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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 previously healthy 75-year-old White woman was referred to our tertiary care center when a workup for abdominal pain and jaundice revealed a duodenal mass. She underwent a metastatic workup. High-resolution computed tomography revealed a 3[thin space][multiplication sign][thin space]4-cm circumferential lesion in the second and third portions of the duodenum involving the pancreatic head (Figure 1). Multiple nodules were noted along the peritoneal reflection of the right paracolic gutter. The results of a biochemical analysis were remarkable with a total bilirubin level of 6.8 mg/dL (to convert to micromoles per liter, multiply by 17.104), an aspartate aminotransferase level of 394 U/L, an alanine transaminase level of 746 U/L, and an alkaline phosphatase level of 1146 U/L (to convert the last 3 analytes to microkatals per liter, multiply by 0.0167). Her medical history was significant for hypertension and a previous laparoscopic cholecystectomy approximately 6 years ago.Coronal computed tomographic (CT) image of abdominal mass (arrowhead) (A) and axial CT image of peritoneal implant (arrowhead) (B).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Peritoneal mesothelioma\nB. Peritoneal carcinomatosis\nC. Dropped gallstones\nD. Lymphoma\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 75-year-old Arab patient was referred to our tertiary care center when a workup for abdominal pain and jaundice revealed a duodenal mass. They underwent a metastatic workup. High-resolution computed tomography revealed a 3[thin space][multiplication sign][thin space]4-cm circumferential lesion in the second and third portions of the duodenum involving the pancreatic head (Figure 1). Multiple nodules were noted along the peritoneal reflection of the right paracolic gutter. The results of a biochemical analysis were remarkable with a total bilirubin level of 6.8 mg/dL (to convert to micromoles per liter, multiply by 17.104), an aspartate aminotransferase level of 394 U/L, an alanine transaminase level of 746 U/L, and an alkaline phosphatase level of 1146 U/L (to convert the last 3 analytes to microkatals per liter, multiply by 0.0167). Them medical history was significant for hypertension and a previous laparoscopic cholecystectomy approximately 6 years ago.Coronal computed tomographic (CT) image of abdominal mass (arrowhead) (A) and axial CT image of peritoneal implant (arrowhead) (B).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Peritoneal mesothelioma\nB. Peritoneal carcinomatosis\nC. Dropped gallstones\nD. Lymphoma\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 75-year-old Asian man was referred to our tertiary care center when a workup for abdominal pain and jaundice revealed a duodenal mass. He underwent a metastatic workup. High-resolution computed tomography revealed a 3[thin space][multiplication sign][thin space]4-cm circumferential lesion in the second and third portions of the duodenum involving the pancreatic head (Figure 1). Multiple nodules were noted along the peritoneal reflection of the right paracolic gutter. The results of a biochemical analysis were remarkable with a total bilirubin level of 6.8 mg/dL (to convert to micromoles per liter, multiply by 17.104), an aspartate aminotransferase level of 394 U/L, an alanine transaminase level of 746 U/L, and an alkaline phosphatase level of 1146 U/L (to convert the last 3 analytes to microkatals per liter, multiply by 0.0167). Him medical history was significant for hypertension and a previous laparoscopic cholecystectomy approximately 6 years ago.Coronal computed tomographic (CT) image of abdominal mass (arrowhead) (A) and axial CT image of peritoneal implant (arrowhead) (B).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Peritoneal mesothelioma\nB. Peritoneal carcinomatosis\nC. Dropped gallstones\nD. Lymphoma\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 32-year-old man with a history of travel to the rainforests of Salto [latin capital letter a with acute]ngel, Venezuela, presented 6 months after his travel with skin lesions on the nose and neck of 3 months[right single quotation mark] duration. He was seen by 2 dermatologists, a family physician, and an otolaryngologist in Venezuela as well as 2 dermatologists, 2 family physicians, a nurse practitioner, and an infectious diseases specialist in the United States. These 10 clinicians collectively prescribed oral amoxicillin, cefadroxil, cephalexin, azithromycin, clindamycin, and cefdinir as well as intramuscular ceftriaxone and topical bacitracin, mupirocin, and polymyxin B. None of these therapies was of benefit.The patient reported no significant medical history and was not taking other medications. He reported nasal congestion and pain, bleeding, and minor sloughing of nasal mucosal tissue. On examination he had an erythematous plaque without ulceration on the right side of the neck (Figure, left). Examination also revealed erythema and swelling of the left nasal ala extending to the infratip lobule (lowermost portion of the nasal tip directly above the nostril openings) and left alar rim as well as disruption of the nasal architecture with crusting of the left nare (Figure, right). Cervical lymphadenopathy was present and most pronounced on the right side. The remainder of the physical examination was unremarkable. A biopsy of the nasal tissue revealed pseudoepitheliomatous hyperplasia, a lymphoplasmocytic inflammation, with no organisms found using special staining.Left, Erythematous plaque with crusting on the right side of the neck. No ulceration was noted. Right, Pronounced erythema, swelling, and crusting of the left nasal ala, extending to the infratip lobule and left alar rim.Perform leishmaniasis polymerase chain reaction testing of biopsied tissuePrescribe intravenous vancomycin for methicillin-resistant Staphylococcus aureus infection\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Prescribe intravenous vancomycin for methicillin-resistant Staphylococcus aureus infection\nB. Perform biopsy with oncology consultation\nC. Perform leishmaniasis polymerase chain reaction testing of biopsied tissue\nD. Obtain immunofluorescence of biopsied tissue\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 32-year-old Black woman with a history of travel to the rainforests of Salto [latin capital letter a with acute]ngel, Venezuela, presented 6 months after her travel with skin lesions on the nose and neck of 3 months[right single quotation mark] duration. She was seen by 2 dermatologists, a family physician, and an otolaryngologist in Venezuela as well as 2 dermatologists, 2 family physicians, a nurse practitioner, and an infectious diseases specialist in the United States. These 10 clinicians collectively prescribed oral amoxicillin, cefadroxil, cephalexin, azithromycin, clindamycin, and cefdinir as well as intramuscular ceftriaxone and topical bacitracin, mupirocin, and polymyxin B. None of these therapies was of benefit.The Black woman reported no significant medical history and was not taking other medications. She reported nasal congestion and pain, bleeding, and minor sloughing of nasal mucosal tissue. On examination she had an erythematous plaque without ulceration on the right side of the neck (Figure, left). Examination also revealed erythema and swelling of the left nasal ala extending to the infratip lobule (lowermost portion of the nasal tip directly above the nostril openings) and left alar rim as well as disruption of the nasal architecture with crusting of the left nare (Figure, right). Cervical lymphadenopathy was present and most pronounced on the right side. The remainder of the physical examination was unremarkable. A biopsy of the nasal tissue revealed pseudoepitheliomatous hyperplasia, a lymphoplasmocytic inflammation, with no organisms found using special staining.Left, Erythematous plaque with crusting on the right side of the neck. No ulceration was noted. Right, Pronounced erythema, swelling, and crusting of the left nasal ala, extending to the infratip lobule and left alar rim.Perform leishmaniasis polymerase chain reaction testing of biopsied tissuePrescribe intravenous vancomycin for methicillin-resistant Staphylococcus aureus infection\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Prescribe intravenous vancomycin for methicillin-resistant Staphylococcus aureus infection\nB. Perform biopsy with oncology consultation\nC. Perform leishmaniasis polymerase chain reaction testing of biopsied tissue\nD. Obtain immunofluorescence of biopsied tissue\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 32-year-old Hispanic man with a history of travel to the rainforests of Salto [latin capital letter a with acute]ngel, Venezuela, presented 6 months after his travel with skin lesions on the nose and neck of 3 months[right single quotation mark] duration. He was seen by 2 dermatologists, a family physician, and an otolaryngologist in Venezuela as well as 2 dermatologists, 2 family physicians, a nurse practitioner, and an infectious diseases specialist in the United States. These 10 clinicians collectively prescribed oral amoxicillin, cefadroxil, cephalexin, azithromycin, clindamycin, and cefdinir as well as intramuscular ceftriaxone and topical bacitracin, mupirocin, and polymyxin B. None of these therapies was of benefit.The Hispanic patient reported no significant medical history and was not taking other medications. He reported nasal congestion and pain, bleeding, and minor sloughing of nasal mucosal tissue. On examination he had an erythematous plaque without ulceration on the right side of the neck (Figure, left). Examination also revealed erythema and swelling of the left nasal ala extending to the infratip lobule (lowermost portion of the nasal tip directly above the nostril openings) and left alar rim as well as disruption of the nasal architecture with crusting of the left nare (Figure, right). Cervical lymphadenopathy was present and most pronounced on the right side. The remainder of the physical examination was unremarkable. A biopsy of the nasal tissue revealed pseudoepitheliomatous hyperplasia, a lymphoplasmocytic inflammation, with no organisms found using special staining.Left, Erythematous plaque with crusting on the right side of the