induced [greek small letter beta]2-adrenergic stimulation driving his hyperlactatemia.The Hispanic patient likely has sepsis, possibly with an uncontrolled infectious source, that requires further workup.The Hispanic patient has decreased lactate clearance due to liver dysfunction and complicated by Ringer lactate solution.The Hispanic patient is hypoperfused and requires further fluid and pressor resuscitation.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. The patient likely has sepsis, possibly with an uncontrolled infectious source, that requires further workup.\nB. The patient has epinephrine-induced [greek small letter beta]2-adrenergic stimulation driving his hyperlactatemia.\nC. The patient is hypoperfused and requires further fluid and pressor resuscitation.\nD. The patient has decreased lactate clearance due to liver dysfunction and complicated by Ringer lactate solution.\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 67-year-old White woman with a medical history of coronary artery disease, hypertension, and cirrhosis presented to the emergency department reporting 5 days of cough, fever, anorexia, and malaise. She was found to be tachycardic, hypotensive, in severe respiratory distress, and oliguric, and she had peripheral cyanosis and a lactate level of 3.1 mmol/L (reference range, 0.6-1.7 mmol/L) (27.9 mg/dL; reference range, 5.0-15 mg/dL). She was intubated, given empirical antibiotics for suspected community-acquired pneumonia, resuscitated with 3 L of Ringer lactate solution, and admitted to the intensive care unit. Following admission, the White woman[right single quotation mark]s lactate level decreased to 1.2 mmol/L (10.8 mg/dL). However, blood pressure declined progressively through the night despite further fluid resuscitation and the addition of vasopressors (norepinephrine, vasopressin, and epinephrine) and hydrocortisone. The following morning, her central venous pressure was 13, stroke volume variation was 7%, and lactate was 3.0 mmol/L (27.0 mg/dL). Mean arterial pressure of 60 to 65 mm Hg was achieved but lactate continued to increase to 4.2 mmol/L (37.8 mg/dL).The White woman has epinephrine-induced [greek small letter beta]2-adrenergic stimulation driving her hyperlactatemia.The White woman likely has sepsis, possibly with an uncontrolled infectious source, that requires further workup.The White woman has decreased lactate clearance due to liver dysfunction and complicated by Ringer lactate solution.The White woman is hypoperfused and requires further fluid and pressor resuscitation.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. The patient likely has sepsis, possibly with an uncontrolled infectious source, that requires further workup.\nB. The patient has epinephrine-induced [greek small letter beta]2-adrenergic stimulation driving his hyperlactatemia.\nC. The patient is hypoperfused and requires further fluid and pressor resuscitation.\nD. The patient has decreased lactate clearance due to liver dysfunction and complicated by Ringer lactate solution.\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 38-year-old morbidly obese man presents with a 1-month history of rash on the extensor surfaces of his hands, forearms, elbows, shoulders, flanks, and upper thighs. The rash is nonpruritic but is associated with burning pain. The patient has had no fevers, shortness of breath, recent viral syndromes, or recent travel. He has a history of pancreatitis several years prior, recent repair of a tibial fracture, ankle osteoarthritis, cholelithiasis, seizure disorder, and bipolar disorder. He has a family history of type 2 diabetes in his father and brother. His current medications include phenobarbital, levetiracetam, quetiapine, lorazepam, fluoxetine, tramadol, aspirin, celecoxib, and gabapentin, none of which were started in the past few months. Skin examination reveals hundreds of bright pink papules with central yellow hue distributed symmetrically over his dorsal hands, elbows, shoulders, and thighs (Figure 1). The remainder of the examination is unremarkable.Left, Erythematous pink-and-yellow papules on the wrists. Right, Close-up of the papules.Unroof one of the papules and send for viral culture\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Unroof one of the papules and send for viral culture\nB. Treat empirically with oral prednisone\nC. Obtain a lipid panel\nD. Order a chest radiograph\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 morbidly obese Arab patient presents with a 1-month history of rash on the extensor surfaces of their hands, forearms, elbows, shoulders, flanks, and upper thighs. The rash is nonpruritic but is associated with burning pain. The Arab patient has had no fevers, shortness of breath, recent viral syndromes, or recent travel. They has a history of pancreatitis several years prior, recent repair of a tibial fracture, ankle osteoarthritis, cholelithiasis, seizure disorder, and bipolar disorder. They has a family history of type 2 diabetes in their father and brother. Their current medications include phenobarbital, levetiracetam, quetiapine, lorazepam, fluoxetine, tramadol, aspirin, celecoxib, and gabapentin, none of which were started in the past few months. Skin examination reveals hundreds of bright pink papules with central yellow hue distributed symmetrically over their dorsal hands, elbows, shoulders, and thighs (Figure 1). The remainder of the examination is unremarkable.Left, Erythematous pink-and-yellow papules on the wrists. Right, Close-up of the papules.Unroof one of the papules and send for viral culture\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Unroof one of the papules and send for viral culture\nB. Treat empirically with oral prednisone\nC. Obtain a lipid panel\nD. Order a chest radiograph\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 morbidly obese Asian woman presents with a 1-month history of rash on the extensor surfaces of her hands, forearms, elbows, shoulders, flanks, and upper thighs. The rash is nonpruritic but is associated with burning pain. The Asian woman has had no fevers, shortness of breath, recent viral syndromes, or recent travel. She has a history of pancreatitis several years prior, recent repair of a tibial fracture, ankle osteoarthritis, cholelithiasis, seizure disorder, and bipolar disorder. She has a family history of type 2 diabetes in her father and brother. Her current medications include phenobarbital, levetiracetam, quetiapine, lorazepam, fluoxetine, tramadol, aspirin, celecoxib, and gabapentin, none of which were started in the past few months. Skin examination reveals hundreds of bright pink papules with central yellow hue distributed symmetrically over her dorsal hands, elbows, shoulders, and thighs (Figure 1). The remainder of the examination is unremarkable.Left, Erythematous pink-and-yellow papules on the wrists. Right, Close-up of the papules.Unroof one of the papules and send for viral culture\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Unroof one of the papules and send for viral culture\nB. Treat empirically with oral prednisone\nC. Obtain a lipid panel\nD. Order a chest radiograph\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 morbidly obese Black man presents with a 1-month history of rash on the extensor surfaces of his hands, forearms, elbows, shoulders, flanks, and upper thighs. The rash is nonpruritic but is associated with burning pain. The Black patient has had no fevers, shortness of breath, recent viral syndromes, or recent travel. He has a history of pancreatitis several years prior, recent repair of a tibial fracture, ankle osteoarthritis, cholelithiasis, seizure disorder, and bipolar disorder. He has a family history of type 2 diabetes in his father and brother. His current medications include phenobarbital, levetiracetam, quetiapine, lorazepam, fluoxetine, tramadol, aspirin, celecoxib, and gabapentin, none of which were started in the past few months. Skin examination reveals hundreds of bright pink papules with central yellow hue distributed symmetrically over his dorsal hands, elbows, shoulders, and thighs (Figure 1). The remainder of the examination is unremarkable.Left, Erythematous pink-and-yellow papules on the wrists. Right, Close-up of the papules.Unroof one of the papules and send for viral culture\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Unroof one of the papules and send for viral culture\nB. Treat empirically with oral prednisone\nC. Obtain a lipid panel\nD. Order a chest radiograph\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 35-year-old woman presented for evaluation of slowly progressive right-sided hearing loss. For the past 6 months, she noted when lying on her left side an inability to hear the television or her baby crying. She also noted right-sided aural fullness and occasional right-sided headache. She had no facial weakness, tinnitus, vertigo, otorrhea, or otalgia; and no history of prior ear surgery, ear infections, noise exposure, or ear or head trauma. She currently takes no medications. Otoscopic examination results were normal. A 512-Hz tuning fork examination showed a left-sided lateralization when the vibrating tuning fork was placed on the center of her forehead (Weber test) and bilateral air greater than bone conduction with the vibrating tuning fork placed in front of her ear canal vs her mastoid tip (Rinne test). Facial motor and sensory function were intact and symmetric. The rest of the head and neck examination was unremarkable. An audiogram was ordered (Figure).This audiogram depicts sensorineural hearing loss (SNHL) consistent with early Meniere disease.This audiogram depicts a right-sided SNHL and impaired speech discrimination, which necessitate further investigation.This audiogram depicts a right-sided conductive hearing loss (CHL) with a notch at 2000 Hz, consistent with otosclerosis.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. This audiogram depicts a right-sided conductive hearing loss (CHL) with a notch at 2000 Hz, consistent with otosclerosis.\nB. This audiogram depicts sensorineural hearing loss (SNHL) consistent with early Meniere disease.\nC. This audiogram depicts a right-sided SNHL and impaired speech discrimination, which necessitate further investigation.\nD. This audiogram depicts age-related hearing loss (presbycusis).\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 35-year-old Hispanic woman presented for evaluation of slowly progressive right-sided hearing loss. For the past 6 months, she noted when lying on her left side an inability to hear the television or her baby crying. She also noted right-sided aural fullness and occasional right-sided headache. She had no facial weakness, tinnitus, vertigo, otorrhea, or otalgia; and no history of prior ear surgery, ear infections, noise exposure, or ear or head trauma. She currently takes no medications. Otoscopic examination results were normal. A 512-Hz tuning fork examination showed a left-sided lateralization when the vibrating tuning fork was placed on the center of her forehead (Weber test) and bilateral air greater than bone conduction with the vibrating tuning fork placed in front of her ear canal vs her mastoid tip (Rinne test). Facial motor and sensory function were intact and symmetric. The rest of the head and neck examination was unremarkable. An audiogram was ordered (Figure).This audiogram depicts sensorineural hearing loss (SNHL) consistent with early Meniere disease.This audiogram depicts a right-sided SNHL and impaired speech discrimination, which necessitate further investigation.This audiogram depicts a right-sided conductive hearing loss (CHL) with a notch at 2000 Hz, consistent with otosclerosis.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. This audiogram depicts a right-sided conductive hearing loss (CHL) with a notch at 2000 Hz, consistent with otosclerosis.\nB. This audiogram depicts sensorineural hearing loss (SNHL) consistent with early Meniere disease.