neck. No ulceration was noted. Right, Pronounced erythema, swelling, and crusting of the left nasal ala, extending to the infratip lobule and left alar rim.Perform leishmaniasis polymerase chain reaction testing of biopsied tissuePrescribe intravenous vancomycin for methicillin-resistant Staphylococcus aureus infection\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Prescribe intravenous vancomycin for methicillin-resistant Staphylococcus aureus infection\nB. Perform biopsy with oncology consultation\nC. Perform leishmaniasis polymerase chain reaction testing of biopsied tissue\nD. Obtain immunofluorescence of biopsied tissue\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 32-year-old White patient with a history of travel to the rainforests of Salto [latin capital letter a with acute]ngel, Venezuela, presented 6 months after their travel with skin lesions on the nose and neck of 3 months[right single quotation mark] duration. They was seen by 2 dermatologists, a family physician, and an otolaryngologist in Venezuela as well as 2 dermatologists, 2 family physicians, a nurse practitioner, and an infectious diseases specialist in the United States. These 10 clinicians collectively prescribed oral amoxicillin, cefadroxil, cephalexin, azithromycin, clindamycin, and cefdinir as well as intramuscular ceftriaxone and topical bacitracin, mupirocin, and polymyxin B. None of these therapies was of benefit.The White patient reported no significant medical history and was not taking other medications. They reported nasal congestion and pain, bleeding, and minor sloughing of nasal mucosal tissue. On examination they had an erythematous plaque without ulceration on the right side of the neck (Figure, left). Examination also revealed erythema and swelling of the left nasal ala extending to the infratip lobule (lowermost portion of the nasal tip directly above the nostril openings) and left alar rim as well as disruption of the nasal architecture with crusting of the left nare (Figure, right). Cervical lymphadenopathy was present and most pronounced on the right side. The remainder of the physical examination was unremarkable. A biopsy of the nasal tissue revealed pseudoepitheliomatous hyperplasia, a lymphoplasmocytic inflammation, with no organisms found using special staining.Left, Erythematous plaque with crusting on the right side of the neck. No ulceration was noted. Right, Pronounced erythema, swelling, and crusting of the left nasal ala, extending to the infratip lobule and left alar rim.Perform leishmaniasis polymerase chain reaction testing of biopsied tissuePrescribe intravenous vancomycin for methicillin-resistant Staphylococcus aureus infection\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Prescribe intravenous vancomycin for methicillin-resistant Staphylococcus aureus infection\nB. Perform biopsy with oncology consultation\nC. Perform leishmaniasis polymerase chain reaction testing of biopsied tissue\nD. Obtain immunofluorescence of biopsied tissue\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA woman in her 50s with a medical history of asthma and seasonal allergies presented with numerous asymptomatic flesh-colored to translucent papules on her palms and palmar and lateral aspects of her fingers (Figure, A and B). Many of the papules were depressed centrally. There was no extension onto the dorsal aspect of the hands. There were similar translucent papules over the margins of her feet, particularly her great toes, and hyperkeratotic yellow plaques with scattered pits over her bilateral soles, concentrated in areas of pressure. The lesions on her hands first developed in her 40s and were exacerbated by alcohol-based hand sanitizer at work. They became more prominent with exposure to water but remained asymptomatic. Occasional application of urea cream to her feet did not lead to significant improvement. She also had fine-textured hair, present since childhood with thinning noted in the past 7 years. She had no history of eczema. At the time, she denied a family history of similar skin findings but recently reported similar hand and foot findings in her mother. Two punch biopsies were performed from the left thenar eminence (Figure, C).A, Clinical photograph of the palm showing dozens of flesh-colored to translucent palmar papules. B, Closer clinical view of the palmar papules over the thenar eminence, some with central depression. C, Histologic image from a skin biopsy specimen from the thenar eminence (hematoxylin-eosin, original magnification [multiplication sign]40).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Hereditary papulotranslucent acrokeratoderma\nB. Epidermolysis bullosa simplex\nC. Dyshidrotic eczema\nD. Dyshidrotic pemphigoid\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Arab patient in them 50s with a medical history of asthma and seasonal allergies presented with numerous asymptomatic flesh-colored to translucent papules on them palms and palmar and lateral aspects of them fingers (Figure, A and B). Many of the papules were depressed centrally. There was no extension onto the dorsal aspect of the hands. There were similar translucent papules over the margins of them feet, particularly them great toes, and hyperkeratotic yellow plaques with scattered pits over them bilateral soles, concentrated in areas of pressure. The lesions on them hands first developed in them 40s and were exacerbated by alcohol-based hand sanitizer at work. They became more prominent with exposure to water but remained asymptomatic. Occasional application of urea cream to them feet did not lead to significant improvement. They also had fine-textured hair, present since childhood with thinning noted in the past 7 years. They had no history of eczema. At the time, they denied a family history of similar skin findings but recently reported similar hand and foot findings in them mother. Two punch biopsies were performed from the left thenar eminence (Figure, C).A, Clinical photograph of the palm showing dozens of flesh-colored to translucent palmar papules. B, Closer clinical view of the palmar papules over the thenar eminence, some with central depression. C, Histologic image from a skin biopsy specimen from the thenar eminence (hematoxylin-eosin, original magnification [multiplication sign]40).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Hereditary papulotranslucent acrokeratoderma\nB. Epidermolysis bullosa simplex\nC. Dyshidrotic eczema\nD. Dyshidrotic pemphigoid\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Asian woman in her 50s with a medical history of asthma and seasonal allergies presented with numerous asymptomatic flesh-colored to translucent papules on her palms and palmar and lateral aspects of her fingers (Figure, A and B). Many of the papules were depressed centrally. There was no extension onto the dorsal aspect of the hands. There were similar translucent papules over the margins of her feet, particularly her great toes, and hyperkeratotic yellow plaques with scattered pits over her bilateral soles, concentrated in areas of pressure. The lesions on her hands first developed in her 40s and were exacerbated by alcohol-based hand sanitizer at work. They became more prominent with exposure to water but remained asymptomatic. Occasional application of urea cream to her feet did not lead to significant improvement. She also had fine-textured hair, present since childhood with thinning noted in the past 7 years. She had no history of eczema. At the time, she denied a family history of similar skin findings but recently reported similar hand and foot findings in her mother. Two punch biopsies were performed from the left thenar eminence (Figure, C).A, Clinical photograph of the palm showing dozens of flesh-colored to translucent palmar papules. B, Closer clinical view of the palmar papules over the thenar eminence, some with central depression. C, Histologic image from a skin biopsy specimen from the thenar eminence (hematoxylin-eosin, original magnification [multiplication sign]40).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Hereditary papulotranslucent acrokeratoderma\nB. Epidermolysis bullosa simplex\nC. Dyshidrotic eczema\nD. Dyshidrotic pemphigoid\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Black man in him 50s with a medical history of asthma and seasonal allergies presented with numerous asymptomatic flesh-colored to translucent papules on him palms and palmar and lateral aspects of him fingers (Figure, A and B). Many of the papules were depressed centrally. There was no extension onto the dorsal aspect of the hands. There were similar translucent papules over the margins of him feet, particularly him great toes, and hyperkeratotic yellow plaques with scattered pits over him bilateral soles, concentrated in areas of pressure. The lesions on him hands first developed in him 40s and were exacerbated by alcohol-based hand sanitizer at work. They became more prominent with exposure to water but remained asymptomatic. Occasional application of urea cream to him feet did not lead to significant improvement. He also had fine-textured hair, present since childhood with thinning noted in the past 7 years. He had no history of eczema. At the time, he denied a family history of similar skin findings but recently reported similar hand and foot findings in him mother. Two punch biopsies were performed from the left thenar eminence (Figure, C).A, Clinical photograph of the palm showing dozens of flesh-colored to translucent palmar papules. B, Closer clinical view of the palmar papules over the thenar eminence, some with central depression. C, Histologic image from a skin biopsy specimen from the thenar eminence (hematoxylin-eosin, original magnification [multiplication sign]40).