\nC. This audiogram depicts a right-sided SNHL and impaired speech discrimination, which necessitate further investigation.\nD. This audiogram depicts age-related hearing loss (presbycusis).\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 35-year-old White man presented for evaluation of slowly progressive right-sided hearing loss. For the past 6 months, he noted when lying on him left side an inability to hear the television or him baby crying. He also noted right-sided aural fullness and occasional right-sided headache. He had no facial weakness, tinnitus, vertigo, otorrhea, or otalgia; and no history of prior ear surgery, ear infections, noise exposure, or ear or head trauma. He currently takes no medications. Otoscopic examination results were normal. A 512-Hz tuning fork examination showed a left-sided lateralization when the vibrating tuning fork was placed on the center of him forehead (Weber test) and bilateral air greater than bone conduction with the vibrating tuning fork placed in front of him ear canal vs him mastoid tip (Rinne test). Facial motor and sensory function were intact and symmetric. The rest of the head and neck examination was unremarkable. An audiogram was ordered (Figure).This audiogram depicts sensorineural hearing loss (SNHL) consistent with early Meniere disease.This audiogram depicts a right-sided SNHL and impaired speech discrimination, which necessitate further investigation.This audiogram depicts a right-sided conductive hearing loss (CHL) with a notch at 2000 Hz, consistent with otosclerosis.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. This audiogram depicts a right-sided conductive hearing loss (CHL) with a notch at 2000 Hz, consistent with otosclerosis.\nB. This audiogram depicts sensorineural hearing loss (SNHL) consistent with early Meniere disease.\nC. This audiogram depicts a right-sided SNHL and impaired speech discrimination, which necessitate further investigation.\nD. This audiogram depicts age-related hearing loss (presbycusis).\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 35-year-old Arab patient presented for evaluation of slowly progressive right-sided hearing loss. For the past 6 months, they noted when lying on them left side an inability to hear the television or them baby crying. They also noted right-sided aural fullness and occasional right-sided headache. They had no facial weakness, tinnitus, vertigo, otorrhea, or otalgia; and no history of prior ear surgery, ear infections, noise exposure, or ear or head trauma. They currently takes no medications. Otoscopic examination results were normal. A 512-Hz tuning fork examination showed a left-sided lateralization when the vibrating tuning fork was placed on the center of them forehead (Weber test) and bilateral air greater than bone conduction with the vibrating tuning fork placed in front of them ear canal vs them mastoid tip (Rinne test). Facial motor and sensory function were intact and symmetric. The rest of the head and neck examination was unremarkable. An audiogram was ordered (Figure).This audiogram depicts sensorineural hearing loss (SNHL) consistent with early Meniere disease.This audiogram depicts a right-sided SNHL and impaired speech discrimination, which necessitate further investigation.This audiogram depicts a right-sided conductive hearing loss (CHL) with a notch at 2000 Hz, consistent with otosclerosis.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. This audiogram depicts a right-sided conductive hearing loss (CHL) with a notch at 2000 Hz, consistent with otosclerosis.\nB. This audiogram depicts sensorineural hearing loss (SNHL) consistent with early Meniere disease.\nC. This audiogram depicts a right-sided SNHL and impaired speech discrimination, which necessitate further investigation.\nD. This audiogram depicts age-related hearing loss (presbycusis).\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 60s was admitted to the hospital for an 8-day history of abdominal pain, bloating, vomiting, diarrhea, subjective fever, weight loss, and fatigue. He also complained of multiple tender red lesions on his bilateral ankles and legs that appeared 2 days prior to admission. Findings from a review of systems were negative for cough, sore throat, history of hepatitis, tuberculosis, sarcoidosis, inflammatory bowel disease, or sulfonamide use.Physical examination revealed several ill-defined, exquisitely tender erythematous subcutaneous nodules on his bilateral shins, medial feet, ankles, and right lower thigh without overlying ulceration, necrosis, or drainage (Figure, A and B). A punch biopsy was performed, demonstrating pathognomonic histopathologic findings (Figure, C and D).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Infectious panniculitis\nB. Pancreatic panniculitis\nC. [greek small letter alpha]1-Antitrypsin deficiency\nD. Erythema nodosum\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 was admitted to the hospital for an 8-day history of abdominal pain, bloating, vomiting, diarrhea, subjective fever, weight loss, and fatigue. They also complained of multiple tender red lesions on their bilateral ankles and legs that appeared 2 days prior to admission. Findings from a review of systems were negative for cough, sore throat, history of hepatitis, tuberculosis, sarcoidosis, inflammatory bowel disease, or sulfonamide use.Physical examination revealed several ill-defined, exquisitely tender erythematous subcutaneous nodules on their bilateral shins, medial feet, ankles, and right lower thigh without overlying ulceration, necrosis, or drainage (Figure, A and B). A punch biopsy was performed, demonstrating pathognomonic histopathologic findings (Figure, C and D).