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Hereditary papulotranslucent acrokeratoderma\nB. Epidermolysis bullosa simplex\nC. Dyshidrotic eczema\nD. Dyshidrotic pemphigoid\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 60s developed fever, rigors, periorbital swelling, and a painful perivulvar eruption, 7 days after her first cycle of cytarabine and daunorubicin hydrochloride for newly diagnosed acute myeloid leukemia (AML). She had a history of type 2 diabetes mellitus, hypothyroidism, and hypercholesterolemia. Her regular medications included metformin, insulin, rosuvastatin calcium, levothyroxine sodium, and aspirin. Examination revealed edematous labia and multiple perivulvar tender nodules on violaceous and indurated plaques sparing the vaginal mucosa and inguinal creases (Figure, A). She also had bilateral injected conjunctivae with periorbital swelling. A punch biopsy of the perivulvar lesions was performed for histopathologic analysis (Figure, B and C) and tissue culture.A, Perivulvar plaques and nodules that developed after chemotherapy for acute myeloid leukemia. Edematous labia with perivulvar violaceous plaques and nodules. B and C, Skin histologic images from perivulvar plaques and nodules. B, Spongiosis and hyperplasia of the epidermis with neutrophilic infiltrate within the dermis (hematoxylin-eosin, original magnification [multiplication sign]10). C, Necrotic collagen and eccrine gland destruction (hematoxylin-eosin, original magnification [multiplication sign]10).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Herpes genitalis\nB. Deep fungal or atypical mycobacterial infection\nC. Perivulvar neutrophilic eccrine hidradenitis\nD. Sweet syndrome\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Hispanic woman in her 60s developed fever, rigors, periorbital swelling, and a painful perivulvar eruption, 7 days after her first cycle of cytarabine and daunorubicin hydrochloride for newly diagnosed acute myeloid leukemia (AML). She had a history of type 2 diabetes mellitus, hypothyroidism, and hypercholesterolemia. Her regular medications included metformin, insulin, rosuvastatin calcium, levothyroxine sodium, and aspirin. Examination revealed edematous labia and multiple perivulvar tender nodules on violaceous and indurated plaques sparing the vaginal mucosa and inguinal creases (Figure, A). She also had bilateral injected conjunctivae with periorbital swelling. A punch biopsy of the perivulvar lesions was performed for histopathologic analysis (Figure, B and C) and tissue culture.A, Perivulvar plaques and nodules that developed after chemotherapy for acute myeloid leukemia. Edematous labia with perivulvar violaceous plaques and nodules. B and C, Skin histologic images from perivulvar plaques and nodules. B, Spongiosis and hyperplasia of the epidermis with neutrophilic infiltrate within the dermis (hematoxylin-eosin, original magnification [multiplication sign]10). C, Necrotic collagen and eccrine gland destruction (hematoxylin-eosin, original magnification [multiplication sign]10).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Herpes genitalis\nB. Deep fungal or atypical mycobacterial infection\nC. Perivulvar neutrophilic eccrine hidradenitis\nD. Sweet syndrome\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 him 60s developed fever, rigors, periorbital swelling, and a painful perivulvar eruption, 7 days after him first cycle of cytarabine and daunorubicin hydrochloride for newly diagnosed acute myeloid leukemia (AML). He had a history of type 2 diabetes mellitus, hypothyroidism, and hypercholesterolemia. Him regular medications included metformin, insulin, rosuvastatin calcium, levothyroxine sodium, and aspirin. Examination revealed edematous labia and multiple perivulvar tender nodules on violaceous and indurated plaques sparing the vaginal mucosa and inguinal creases (Figure, A). He also had bilateral injected conjunctivae with periorbital swelling. A punch biopsy of the perivulvar lesions was performed for histopathologic analysis (Figure, B and C) and tissue culture.A, Perivulvar plaques and nodules that developed after chemotherapy for acute myeloid leukemia. Edematous labia with perivulvar violaceous plaques and nodules. B and C, Skin histologic images from perivulvar plaques and nodules. B, Spongiosis and hyperplasia of the epidermis with neutrophilic infiltrate within the dermis (hematoxylin-eosin, original magnification [multiplication sign]10). C, Necrotic collagen and eccrine gland destruction (hematoxylin-eosin, original magnification [multiplication sign]10).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Herpes genitalis\nB. Deep fungal or atypical mycobacterial infection\nC. Perivulvar neutrophilic eccrine hidradenitis\nD. Sweet syndrome\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Arab patient in them 60s developed fever, rigors, periorbital swelling, and a painful perivulvar eruption, 7 days after them first cycle of cytarabine and daunorubicin hydrochloride for newly diagnosed acute myeloid leukemia (AML). They had a history of type 2 diabetes mellitus, hypothyroidism, and hypercholesterolemia. Them regular medications included metformin, insulin, rosuvastatin calcium, levothyroxine sodium, and aspirin. Examination revealed edematous labia and multiple perivulvar tender nodules on violaceous and indurated plaques sparing the vaginal mucosa and inguinal creases (Figure, A). They also had bilateral injected conjunctivae with periorbital swelling. A punch biopsy of the perivulvar lesions was performed for histopathologic analysis (Figure, B and C) and tissue culture.A, Perivulvar plaques and nodules that developed after chemotherapy for acute myeloid leukemia. Edematous labia with perivulvar violaceous plaques and nodules. B and C, Skin histologic images from perivulvar plaques and nodules. B, Spongiosis and hyperplasia of the epidermis with neutrophilic infiltrate within the dermis (hematoxylin-eosin, original magnification [multiplication sign]10). C, Necrotic collagen and eccrine gland destruction (hematoxylin-eosin, original magnification [multiplication sign]10).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Herpes genitalis\nB. Deep fungal or atypical mycobacterial infection\nC. Perivulvar neutrophilic eccrine hidradenitis\nD. Sweet syndrome\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 6-day-old male infant presented to the emergency department with a linear band of skin-colored papules on his left upper extremity. These papules had been present at birth and were persistent at the time of the patient[right single quotation mark]s initial hospital discharge. Because no resolution had been noted over the next few days, the patient was taken to his primary care physician for evaluation and then sent to the emergency department for further workup. The patient was afebrile. The patient[right single quotation mark]s mother noted that both the pregnancy and the delivery were uncomplicated. She denied ever having a miscarriage and had another healthy male child at home without any similar lesions. The mother had a history of varicella as a child; she did not have a history of herpes simplex virus and had no oral or genital lesions at the time of delivery. On examination, the patient was noted to have 2- to 3-mm vesicles on the left upper extremity in a linear, bandlike distribution (Figure, A), and similar 2- to 3-mm deep-seated vesicles on his left medial thigh in a whorled configuration, approximately 4[thin space][multiplication sign][thin space]3 cm in total size (Figure, B). In addition, the patient had a 1-mm vesicle on his abdomen.A, Vesicles (2-3 mm in diameter) on the left forearm are in a linear, bandlike distribution. B, Deep-seated vesicles on left medial thigh are in a whorled configuration.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Varicella-zoster virus\nB. Langerhans cell histiocytosis\nC. Herpes simplex virus\nD. Incontinentia pigmenti\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 6-day-old Asian female infant presented to the emergency department with a linear band of skin-colored papules on her left upper extremity. These papules had been present at birth and were persistent at the time of the Asian woman[right single quotation mark]s initial hospital discharge. Because no resolution had been noted over the next few days, the Asian woman was taken to her primary care physician for evaluation and then sent to the emergency department for further workup. The Asian woman was afebrile. The Asian woman[right single quotation mark]s mother noted that both the pregnancy and the delivery were uncomplicated. They denied ever having a miscarriage and had another healthy Asian female Asian child at home without any similar lesions. The mother had a history of varicella as a Asian child; they did not have a history of herpes simplex virus and had no oral or genital lesions at the time of delivery. On examination, the Asian woman was noted to have 2- to 3-mm vesicles on the left upper extremity in a linear, bandlike distribution (Figure, A), and similar 2- to 3-mm deep-seated vesicles on her left medial thigh in a whorled configuration, approximately 4[thin space][multiplication sign][thin space]3 cm in total size (Figure, B). In addition, the Asian woman had a 1-mm vesicle on her abdomen.A, Vesicles (2-3 mm in diameter) on the left forearm are in a linear, bandlike distribution. B, Deep-seated vesicles on left medial thigh are in a whorled configuration.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Varicella-zoster virus\nB. Langerhans cell histiocytosis\nC. Herpes simplex virus\nD. Incontinentia pigmenti\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 6-day-old Black person infant presented to the emergency department with a linear band of skin-colored papules on their left upper extremity. These papules had been present at birth and were persistent at the time of the Black patient[right single quotation mark]s initial hospital discharge. Because no resolution had been noted over the next few days, the Black patient was taken to their primary care physician for evaluation and then sent to the emergency department for further workup. The Black patient was afebrile. The Black patient[right single quotation mark]s mother noted that both the pregnancy and the delivery were uncomplicated. They denied ever having a miscarriage and had another healthy Black person Black child at home without any similar lesions. The mother had a history of varicella as a Black child; they did not have a history of herpes simplex virus and had no oral or genital lesions at the time of delivery. On examination, the Black patient was noted to have 2- to 3-mm vesicles on the left upper extremity in a linear, bandlike distribution (Figure, A), and similar 2- to 3-mm deep-seated vesicles on their left medial thigh in a whorled configuration, approximately 4[thin space][multiplication sign][thin space]3 cm in total size (Figure, B). In addition, the Black patient had a 1-mm vesicle on their abdomen.A, Vesicles (2-3 mm in diameter) on the left forearm are in a linear, bandlike distribution. B, Deep-seated vesicles on left medial thigh are in a whorled configuration.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Varicella-zoster virus\nB. Langerhans cell histiocytosis\nC. Herpes simplex virus\nD. Incontinentia pigmenti\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 6-day-old Hispanic male infant presented to the emergency department with a linear band of skin-colored papules on his left upper extremity. These papules had been present at birth and were persistent at the time of the Hispanic patient[right single quotation mark]s initial hospital discharge. Because no resolution had been noted over the next few days, the Hispanic patient was taken to his primary care physician for evaluation and then sent to the emergency department for further workup. The Hispanic patient was afebrile. The Hispanic patient[right single quotation mark]s mother noted that both the pregnancy and the delivery were uncomplicated. She denied ever having a miscarriage and had another healthy Hispanic male Hispanic child at home without any similar lesions. The mother had a history of varicella as a Hispanic child; she did not have a history of herpes simplex virus and had no oral or genital lesions at the time of delivery. On examination, the Hispanic patient was noted to have 2- to 3-mm vesicles on the left upper extremity in a linear, bandlike distribution (Figure, A), and similar 2- to 3-mm deep-seated vesicles on his left medial thigh in a whorled configuration, approximately 4[thin space][multiplication sign][thin space]3 cm in total size (Figure, B). In addition, the Hispanic patient had a 1-mm vesicle on his abdomen.A, Vesicles (2-3 mm in diameter) on the left forearm are in a linear, bandlike distribution. B, Deep-seated vesicles on left medial thigh are in a whorled configuration.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Varicella-zoster virus\nB. Langerhans cell histiocytosis\nC. Herpes simplex virus\nD. Incontinentia pigmenti\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 presented with diffuse, painful swelling of the right upper eyelid (Figure, A). The patient[right single quotation mark]s medical history was notable for rheumatoid arthritis that had been well controlled with methotrexate for 15 years. The lesion was first noted 6 months prior to presentation and was initially diagnosed as a chalazion. The nodule increased in size during the next several months despite conservative measures including warm compresses. A biopsy revealed a mixed inflammatory infiltrate without evidence of neoplasia, supporting a diagnosis of chalazion. Intralesional triamcinolone was then administered. Despite an initial decrease in lesion size, 6 weeks postinjection, new-onset ipsilateral extraocular motility deficits and palpable preauricular lymphadenopathy were noted. A magnetic resonance image revealed an infiltrative process in the involved eyelid and lymphadenopathy (Figure, B and C). A second biopsy of the eyelid lesion revealed large, atypical lymphocytes diffusely positive for CD20 and negative for CD5 and Bcl-1 (Figure, D-G), supporting a diagnosis of diffuse large B-cell lymphoma (DLBCL). Findings from systemic evaluation, including complete blood cell count, serum protein electrophoresis, serum lactate dehydrogenase, and whole-body positron emission tomography, were unremarkable.A, Swollen right upper eyelid. Magnetic resonance images demonstrating diffuse eyelid infiltration (B, arrowhead) and lymphadenopathy (C, arrowhead). Biopsy of the eyelid lesion showing large atypical lymphocytes on hematoxylin-eosin stain (D, original magnification [multiplication sign]400) that was positive for CD20 (E, original magnification [multiplication sign]100), negative for CD5 (F, original magnification [multiplication sign]100), and negative for Bcl-1 (G, original magnification [multiplication sign]100).Determine Epstein-Barr virus status and consider observation following cessation of methotrexate therapy\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Initiate treatment with radiation and/or chemotherapy\nB. Initiate treatment with rituximab\nC. Excise the eyelid lesion\nD. Determine Epstein-Barr virus status and consider observation following cessation of methotrexate therapy\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 White woman presented with diffuse, painful swelling of the right upper eyelid (Figure, A). The White woman[right single quotation mark]s medical history was notable for rheumatoid arthritis that had been well controlled with methotrexate for 15 years. The lesion was first noted 6 months prior to presentation and was initially diagnosed as a chalazion. The nodule increased in size during the next several months despite conservative measures including warm compresses. A biopsy revealed a mixed inflammatory infiltrate without evidence of neoplasia, supporting a diagnosis of chalazion. Intralesional triamcinolone was then administered. Despite an initial decrease in lesion size, 6 weeks postinjection, new-onset ipsilateral extraocular motility deficits and palpable preauricular lymphadenopathy were noted. A magnetic resonance image revealed an infiltrative process in the involved eyelid and lymphadenopathy (Figure, B and C). A second biopsy of the eyelid lesion revealed large, atypical lymphocytes diffusely positive for CD20 and negative for CD5 and Bcl-1 (Figure, D-G), supporting a diagnosis of diffuse large B-cell lymphoma (DLBCL). Findings from systemic evaluation, including complete blood cell count, serum protein electrophoresis, serum lactate dehydrogenase, and whole-body positron emission tomography, were unremarkable.A, Swollen right upper eyelid. Magnetic resonance images demonstrating diffuse eyelid infiltration (B, arrowhead) and lymphadenopathy (C, arrowhead). Biopsy of the eyelid lesion showing large atypical lymphocytes on hematoxylin-eosin stain (D, original magnification [multiplication sign]400) that was positive for CD20 (E, original magnification [multiplication sign]100), negative for CD5 (F, original magnification [multiplication sign]100), and negative for Bcl-1 (G, original magnification [multiplication sign]100).Determine Epstein-Barr virus status and consider observation following cessation of methotrexate therapy\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Initiate treatment with radiation and/or chemotherapy\nB. Initiate treatment with rituximab\nC. Excise the eyelid lesion\nD. Determine Epstein-Barr virus status and consider observation following cessation of methotrexate therapy\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 Arab patient presented with diffuse, painful swelling of the right upper eyelid (Figure, A). The Arab patient[right single quotation mark]s medical history was notable for rheumatoid arthritis that had been well controlled with methotrexate for 15 years. The lesion was first noted 6 months prior to presentation and was initially diagnosed as a chalazion. The nodule increased in size during the next several months despite conservative measures including warm compresses. A biopsy revealed a mixed inflammatory infiltrate without evidence of neoplasia, supporting a diagnosis of chalazion. Intralesional triamcinolone was then administered. Despite an initial decrease in lesion size, 6 weeks postinjection, new-onset ipsilateral extraocular motility deficits and palpable preauricular lymphadenopathy were noted. A magnetic resonance image revealed an infiltrative process in the involved eyelid and lymphadenopathy (Figure, B and C). A second biopsy of the eyelid lesion revealed large, atypical lymphocytes diffusely positive for CD20 and negative for CD5 and Bcl-1 (Figure, D-G), supporting a diagnosis of diffuse large B-cell lymphoma (DLBCL). Findings from systemic evaluation, including complete blood cell count, serum protein electrophoresis, serum lactate dehydrogenase, and whole-body positron emission tomography, were unremarkable.A, Swollen right upper eyelid. Magnetic resonance images demonstrating diffuse eyelid infiltration (B, arrowhead) and lymphadenopathy (C, arrowhead). Biopsy of the eyelid lesion showing large atypical lymphocytes on hematoxylin-eosin stain (D, original magnification [multiplication sign]400) that was positive for CD20 (E, original magnification [multiplication sign]100), negative for CD5 (F, original magnification [multiplication sign]100), and negative for Bcl-1 (G, original magnification [multiplication sign]100).Determine Epstein-Barr virus status and consider observation following cessation of methotrexate therapy\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Initiate treatment with radiation and/or chemotherapy\nB. Initiate treatment with rituximab\nC. Excise the eyelid lesion\nD. Determine Epstein-Barr virus status and consider observation following cessation of methotrexate therapy\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 Asian man presented with diffuse, painful swelling of the right upper eyelid (Figure, A). The Asian patient[right single quotation mark]s medical history was notable for rheumatoid arthritis that had been well controlled with methotrexate for 15 years. The lesion was first noted 6 months prior to presentation and was initially diagnosed as a chalazion. The nodule increased in size during the next several months despite conservative measures including warm compresses. A biopsy revealed a mixed inflammatory infiltrate without evidence of neoplasia, supporting a diagnosis of chalazion. Intralesional triamcinolone was then administered. Despite an initial decrease in lesion size, 6 weeks postinjection, new-onset ipsilateral extraocular motility deficits and palpable preauricular lymphadenopathy were noted. A magnetic resonance image revealed an infiltrative process in the involved eyelid and lymphadenopathy (Figure, B and C). A second biopsy of the eyelid lesion revealed large, atypical lymphocytes diffusely positive for CD20 and negative for CD5 and Bcl-1 (Figure, D-G), supporting a diagnosis of diffuse large B-cell lymphoma (DLBCL). Findings from systemic evaluation, including complete blood cell count, serum protein electrophoresis, serum lactate dehydrogenase, and