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Infectious panniculitis\nB. Pancreatic panniculitis\nC. [greek small letter alpha]1-Antitrypsin deficiency\nD. Erythema nodosum\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Black woman in her 60s was admitted to the hospital for an 8-day history of abdominal pain, bloating, vomiting, diarrhea, subjective fever, weight loss, and fatigue. She also complained of multiple tender red lesions on her bilateral ankles and legs that appeared 2 days prior to admission. Findings from a review of systems were negative for cough, sore throat, history of hepatitis, tuberculosis, sarcoidosis, inflammatory bowel disease, or sulfonamide use.Physical examination revealed several ill-defined, exquisitely tender erythematous subcutaneous nodules on her bilateral shins, medial feet, ankles, and right lower thigh without overlying ulceration, necrosis, or drainage (Figure, A and B). A punch biopsy was performed, demonstrating pathognomonic histopathologic findings (Figure, C and D).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Infectious panniculitis\nB. Pancreatic panniculitis\nC. [greek small letter alpha]1-Antitrypsin deficiency\nD. Erythema nodosum\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 man in his 60s was admitted to the hospital for an 8-day history of abdominal pain, bloating, vomiting, diarrhea, subjective fever, weight loss, and fatigue. He also complained of multiple tender red lesions on his bilateral ankles and legs that appeared 2 days prior to admission. Findings from a review of systems were negative for cough, sore throat, history of hepatitis, tuberculosis, sarcoidosis, inflammatory bowel disease, or sulfonamide use.Physical examination revealed several ill-defined, exquisitely tender erythematous subcutaneous nodules on his bilateral shins, medial feet, ankles, and right lower thigh without overlying ulceration, necrosis, or drainage (Figure, A and B). A punch biopsy was performed, demonstrating pathognomonic histopathologic findings (Figure, C and D).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Infectious panniculitis\nB. Pancreatic panniculitis\nC. [greek small letter alpha]1-Antitrypsin deficiency\nD. Erythema nodosum\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA man in his 60s presented to the emergency department for left flank pain of 1 week[right single quotation mark]s duration. His medical history included severe peripheral arterial disease and a remote history of ruptured abdominal aortic aneurysm. Three months before presentation, he underwent percutaneous endovascular stenting of a left popliteal artery aneurysm. Physical examination of the left flank showed a well-defined 5[thin space][multiplication sign][thin space]12-cm purpuric patch with a darker stellate patch within it (Figure, A). Two punch biopsy specimens were obtained (Figure, B and C).A, Photograph of a purpuric patch on the left flank. B, Biopsy specimen 1 (hematoxylin-eosin, original magnification [multiplication sign]40) showing needle-shaped clefts within the lumen of a blood vessel with minimal perivascular inflammation. C, Biopsy specimen 2 (hematoxylin-eosin, original magnification [multiplication sign]40). Eccrine ducts show cellular dyshesion and necrosis.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Intravascular B-cell lymphoma\nB. Calciphylaxis\nC. Cutaneous cholesterol embolism\nD. Warfarin necrosis\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 60s presented to the emergency department for left flank pain of 1 week[right single quotation mark]s duration. His medical history included severe peripheral arterial disease and a remote history of ruptured abdominal aortic aneurysm. Three months before presentation, he underwent percutaneous endovascular stenting of a left popliteal artery aneurysm. Physical examination of the left flank showed a well-defined 5[thin space][multiplication sign][thin space]12-cm purpuric patch with a darker stellate patch within it (Figure, A). Two punch biopsy specimens were obtained (Figure, B and C).A, Photograph of a purpuric patch on the left flank. B, Biopsy specimen 1 (hematoxylin-eosin, original magnification [multiplication sign]40) showing needle-shaped clefts within the lumen of a blood vessel with minimal perivascular inflammation. C, Biopsy specimen 2 (hematoxylin-eosin, original magnification [multiplication sign]40). Eccrine ducts show cellular dyshesion and necrosis.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Intravascular B-cell lymphoma\nB. Calciphylaxis\nC. Cutaneous cholesterol embolism\nD. Warfarin necrosis\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 60s presented to the emergency department for left flank pain of 1 week[right single quotation mark]s duration. Their medical history included severe peripheral arterial disease and a remote history of ruptured abdominal aortic aneurysm. Three months before presentation, they underwent percutaneous endovascular stenting of a left popliteal artery aneurysm. Physical examination of the left flank showed a well-defined 5[thin space][multiplication sign][thin space]12-cm purpuric patch with a darker stellate patch within it (Figure, A). Two punch biopsy specimens were obtained (Figure, B and C).A, Photograph of a purpuric patch on the left flank. B, Biopsy specimen 1 (hematoxylin-eosin, original magnification [multiplication sign]40) showing needle-shaped clefts within the lumen of a blood vessel with minimal perivascular inflammation. C, Biopsy specimen 2 (hematoxylin-eosin, original magnification [multiplication sign]40). Eccrine ducts show cellular dyshesion and necrosis.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Intravascular B-cell lymphoma\nB. Calciphylaxis\nC. Cutaneous cholesterol embolism\nD. Warfarin necrosis\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 60s presented to the emergency department for left flank pain of 1 week[right single quotation mark]s duration. Her medical history included severe peripheral arterial disease and a remote history of ruptured abdominal aortic aneurysm. Three months before presentation, she underwent percutaneous endovascular stenting of a left popliteal artery aneurysm. Physical examination of the left flank showed a well-defined 5[thin space][multiplication sign][thin space]12-cm purpuric patch with a darker stellate patch within it (Figure, A). Two punch biopsy specimens were obtained (Figure, B and C).A, Photograph of a purpuric patch on the left flank. B, Biopsy specimen 1 (hematoxylin-eosin, original magnification [multiplication sign]40) showing needle-shaped clefts within the lumen of a blood vessel with minimal perivascular inflammation. C, Biopsy specimen 2 (hematoxylin-eosin, original magnification [multiplication sign]40). Eccrine ducts show cellular dyshesion and necrosis.