whole-body positron emission tomography, were unremarkable.A, Swollen right upper eyelid. Magnetic resonance images demonstrating diffuse eyelid infiltration (B, arrowhead) and lymphadenopathy (C, arrowhead). Biopsy of the eyelid lesion showing large atypical lymphocytes on hematoxylin-eosin stain (D, original magnification [multiplication sign]400) that was positive for CD20 (E, original magnification [multiplication sign]100), negative for CD5 (F, original magnification [multiplication sign]100), and negative for Bcl-1 (G, original magnification [multiplication sign]100).Determine Epstein-Barr virus status and consider observation following cessation of methotrexate therapy\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Initiate treatment with radiation and/or chemotherapy\nB. Initiate treatment with rituximab\nC. Excise the eyelid lesion\nD. Determine Epstein-Barr virus status and consider observation following cessation of methotrexate therapy\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 5-year-old boy with Sturge-Weber syndrome (SWS) and glaucoma receiving treatment since infancy elsewhere presented with raised intraocular pressure (IOP) in the right eye. He had undergone trabeculectomy in the right eye with mitomycin C 4 years earlier. On examination, his best-corrected visual acuity was 6/60 ([minus sign]2.5 diopters sphere/0.5 diopters cylinder[thin space][multiplication sign][thin space]90) and 6/6 (0.5 diopters sphere) OD and OS, respectively. His IOP was 36 mm Hg and 12 mm Hg OD and OS, respectively, while receiving the maximum-tolerated antiglaucoma medications. Fundus examination was normal (Figure 1A and B), and B-scan ultrasonography revealed no mass lesion in the right eye. The left eye was normal.A and B, Right eye at presentation showing marked red glow of the fundus (A) compared with the left eye (B). C, First postoperative day following Ahmed glaucoma valve implantation in the right eye with a flat anterior chamber. Note the iris plugging the opening of the Ahmed glaucoma valve tube. D, Large serous retinal detachment and choroidal effusion following fibrous capsule excision.He underwent Ahmed glaucoma valve implantation in the right eye. On the first postoperative day, the anterior chamber was flat with corneolenticular touch (Figure 1C) and serous choroidal effusion. The anterior chamber repeatedly flattened despite viscoelastic injection, and the choroidal effusion persisted. The Ahmed glaucoma valve tube was ligated a week later, following which the IOP stabilized and choroidal effusion subsided.After 9 months, the IOP rose to 30 mm Hg, which could not be controlled medically. There was a tense fibrous capsule encapsulating the Ahmed glaucoma valve plate, which was excised. Postoperatively, it again led to hypotony and a shallow anterior chamber. The accompanying choroidal effusion was now associated with exudative retinal detachment, with retina-lenticular touch (Figure 1D) and the patient did not respond to conservative management.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Anti[en dash]vascular endothelial growth factor therapy\nB. Oral propranolol\nC. Drainage of the choroidal effusion\nD. Oral steroids\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 5-year-old Black boy with Sturge-Weber syndrome (SWS) and glaucoma receiving treatment since infancy elsewhere presented with raised intraocular pressure (IOP) in the right eye. He had undergone trabeculectomy in the right eye with mitomycin C 4 years earlier. On examination, his best-corrected visual acuity was 6/60 ([minus sign]2.5 diopters sphere/0.5 diopters cylinder[thin space][multiplication sign][thin space]90) and 6/6 (0.5 diopters sphere) OD and OS, respectively. His IOP was 36 mm Hg and 12 mm Hg OD and OS, respectively, while receiving the maximum-tolerated antiglaucoma medications. Fundus examination was normal (Figure 1A and B), and B-scan ultrasonography revealed no mass lesion in the right eye. The left eye was normal.A and B, Right eye at presentation showing marked red glow of the fundus (A) compared with the left eye (B). C, First postoperative day following Ahmed glaucoma valve implantation in the right eye with a flat anterior chamber. Note the iris plugging the opening of the Ahmed glaucoma valve tube. D, Large serous retinal detachment and choroidal effusion following fibrous capsule excision.He underwent Ahmed glaucoma valve implantation in the right eye. On the first postoperative day, the anterior chamber was flat with corneolenticular touch (Figure 1C) and serous choroidal effusion. The anterior chamber repeatedly flattened despite viscoelastic injection, and the choroidal effusion persisted. The Ahmed glaucoma valve tube was ligated a week later, following which the IOP stabilized and choroidal effusion subsided.After 9 months, the IOP rose to 30 mm Hg, which could not be controlled medically. There was a tense fibrous capsule encapsulating the Ahmed glaucoma valve plate, which was excised. Postoperatively, it again led to hypotony and a shallow anterior chamber. The accompanying choroidal effusion was now associated with exudative retinal detachment, with retina-lenticular touch (Figure 1D) and the Black patient did not respond to conservative management.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Anti[en dash]vascular endothelial growth factor therapy\nB. Oral propranolol\nC. Drainage of the choroidal effusion\nD. Oral steroids\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 5-year-old Hispanic girl with Sturge-Weber syndrome (SWS) and glaucoma receiving treatment since infancy elsewhere presented with raised intraocular pressure (IOP) in the right eye. She had undergone trabeculectomy in the right eye with mitomycin C 4 years earlier. On examination, her best-corrected visual acuity was 6/60 ([minus sign]2.5 diopters sphere/0.5 diopters cylinder[thin space][multiplication sign][thin space]90) and 6/6 (0.5 diopters sphere) OD and OS, respectively. Her IOP was 36 mm Hg and 12 mm Hg OD and OS, respectively, while receiving the maximum-tolerated antiglaucoma medications. Fundus examination was normal (Figure 1A and B), and B-scan ultrasonography revealed no mass lesion in the right eye. The left eye was normal.A and B, Right eye at presentation showing marked red glow of the fundus (A) compared with the left eye (B). C, First postoperative day following Ahmed glaucoma valve implantation in the right eye with a flat anterior chamber. Note the iris plugging the opening of the Ahmed glaucoma valve tube. D, Large serous retinal detachment and choroidal effusion following fibrous capsule excision.She underwent Ahmed glaucoma valve implantation in the right eye. On the first postoperative day, the anterior chamber was flat with corneolenticular touch (Figure 1C) and serous choroidal effusion. The anterior chamber repeatedly flattened despite viscoelastic injection, and the choroidal effusion persisted. The Ahmed glaucoma valve tube was ligated a week later, following which the IOP stabilized and choroidal effusion subsided.After 9 months, the IOP rose to 30 mm Hg, which could not be controlled medically. There was a tense fibrous capsule encapsulating the Ahmed glaucoma valve plate, which was excised. Postoperatively, it again led to hypotony and a shallow anterior chamber. The accompanying choroidal effusion was now associated with exudative retinal detachment, with retina-lenticular touch (Figure 1D) and the Hispanic woman did not respond to conservative management.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Anti[en dash]vascular endothelial growth factor therapy\nB. Oral propranolol\nC. Drainage of the choroidal effusion\nD. Oral steroids\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 5-year-old White child with Sturge-Weber syndrome (SWS) and glaucoma receiving treatment since infancy elsewhere presented with raised intraocular pressure (IOP) in the right eye. They had undergone trabeculectomy in the right eye with mitomycin C 4 years earlier. On examination, their best-corrected visual acuity was 6/60 ([minus sign]2.5 diopters sphere/0.5 diopters cylinder[thin space][multiplication sign][thin space]90) and 6/6 (0.5 diopters sphere) OD and OS, respectively. Their IOP was 36 mm Hg and 12 mm Hg OD and OS, respectively, while receiving the maximum-tolerated antiglaucoma medications. Fundus examination was normal (Figure 1A and B), and B-scan ultrasonography revealed no mass lesion in the right eye. The left eye was normal.A and B, Right eye at presentation showing marked red glow of the fundus (A) compared with the left eye (B). C, First postoperative day following Ahmed glaucoma valve implantation in the right eye with a flat anterior chamber. Note the iris plugging the opening of the Ahmed glaucoma valve tube. D, Large serous retinal detachment and choroidal effusion following fibrous capsule excision.They underwent Ahmed glaucoma valve implantation in the right eye. On the first postoperative day, the anterior chamber was flat with corneolenticular touch (Figure 1C) and serous choroidal effusion. The anterior chamber repeatedly flattened despite viscoelastic injection, and the choroidal effusion persisted. The Ahmed glaucoma valve tube was ligated a week later, following which the IOP stabilized and choroidal effusion subsided.After 9 months, the IOP rose to 30 mm Hg, which could not be controlled medically. There was a tense fibrous capsule encapsulating the Ahmed glaucoma valve plate, which was excised. Postoperatively, it again led to hypotony and a shallow anterior chamber. The accompanying choroidal effusion was now associated with exudative retinal detachment, with retina-lenticular touch (Figure 1D) and the White patient did not respond to conservative management.