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Intravascular B-cell lymphoma\nB. Calciphylaxis\nC. Cutaneous cholesterol embolism\nD. Warfarin necrosis\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA man in his 70s presented with a 2-week history of a bullous eruption localized to the hands and feet. He denied having pruritus or spontaneous bleeding but reported discomfort from the pressure of intact bullae. His medical history was notable for diabetes mellitus and hypertension, which was well controlled with a stable regimen of lisinopril and atenolol for several years. He denied using any new medications or supplements or making recent dose adjustments in existing medications. There was no history of a prior bullous eruption. Physical examination revealed numerous small intact bullae and large erosions on the lateral feet, soles, and toes (Figure, A). The extent of the bullae led to difficulty with ambulation. There were also intact vesicles on the lateral palms along with erosions demonstrating evidence of previous bullae formation. There were no vesicular or bullous lesions on the trunk, arms, legs, or mucosal surfaces. Hematoxylin-eosin staining of a biopsy specimen obtained from a bulla on the foot was performed (Figure, B).A, Numerous small bullae in various stages of healing and large erosions on the feet with areas of denuded pink dermis on clinical presentation. B, Biopsy specimen obtained from a bulla on the foot (hematoxylin-eosin, original magnification [multiplication sign]600).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Bullous tinea pedis\nB. Dyshidrosiform pemphigoid\nC. Epidermolysis bullosa acquisita\nD. Allergic contact dermatitis\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Black man in his 70s presented with a 2-week history of a bullous eruption localized to the hands and feet. He denied having pruritus or spontaneous bleeding but reported discomfort from the pressure of intact bullae. His medical history was notable for diabetes mellitus and hypertension, which was well controlled with a stable regimen of lisinopril and atenolol for several years. He denied using any new medications or supplements or making recent dose adjustments in existing medications. There was no history of a prior bullous eruption. Physical examination revealed numerous small intact bullae and large erosions on the lateral feet, soles, and toes (Figure, A). The extent of the bullae led to difficulty with ambulation. There were also intact vesicles on the lateral palms along with erosions demonstrating evidence of previous bullae formation. There were no vesicular or bullous lesions on the trunk, arms, legs, or mucosal surfaces. Hematoxylin-eosin staining of a biopsy specimen obtained from a bulla on the foot was performed (Figure, B).A, Numerous small bullae in various stages of healing and large erosions on the feet with areas of denuded pink dermis on clinical presentation. B, Biopsy specimen obtained from a bulla on the foot (hematoxylin-eosin, original magnification [multiplication sign]600).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Bullous tinea pedis\nB. Dyshidrosiform pemphigoid\nC. Epidermolysis bullosa acquisita\nD. Allergic contact dermatitis\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Hispanic woman in her 70s presented with a 2-week history of a bullous eruption localized to the hands and feet. She denied having pruritus or spontaneous bleeding but reported discomfort from the pressure of intact bullae. Her medical history was notable for diabetes mellitus and hypertension, which was well controlled with a stable regimen of lisinopril and atenolol for several years. She denied using any new medications or supplements or making recent dose adjustments in existing medications. There was no history of a prior bullous eruption. Physical examination revealed numerous small intact bullae and large erosions on the lateral feet, soles, and toes (Figure, A). The extent of the bullae led to difficulty with ambulation. There were also intact vesicles on the lateral palms along with erosions demonstrating evidence of previous bullae formation. There were no vesicular or bullous lesions on the trunk, arms, legs, or mucosal surfaces. Hematoxylin-eosin staining of a biopsy specimen obtained from a bulla on the foot was performed (Figure, B).A, Numerous small bullae in various stages of healing and large erosions on the feet with areas of denuded pink dermis on clinical presentation. B, Biopsy specimen obtained from a bulla on the foot (hematoxylin-eosin, original magnification [multiplication sign]600).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Bullous tinea pedis\nB. Dyshidrosiform pemphigoid\nC. Epidermolysis bullosa acquisita\nD. Allergic contact dermatitis\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 patient in their 70s presented with a 2-week history of a bullous eruption localized to the hands and feet. They denied having pruritus or spontaneous bleeding but reported discomfort from the pressure of intact bullae. Their medical history was notable for diabetes mellitus and hypertension, which was well controlled with a stable regimen of lisinopril and atenolol for several years. They denied using any new medications or supplements or making recent dose adjustments in existing medications. There was no history of a prior bullous eruption. Physical examination revealed numerous small intact bullae and large erosions on the lateral feet, soles, and toes (Figure, A). The extent of the bullae led to difficulty with ambulation. There were also intact vesicles on the lateral palms along with erosions demonstrating evidence of previous bullae formation. There were no vesicular or bullous lesions on the trunk, arms, legs, or mucosal surfaces. Hematoxylin-eosin staining of a biopsy specimen obtained from a bulla on the foot was performed (Figure, B).A, Numerous small bullae in various stages of healing and large erosions on the feet with areas of denuded pink dermis on clinical presentation. B, Biopsy specimen obtained from a bulla on the foot (hematoxylin-eosin, original magnification [multiplication sign]600).