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Anti[en dash]vascular endothelial growth factor therapy\nB. Oral propranolol\nC. Drainage of the choroidal effusion\nD. Oral steroids\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 90-year-old woman presented with vomiting and acute abdominal pain that started 24 hours earlier. Her medical history included a partial oophorectomy of a right ovarian cyst, hypertension, and vomiting and abdominal pain once a year that started 10 years earlier. She had always been diagnosed as having adhesive ileus, and her symptoms always improved within a day after hospital admission. A physical examination at admission revealed that her abdomen was slightly distended and tender to palpation on the right side of the paraumbilical point without muscle guarding. The hematologic findings revealed slight anemia and amylasemia; her hemoglobin level was 9.3 g/dL (to convert to grams per liter, multiply by 10.0), and her amylase level was 168 U/L (to convert to microkatals per liter, multiply by 0.0167). Abdominal computed tomography (CT) with intravenous contrast agent revealed a mass on the right side of the paraumbilical point (Figure 1).Contrast-enhanced computed tomographic scan through the abdomen showing a mass on the right side of the paraumbilical point.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Small-bowel volvulus\nB. Mesenteric ischemia\nC. Colon cancer\nD. Intussusception\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 90-year-old Arab man presented with vomiting and acute abdominal pain that started 24 hours earlier. Him medical history included a partial oophorectomy of a right ovarian cyst, hypertension, and vomiting and abdominal pain once a year that started 10 years earlier. He had always been diagnosed as having adhesive ileus, and him symptoms always improved within a day after hospital admission. A physical examination at admission revealed that him abdomen was slightly distended and tender to palpation on the right side of the paraumbilical point without muscle guarding. The hematologic findings revealed slight anemia and amylasemia; him hemoglobin level was 9.3 g/dL (to convert to grams per liter, multiply by 10.0), and him amylase level was 168 U/L (to convert to microkatals per liter, multiply by 0.0167). Abdominal computed tomography (CT) with intravenous contrast agent revealed a mass on the right side of the paraumbilical point (Figure 1).Contrast-enhanced computed tomographic scan through the abdomen showing a mass on the right side of the paraumbilical point.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Small-bowel volvulus\nB. Mesenteric ischemia\nC. Colon cancer\nD. Intussusception\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 90-year-old Asian woman presented with vomiting and acute abdominal pain that started 24 hours earlier. Her medical history included a partial oophorectomy of a right ovarian cyst, hypertension, and vomiting and abdominal pain once a year that started 10 years earlier. She had always been diagnosed as having adhesive ileus, and her symptoms always improved within a day after hospital admission. A physical examination at admission revealed that her abdomen was slightly distended and tender to palpation on the right side of the paraumbilical point without muscle guarding. The hematologic findings revealed slight anemia and amylasemia; her hemoglobin level was 9.3 g/dL (to convert to grams per liter, multiply by 10.0), and her amylase level was 168 U/L (to convert to microkatals per liter, multiply by 0.0167). Abdominal computed tomography (CT) with intravenous contrast agent revealed a mass on the right side of the paraumbilical point (Figure 1).Contrast-enhanced computed tomographic scan through the abdomen showing a mass on the right side of the paraumbilical point.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Small-bowel volvulus\nB. Mesenteric ischemia\nC. Colon cancer\nD. Intussusception\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 90-year-old Black patient presented with vomiting and acute abdominal pain that started 24 hours earlier. Them medical history included a partial oophorectomy of a right ovarian cyst, hypertension, and vomiting and abdominal pain once a year that started 10 years earlier. They had always been diagnosed as having adhesive ileus, and them symptoms always improved within a day after hospital admission. A physical examination at admission revealed that them abdomen was slightly distended and tender to palpation on the right side of the paraumbilical point without muscle guarding. The hematologic findings revealed slight anemia and amylasemia; them hemoglobin level was 9.3 g/dL (to convert to grams per liter, multiply by 10.0), and them amylase level was 168 U/L (to convert to microkatals per liter, multiply by 0.0167). Abdominal computed tomography (CT) with intravenous contrast agent revealed a mass on the right side of the paraumbilical point (Figure 1).Contrast-enhanced computed tomographic scan through the abdomen showing a mass on the right side of the paraumbilical point.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Small-bowel volvulus\nB. Mesenteric ischemia\nC. Colon cancer\nD. Intussusception\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 68-year-old woman presented 1 year after noticing a flank bulge that developed following a forceful coughing episode. Her medical history included gastroesophageal reflux disease, irritable bowel syndrome, hypothyroidism, hypertension, asthma, and obesity. On palpation, the mass extended superiorly to the costal margins and inferiorly to the anterior-superior iliac spine; no fascial edge was palpable medially. A computed tomographic (CT) scan demonstrated abdominal contents[em dash]including liver, ascending colon, and omental fat[em dash]protruding through a 12-cm defect. Weight loss was counseled and 8 weeks allowed for optimization before exploration. On incision, we encountered this view (Figure 1).Right thoracotomy with primary closure and mesh placement\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Video-assisted thoracic surgery reduction with primary closure\nB. Video-assisted thoracic surgery reduction\nC. Transabdominal laparoscopic reduction and mesh placement\nD. Right thoracotomy with primary closure and mesh placement\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 68-year-old Hispanic patient presented 1 year after noticing a flank bulge that developed following a forceful coughing episode. Them medical history included gastroesophageal reflux disease, irritable bowel syndrome, hypothyroidism, hypertension, asthma, and obesity. On palpation, the mass extended superiorly to the costal margins and inferiorly to the anterior-superior iliac spine; no fascial edge was palpable medially. A computed tomographic (CT) scan demonstrated abdominal contents[em dash]including liver, ascending colon, and omental fat[em dash]protruding through a 12-cm defect. Weight loss was counseled and 8 weeks allowed for optimization before exploration. On incision, we encountered this view (Figure 1).Right thoracotomy with primary closure and mesh placement\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Video-assisted thoracic surgery reduction with primary closure\nB. Video-assisted thoracic surgery reduction\nC. Transabdominal laparoscopic reduction and mesh placement\nD. Right thoracotomy with primary closure and mesh placement\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 68-year-old White woman presented 1 year after noticing a flank bulge that developed following a forceful coughing episode. Her medical history included gastroesophageal reflux disease, irritable bowel syndrome, hypothyroidism, hypertension, asthma, and obesity. On palpation, the mass extended superiorly to the costal margins and inferiorly to the anterior-superior iliac spine; no fascial edge was palpable medially. A computed tomographic (CT) scan demonstrated abdominal contents[em dash]including liver, ascending colon, and omental fat[em dash]protruding through a 12-cm defect. Weight loss was counseled and 8 weeks allowed for optimization before exploration. On incision, we encountered this view (Figure 1).Right thoracotomy with primary closure and mesh placement\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Video-assisted thoracic surgery reduction with primary closure\nB. Video-assisted thoracic surgery reduction\nC. Transabdominal laparoscopic reduction and mesh placement\nD. Right thoracotomy with primary closure and mesh placement\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 68-year-old Arab man presented 1 year after noticing a flank bulge that developed following a forceful coughing episode. Him medical history included gastroesophageal reflux disease, irritable bowel syndrome, hypothyroidism, hypertension, asthma, and obesity. On palpation, the mass extended superiorly to the costal margins and inferiorly to the anterior-superior iliac spine; no fascial edge was palpable medially. A computed tomographic (CT) scan demonstrated abdominal contents[em dash]including liver, ascending colon, and omental fat[em dash]protruding through a 12-cm defect. Weight loss was counseled and 8 weeks allowed for optimization before exploration. On incision, we encountered this view (Figure 1).Right thoracotomy with primary closure and mesh placement\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Video-assisted thoracic surgery reduction with primary closure\nB. Video-assisted thoracic surgery reduction\nC. Transabdominal laparoscopic reduction and mesh placement\nD. Right thoracotomy with primary closure and mesh placement\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 30s with a history of chronic hepatitis B was found on computed tomography to have a 13-cm retroperitoneal mass on her left side with a significant mass effect. The patient was symptomatic with intermittent left upper quadrant abdominal pain that was associated with nausea and constipation. She reported no other gastrointestinal, genitourinary, or overall symptoms. In addition to chronic hepatitis B, her medical history was notable for hypertension and her surgical history was significant for a recent liver biopsy. Physical examination revealed a soft, nontender, minimally distended abdomen with no palpable masses and no costovertebral angle tenderness.Laboratory test results at presentation revealed complete blood cell count, comprehensive metabolic panel, and amylase values within the reference ranges and a hepatitis B virus quantification level of 1590 IU/mL. A computed tomographic scan of the abdomen and pelvis using intravenous contrast was obtained (Figure 1).Coronal computed tomographic imaging on initial presentation.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Serous cystadenoma of the pancreas\nB. Pheochromocytoma\nC. Endothelial adrenal cyst\nD. Retroperitoneal abscess\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 him 30s with a history of chronic hepatitis B was found on computed tomography to have a 13-cm retroperitoneal mass on him left side with a significant mass effect. The Asian man was symptomatic with intermittent left upper quadrant abdominal pain that was associated with nausea and constipation. He reported no other gastrointestinal, genitourinary, or overall symptoms. In addition to chronic hepatitis B, him medical history was notable for hypertension and him surgical history was significant for a recent liver biopsy. Physical examination revealed a soft, nontender, minimally distended abdomen with no palpable masses and no costovertebral angle tenderness.Laboratory test results at presentation revealed complete blood cell count, comprehensive metabolic panel, and amylase values within the reference ranges and a hepatitis B virus quantification level of 1590 IU/mL. A computed tomographic scan of the abdomen and pelvis using intravenous contrast was obtained (Figure 1).Coronal computed tomographic imaging on initial presentation.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Serous cystadenoma of the pancreas\nB. Pheochromocytoma\nC. Endothelial adrenal cyst\nD. Retroperitoneal abscess\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 30s with a history of chronic hepatitis B was found on computed tomography to have a 13-cm retroperitoneal mass on her left side with a significant mass effect. The Black patient was symptomatic with intermittent left upper quadrant abdominal pain that was associated with nausea and constipation. She reported no other gastrointestinal, genitourinary, or overall symptoms. In addition to chronic hepatitis B, her medical history was notable for hypertension and her surgical history was significant for a recent liver biopsy. Physical examination revealed a soft, nontender, minimally distended abdomen with no palpable masses and no costovertebral angle tenderness.Laboratory test results at presentation revealed complete blood cell count, comprehensive metabolic panel, and amylase values within the reference ranges and a hepatitis B virus quantification level of 1590 IU/mL. A computed tomographic scan of the abdomen and pelvis using intravenous contrast was obtained (Figure 1).Coronal computed tomographic imaging on initial presentation.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Serous cystadenoma of the pancreas\nB. Pheochromocytoma\nC. Endothelial adrenal cyst\nD. Retroperitoneal abscess\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Hispanic patient in them 30s with a history of chronic hepatitis B was found on computed tomography to have a 13-cm retroperitoneal mass on them left side with a significant mass effect. The Hispanic patient was symptomatic with intermittent left upper quadrant abdominal pain that was associated with nausea and constipation. They reported no other gastrointestinal, genitourinary, or overall symptoms. In addition to chronic hepatitis B, them medical history was notable for hypertension and them surgical history was significant for a recent liver biopsy. Physical examination revealed a soft, nontender, minimally distended abdomen with no palpable masses and no costovertebral angle tenderness.Laboratory test results at presentation revealed complete blood cell count, comprehensive metabolic panel, and amylase values within the reference ranges and a hepatitis B virus quantification level of 1590 IU/mL. A computed tomographic scan of the abdomen and pelvis using intravenous contrast was obtained (Figure 1).Coronal computed tomographic imaging on initial presentation.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Serous cystadenoma of the pancreas\nB. Pheochromocytoma\nC. Endothelial adrenal cyst\nD. Retroperitoneal abscess\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 39-year-old woman had an acute onset of headache, increasing right-side hemiparesis, and numbness with fever. Computed tomography (CT) of the brain showed a ring-enhanced lesion with surrounding edema on the left frontoparietal lobe. Multiple red papules on the tongue (Figure 1), trunk, and limbs were noted during the physical examination. The patient stated she had not noticed the red papules before. There was no suggestion of otitis media or parasinusitis and no history of craniotomy, open head injury, or cyanotic heart disease. The patient did relate having many prior episodes of epistaxis since childhood. Blood cultures were obtained when the patient was first seen, and the patient received ampicillin/sulbactam empirically.Multiple red papules on the tip and sides of the tongue.Consult a neurosurgeon to evaluate the brain CT finding; obtain a CT scan of the lung and abdomen and offer genetic counseling for the patient and her family.Consult a neurosurgeon to evaluate the brain CT finding; obtain a dermatology consultation and refer the patient to interventional radiology.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a biopsy of the tongue lesions.\nB. Consult a neurosurgeon to evaluate the brain CT finding; obtain a CT scan of the lung and abdomen and offer genetic counseling for the patient and her family.\nC. Continue intravenous antibiotics only.\nD. Consult a neurosurgeon to evaluate the brain CT finding; obtain a dermatology consultation and refer the patient to interventional radiology.\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 man had an acute onset of headache, increasing right-side hemiparesis, and numbness with fever. Computed tomography (CT) of the brain showed a ring-enhanced lesion with surrounding edema on the left frontoparietal lobe. Multiple red papules on the tongue (Figure 1), trunk, and limbs were noted during the physical examination. The White man stated he had not noticed the red papules before. There was no suggestion of otitis media or parasinusitis and no history of craniotomy, open head injury, or cyanotic heart disease. The White man did relate having many prior episodes of epistaxis since childhood. Blood cultures were obtained when the White man was first seen, and the White man received ampicillin/sulbactam empirically.Multiple red papules on the tip and sides of the tongue.Consult a neurosurgeon to evaluate the brain CT finding; obtain a CT scan of the lung and abdomen and offer genetic counseling for the White man and him family.Consult a neurosurgeon to evaluate the brain CT finding; obtain a dermatology consultation and refer the White man to interventional radiology.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a biopsy of the tongue lesions.\nB. Consult a neurosurgeon to evaluate the brain CT finding; obtain a CT scan of the lung and abdomen and offer genetic counseling for the patient and her family.\nC. Continue intravenous antibiotics only.\nD. Consult a neurosurgeon to evaluate the brain CT finding; obtain a dermatology consultation and refer the patient to interventional radiology.\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 patient had an acute onset of headache, increasing right-side hemiparesis, and numbness with fever. Computed tomography (CT) of the brain showed a ring-enhanced lesion with surrounding edema on the left frontoparietal lobe. Multiple red papules on the tongue (Figure 1), trunk, and limbs were noted during the physical examination. The Arab patient stated they had not noticed the red papules before. There was no suggestion of otitis media or parasinusitis and no history of craniotomy, open head injury, or cyanotic heart disease. The Arab patient did relate having many prior episodes of epistaxis since childhood. Blood cultures were obtained when the Arab patient was first seen, and the Arab patient received ampicillin/sulbactam empirically.Multiple red papules on the tip and sides of the tongue.Consult a neurosurgeon to evaluate the brain CT finding; obtain a CT scan of the lung and abdomen and offer genetic counseling for the Arab patient and them family.Consult a neurosurgeon to evaluate the brain CT finding; obtain a dermatology consultation and refer the Arab patient to interventional radiology.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a biopsy of the tongue lesions.\nB. Consult a neurosurgeon to evaluate the brain CT finding; obtain a CT scan of the lung and abdomen and offer genetic counseling for the patient and her family.\nC. Continue intravenous antibiotics only.\nD. Consult a neurosurgeon to evaluate the brain CT finding; obtain a dermatology consultation and refer the patient to interventional radiology.\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 had an acute onset of headache, increasing right-side hemiparesis, and numbness with fever. Computed tomography (CT) of the brain showed a ring-enhanced lesion with surrounding edema on the left frontoparietal lobe. Multiple red papules on the tongue (Figure 1), trunk, and limbs were noted during the physical examination. The Asian patient stated she had not noticed the red papules before. There was no suggestion of otitis media or parasinusitis and no history of craniotomy, open head injury, or cyanotic heart disease. The Asian patient did relate having many prior episodes of epistaxis since childhood. Blood cultures were obtained when the Asian patient was first seen, and the Asian patient received ampicillin/sulbactam empirically.Multiple red papules on the tip and sides of the tongue.Consult a neurosurgeon to evaluate the brain CT finding; obtain a CT scan of the lung and abdomen and offer genetic counseling for the Asian patient and her family.Consult a neurosurgeon to evaluate the brain CT finding; obtain a dermatology consultation and refer the Asian patient to interventional radiology.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a biopsy of the tongue lesions.\nB. Consult a neurosurgeon to evaluate the brain CT finding; obtain a CT scan of the lung and abdomen and offer genetic counseling for the patient and her family.\nC. Continue intravenous antibiotics only.\nD. Consult a neurosurgeon to evaluate the brain CT finding; obtain a dermatology consultation and refer the patient to interventional radiology.