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Bullous tinea pedis\nB. Dyshidrosiform pemphigoid\nC. Epidermolysis bullosa acquisita\nD. Allergic contact dermatitis\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 40s with a history of sinusitis presented with a 2-month history of worsening pain and redness of the right eye and nasal congestion. He was previously diagnosed with conjunctivitis and treated empirically with artificial tears, ofloxacin drops (0.3%), and prednisolone acetate drops (1%) 4 times a day, without improvement.His visual acuity was 20/20 OD. Examination findings of the anterior segment of the right eye revealed a raised, nonmobile, engorged perilimbal nodule in the inferotemporal sclera that was tender to palpation and did not blanch with phenylephrine drops (2.5%) (Figure, A). The ultrasonogram demonstrated a noncystic, regular, dome-shaped lesion with medium to high reflectivity localized to the sclera without intraocular involvement (Figure, B). The remaining results of the right-eye examination and the entire left-eye examination were within the reference range. In addition, the patient had a right-sided intranasal mass.A, Slitlamp photograph of the patient[right single quotation mark]s right eye at presentation. B, Anterior segment ultrasonography of the right eye at presentation.Laboratory test results demonstrated elevated inflammatory markers, with an erythrocyte sedimentation rate of 38 mm/h (reference range, 0-20 mm/h) and a C-reactive protein level of 190 mg/L (reference range, 0.08-3.1 mg/L) (to convert to nanomoles per liter, multiply by 9.524). Results of serum antineutrophil cytoplasmic antibody (ANCA), rheumatoid factor, antinuclear antibody, angiotensin-converting enzyme, fluorescent treponemal antibody absorption, rapid plasma reagin, and tuberculosis skin testing were within their reference ranges. Results of urine microscopy had 4+ red blood cells per high-power field. His blood urea nitrogen and creatinine levels were within their reference ranges.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Increase topical corticosteroid frequency\nB. Inject sub[en dash]Tenon capsule triamcinolone acetonide\nC. Refer to otolaryngologist for nasal mass biopsy\nD. Give oral prednisone\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 40s with a history of sinusitis presented with a 2-month history of worsening pain and redness of the right eye and nasal congestion. They was previously diagnosed with conjunctivitis and treated empirically with artificial tears, ofloxacin drops (0.3%), and prednisolone acetate drops (1%) 4 times a day, without improvement.Their visual acuity was 20/20 OD. Examination findings of the anterior segment of the right eye revealed a raised, nonmobile, engorged perilimbal nodule in the inferotemporal sclera that was tender to palpation and did not blanch with phenylephrine drops (2.5%) (Figure, A). The ultrasonogram demonstrated a noncystic, regular, dome-shaped lesion with medium to high reflectivity localized to the sclera without intraocular involvement (Figure, B). The remaining results of the right-eye examination and the entire left-eye examination were within the reference range. In addition, the Arab patient had a right-sided intranasal mass.A, Slitlamp photograph of the Arab patient[right single quotation mark]s right eye at presentation. B, Anterior segment ultrasonography of the right eye at presentation.Laboratory test results demonstrated elevated inflammatory markers, with an erythrocyte sedimentation rate of 38 mm/h (reference range, 0-20 mm/h) and a C-reactive protein level of 190 mg/L (reference range, 0.08-3.1 mg/L) (to convert to nanomoles per liter, multiply by 9.524). Results of serum antineutrophil cytoplasmic antibody (ANCA), rheumatoid factor, antinuclear antibody, angiotensin-converting enzyme, fluorescent treponemal antibody absorption, rapid plasma reagin, and tuberculosis skin testing were within their reference ranges. Results of urine microscopy had 4+ red blood cells per high-power field. Their blood urea nitrogen and creatinine levels were within their reference ranges.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Increase topical corticosteroid frequency\nB. Inject sub[en dash]Tenon capsule triamcinolone acetonide\nC. Refer to otolaryngologist for nasal mass biopsy\nD. Give oral prednisone\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 man in his 40s with a history of sinusitis presented with a 2-month history of worsening pain and redness of the right eye and nasal congestion. He was previously diagnosed with conjunctivitis and treated empirically with artificial tears, ofloxacin drops (0.3%), and prednisolone acetate drops (1%) 4 times a day, without improvement.His visual acuity was 20/20 OD. Examination findings of the anterior segment of the right eye revealed a raised, nonmobile, engorged perilimbal nodule in the inferotemporal sclera that was tender to palpation and did not blanch with phenylephrine drops (2.5%) (Figure, A). The ultrasonogram demonstrated a noncystic, regular, dome-shaped lesion with medium to high reflectivity localized to the sclera without intraocular involvement (Figure, B). The remaining results of the right-eye examination and the entire left-eye examination were within the reference range. In addition, the Asian patient had a right-sided intranasal mass.A, Slitlamp photograph of the Asian patient[right single quotation mark]s right eye at presentation. B, Anterior segment ultrasonography of the right eye at presentation.Laboratory test results demonstrated elevated inflammatory markers, with an erythrocyte sedimentation rate of 38 mm/h (reference range, 0-20 mm/h) and a C-reactive protein level of 190 mg/L (reference range, 0.08-3.1 mg/L) (to convert to nanomoles per liter, multiply by 9.524). Results of serum antineutrophil cytoplasmic antibody (ANCA), rheumatoid factor, antinuclear antibody, angiotensin-converting enzyme, fluorescent treponemal antibody absorption, rapid plasma reagin, and tuberculosis skin testing were within their reference ranges. Results of urine microscopy had 4+ red blood cells per high-power field. His blood urea nitrogen and creatinine levels were within their reference ranges.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Increase topical corticosteroid frequency\nB. Inject sub[en dash]Tenon capsule triamcinolone acetonide\nC. Refer to otolaryngologist for nasal mass biopsy\nD. Give oral prednisone\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 40s with a history of sinusitis presented with a 2-month history of worsening pain and redness of the right eye and nasal congestion. She was previously diagnosed with conjunctivitis and treated empirically with artificial tears, ofloxacin drops (0.3%), and prednisolone acetate drops (1%) 4 times a day, without improvement.Her visual acuity was 20/20 OD. Examination findings of the anterior segment of the right eye revealed a raised, nonmobile, engorged perilimbal nodule in the inferotemporal sclera that was tender to palpation and did not blanch with phenylephrine drops (2.5%) (Figure, A). The ultrasonogram demonstrated a noncystic, regular, dome-shaped lesion with medium to high reflectivity localized to the sclera without intraocular involvement (Figure, B). The remaining results of the right-eye examination and the entire left-eye examination were within the reference range. In addition, the Black woman had a right-sided intranasal mass.A, Slitlamp photograph of the Black woman[right single quotation mark]s right eye at presentation. B, Anterior segment ultrasonography of the right eye at presentation.Laboratory test results demonstrated elevated inflammatory markers, with an erythrocyte sedimentation rate of 38 mm/h (reference range, 0-20 mm/h) and a C-reactive protein level of 190 mg/L (reference range, 0.08-3.1 mg/L) (to convert to nanomoles per liter, multiply by 9.524). Results of serum antineutrophil cytoplasmic antibody (ANCA), rheumatoid factor, antinuclear antibody, angiotensin-converting enzyme, fluorescent treponemal antibody absorption, rapid plasma reagin, and tuberculosis skin testing were within their reference ranges. Results of urine microscopy had 4+ red blood cells per high-power field. Her blood urea nitrogen and creatinine levels were within their reference ranges.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Increase topical corticosteroid frequency\nB. Inject sub[en dash]Tenon capsule triamcinolone acetonide\nC. Refer to otolaryngologist for nasal mass biopsy\nD. Give oral prednisone\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA previously healthy 13-year-old boy presented to an optometrist 2 days after the onset of blurred vision in his left eye. His best-corrected visual acuity was 20/20 OD and 20/200 OS. Findings on pupillary, motility, and slitlamp examination of the anterior segment were unremarkable. Findings on dilated fundus examination of the right eye were normal. Figure 1A depicts the fundus findings in the left eye. The patient[right single quotation mark]s history was negative for travel, recent vaccinations, or systemic illnesses. He denied having fever, nausea, headache, or other influenzalike symptoms.A, Unilateral isolated disc edema at initial presentation. B, Development of macular edema with exudates 1 week after initial presentation.Findings on magnetic resonance imaging of the brain and orbits showed subtle enhancement of the left optic nerve. No masses or demyelinating lesions were found.One week later, he presented to the ophthalmology office. His best-corrected visual acuity had improved to 20/40 OS. His examination was notable for the fundus finding shown in Figure 1B. The patient reported exposure to cats at home but had no recollection of direct trauma.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Repeated neuroimaging\nB. Cerebrospinal fluid analysis\nC. Blood culture analysis\nD. Serum antibody titer\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA previously healthy 13-year-old Hispanic boy presented to an optometrist 2 days after the onset of blurred vision in his left eye. His best-corrected visual acuity was 20/20 OD and 20/200 OS. Findings on pupillary, motility, and slitlamp examination of the anterior segment were unremarkable. Findings on dilated fundus examination of the right eye were normal. Figure 1A depicts the fundus findings in the left eye. The Hispanic patient[right single quotation mark]s history was negative for travel, recent vaccinations, or systemic illnesses. He denied having fever, nausea, headache, or other influenzalike symptoms.A, Unilateral isolated disc edema at initial presentation. B, Development of macular edema with exudates 1 week after initial presentation.Findings on magnetic resonance imaging of the brain and orbits showed subtle enhancement of the left optic nerve. No masses or demyelinating lesions were found.One week later, he presented to the ophthalmology office. His best-corrected visual acuity had improved to 20/40 OS. His examination was notable for the fundus finding shown in Figure 1B. The Hispanic patient reported exposure to cats at home but had no recollection of direct trauma.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Repeated neuroimaging\nB. Cerebrospinal fluid analysis\nC. Blood culture analysis\nD. Serum antibody titer\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA previously healthy 13-year-old White girl presented to an optometrist 2 days after the onset of blurred vision in her left eye. Her best-corrected visual acuity was 20/20 OD and 20/200 OS. Findings on pupillary, motility, and slitlamp examination of the anterior segment were unremarkable. Findings on dilated fundus examination of the right eye were normal. Figure 1A depicts the fundus findings in the left eye. The White woman[right single quotation mark]s history was negative for travel, recent vaccinations, or systemic illnesses. She denied having fever, nausea, headache, or other influenzalike symptoms.A, Unilateral isolated disc edema at initial presentation. B, Development of macular edema with exudates 1 week after initial presentation.Findings on magnetic resonance imaging of the brain and orbits showed subtle enhancement of the left optic nerve. No masses or demyelinating lesions were found.One week later, she presented to the ophthalmology office. Her best-corrected visual acuity had improved to 20/40 OS. Her examination was notable for the fundus finding shown in Figure 1B. The White woman reported exposure to cats at home but had no recollection of direct trauma.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Repeated neuroimaging\nB. Cerebrospinal fluid analysis\nC. Blood culture analysis\nD. Serum antibody titer\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA previously healthy 13-year-old Arab child presented to an optometrist 2 days after the onset of blurred vision in their left eye. Their best-corrected visual acuity was 20/20 OD and 20/200 OS. Findings on pupillary, motility, and slitlamp examination of the anterior segment were unremarkable. Findings on dilated fundus examination of the right eye were normal. Figure 1A depicts the fundus findings in the left eye. The Arab patient[right single quotation mark]s history was negative for travel, recent vaccinations, or systemic illnesses. They denied having fever, nausea, headache, or other influenzalike symptoms.A, Unilateral isolated disc edema at initial presentation. B, Development of macular edema with exudates 1 week after initial presentation.Findings on magnetic resonance imaging of the brain and orbits showed subtle enhancement of the left optic nerve. No masses or demyelinating lesions were found.One week later, they presented to the ophthalmology office. Their best-corrected visual acuity had improved to 20/40 OS. Their examination was notable for the fundus finding shown in Figure 1B. The Arab patient reported exposure to cats at home but had no recollection of direct trauma.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Repeated neuroimaging\nB. Cerebrospinal fluid analysis\nC. Blood culture analysis\nD. Serum antibody titer\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 early 60s with a history of hypertension and hyperlipidemia was transferred to our hospital after multiple transient ischemic attacks and left internal carotid artery (ICA) stenosis during the past several months. Her most recent presentation was 1 week prior for a minor stroke with amaurosis fugax, slurred speech, right-sided weakness, and facial droop lasting longer than 24 hours. Magnetic resonance imaging of the brain demonstrated subacute infarctions involving the left frontal and parietal hemispheres. She was a current smoker and was taking aspirin and statin medication at the time of presentation. Workup at another facility prior to transfer included computed tomographic angiography of the neck, which showed chronic occlusion of the right ICA and 95% stenosis of the left ICA.On examination, the patient was afebrile with a heart rate of 69 beats/min and blood pressure of 134/69 mm Hg. Pertinent findings included no carotid bruit, a regular cardiac rhythm, and equally palpable upper extremity pulses bilaterally. The patient was neurologically intact, save for 4/5 motor strength in her right upper extremity. Computed tomographic angiography of the head and neck was performed (Figure 1).Sagittal view demonstrates the left internal carotid stenosis (A indicates anterior; P, posterior) (A) and the distal extent of the findings (arrowhead) (B).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Radiographic artifact\nB. Ruptured arterial plaque\nC. Trapped air embolus\nD. Free-floating arterial thrombus\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Asian patient in them early 60s with a history of hypertension and hyperlipidemia was transferred to our hospital after multiple transient ischemic attacks and left internal carotid artery (ICA) stenosis during the past several months. Them most recent presentation was 1 week prior for a minor stroke with amaurosis fugax, slurred speech, right-sided weakness, and facial droop lasting longer than 24 hours. Magnetic resonance imaging of the brain demonstrated subacute infarctions involving the left frontal and parietal hemispheres. They was a current smoker and was taking aspirin and statin medication at the time of presentation. Workup at another facility prior to transfer included computed tomographic angiography of the neck, which showed chronic occlusion of the right ICA and 95% stenosis of the left ICA.On examination, the Asian patient was afebrile with a heart rate of 69 beats/min and blood pressure of 134/69 mm Hg. Pertinent findings included no carotid bruit, a regular cardiac rhythm, and equally palpable upper extremity pulses bilaterally. The Asian patient was neurologically intact, save for 4/5 motor strength in them right upper extremity. Computed tomographic angiography of the head and neck was performed (Figure 1).Sagittal view demonstrates the left internal carotid stenosis (A indicates anterior; P, posterior) (A) and the distal extent of the findings (arrowhead) (B).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Radiographic artifact\nB. Ruptured arterial plaque\nC. Trapped air embolus\nD. Free-floating arterial thrombus\n</options>" }, { "role": "assistant", "content": "D" } ]