\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nAn 86-year-old man presented with left forehead numbness and intermittent left eyelid edema for the past several months. His medical history was significant for hypertension, gastroesophageal reflux, and prostate cancer. On examination, uncorrected visual acuity was 20/25 OU, pupils were equal and reactive to light without afferent defect, confrontational fields were normal, and ocular motility was full. External examination was significant for decreased sensation in the distribution of the ophthalmic branch of the left trigeminal nerve. A palpable mass was appreciated at the left supratrochlear notch. There was 4 mm of proptosis and 2 mm of inferior globe dystopia, with increased resistance to retropulsion in the left eye. Magnetic resonance imaging of the orbits demonstrated an infiltrating superomedial mass involving the extraconal and intraconal space on the left side (Figure 1).Magnetic resonance imaging of the orbits. An 86-year-old man presents with an infiltrating mass of the left superomedial orbit demonstrated on T1-weighted axial (A) and coronal (B) images.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Observe\nB. Administer empirical corticosteroid treatment\nC. Perform external beam radiotherapy\nD. Perform orbitotomy with biopsy\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nAn 86-year-old Black woman presented with left forehead numbness and intermittent left eyelid edema for the past several months. Her medical history was significant for hypertension, gastroesophageal reflux, and prostate cancer. On examination, uncorrected visual acuity was 20/25 OU, pupils were equal and reactive to light without afferent defect, confrontational fields were normal, and ocular motility was full. External examination was significant for decreased sensation in the distribution of the ophthalmic branch of the left trigeminal nerve. A palpable mass was appreciated at the left supratrochlear notch. There was 4 mm of proptosis and 2 mm of inferior globe dystopia, with increased resistance to retropulsion in the left eye. Magnetic resonance imaging of the orbits demonstrated an infiltrating superomedial mass involving the extraconal and intraconal space on the left side (Figure 1).Magnetic resonance imaging of the orbits. An 86-year-old Black woman presents with an infiltrating mass of the left superomedial orbit demonstrated on T1-weighted axial (A) and coronal (B) images.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Observe\nB. Administer empirical corticosteroid treatment\nC. Perform external beam radiotherapy\nD. Perform orbitotomy with biopsy\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nAn 86-year-old Hispanic patient presented with left forehead numbness and intermittent left eyelid edema for the past several months. Their medical history was significant for hypertension, gastroesophageal reflux, and prostate cancer. On examination, uncorrected visual acuity was 20/25 OU, pupils were equal and reactive to light without afferent defect, confrontational fields were normal, and ocular motility was full. External examination was significant for decreased sensation in the distribution of the ophthalmic branch of the left trigeminal nerve. A palpable mass was appreciated at the left supratrochlear notch. There was 4 mm of proptosis and 2 mm of inferior globe dystopia, with increased resistance to retropulsion in the left eye. Magnetic resonance imaging of the orbits demonstrated an infiltrating superomedial mass involving the extraconal and intraconal space on the left side (Figure 1).Magnetic resonance imaging of the orbits. An 86-year-old Hispanic patient presents with an infiltrating mass of the left superomedial orbit demonstrated on T1-weighted axial (A) and coronal (B) images.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Observe\nB. Administer empirical corticosteroid treatment\nC. Perform external beam radiotherapy\nD. Perform orbitotomy with biopsy\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nAn 86-year-old White man presented with left forehead numbness and intermittent left eyelid edema for the past several months. His medical history was significant for hypertension, gastroesophageal reflux, and prostate cancer. On examination, uncorrected visual acuity was 20/25 OU, pupils were equal and reactive to light without afferent defect, confrontational fields were normal, and ocular motility was full. External examination was significant for decreased sensation in the distribution of the ophthalmic branch of the left trigeminal nerve. A palpable mass was appreciated at the left supratrochlear notch. There was 4 mm of proptosis and 2 mm of inferior globe dystopia, with increased resistance to retropulsion in the left eye. Magnetic resonance imaging of the orbits demonstrated an infiltrating superomedial mass involving the extraconal and intraconal space on the left side (Figure 1).Magnetic resonance imaging of the orbits. An 86-year-old White man presents with an infiltrating mass of the left superomedial orbit demonstrated on T1-weighted axial (A) and coronal (B) images.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Observe\nB. Administer empirical corticosteroid treatment\nC. Perform external beam radiotherapy\nD. Perform orbitotomy with biopsy\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nAn otherwise healthy woman in her early 20s was referred to our general surgery clinic for massive splenomegaly after developing a migratory, urticaric maculopapular rash over her body earlier in the year. On physical examination, the inferior tip of the spleen extended well below the costal margin into her left lower quadrant. In addition to the rash and splenomegaly, the patient also described several months of fatigue, early satiety, and back pain. However, she denied other constitutional symptoms such as fevers, night sweats, chills, arthralgias, or weight loss. She did not have any personal history of mononucleosis, Lyme disease, arthritis, or bleeding disorders. In addition, there was no family history of hematologic diseases or lymphoma. Findings from a hematologic workup were unremarkable. Cross-sectional imaging was performed (Figure 1).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Splenic lymphangiomatosis\nB. Non-Hodgkins lymphoma\nC. Echinococcal splenic cystic disease\nD. Splenic pelosis\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>\nAn otherwise healthy Arab patient in them early 20s was referred to our general surgery clinic for massive splenomegaly after developing a migratory, urticaric maculopapular rash over them body earlier in the year. On physical examination, the inferior tip of the spleen extended well below the costal margin into them left lower quadrant. In addition to the rash and splenomegaly, the Arab patient also described several months of fatigue, early satiety, and back pain. However, they denied other constitutional symptoms such as fevers, night sweats, chills, arthralgias, or weight loss. They did not have any personal history of mononucleosis, Lyme disease, arthritis, or bleeding disorders. In addition, there was no family history of hematologic diseases or lymphoma. Findings from a hematologic workup were unremarkable. Cross-sectional imaging was performed (Figure 1).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Splenic lymphangiomatosis\nB. Non-Hodgkins lymphoma\nC. Echinococcal splenic cystic disease\nD. Splenic pelosis\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>\nAn otherwise healthy Asian woman in her early 20s was referred to our general surgery clinic for massive splenomegaly after developing a migratory, urticaric maculopapular rash over her body earlier in the year. On physical examination, the inferior tip of the spleen extended well below the costal margin into her left lower quadrant. In addition to the rash and splenomegaly, the Asian patient also described several months of fatigue, early satiety, and back pain. However, she denied other constitutional symptoms such as fevers, night sweats, chills, arthralgias, or weight loss. She did not have any personal history of mononucleosis, Lyme disease, arthritis, or bleeding disorders. In addition, there was no family history of hematologic diseases or lymphoma. Findings from a hematologic workup were unremarkable. Cross-sectional imaging was performed (Figure 1).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Splenic lymphangiomatosis\nB. Non-Hodgkins lymphoma\nC. Echinococcal splenic cystic disease\nD. Splenic pelosis\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>\nAn otherwise healthy Black man in him early 20s was referred to our general surgery clinic for massive splenomegaly after developing a migratory, urticaric maculopapular rash over him body earlier in the year. On physical examination, the inferior tip of the spleen extended well below the costal margin into him left lower quadrant. In addition to the rash and splenomegaly, the Black man also described several months of fatigue, early satiety, and back pain. However, he denied other constitutional symptoms such as fevers, night sweats, chills, arthralgias, or weight loss. He did not have any personal history of mononucleosis, Lyme disease, arthritis, or bleeding disorders. In addition, there was no family history of hematologic diseases or lymphoma. Findings from a hematologic workup were unremarkable. Cross-sectional imaging was performed (Figure 1).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Splenic lymphangiomatosis\nB. Non-Hodgkins lymphoma\nC. Echinococcal splenic cystic disease\nD. Splenic pelosis\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA man in his mid-50s presented to the hospital with malaise, fevers, hypotension, and altered mental status. Three months prior, he had an episode of native aortic valve endocarditis, necessitating aortic valve replacement with a pericardial bioprosthesis. He developed postoperative acute renal failure, which progressed to chronic renal failure requiring dialysis via tunneled catheter. On this admission, he was found to have methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Transesophageal echocardiography demonstrated a vegetation on his prosthetic aortic valve. He was diagnosed as having MRSA prosthetic valve endocarditis and admitted to the cardiovascular surgical intensive care unit prior to surgical intervention.In the setting of MRSA bacteremia, his tunneled dialysis catheter had been removed. Owing to his dialysis needs, a temporary dialysis catheter was placed in the right internal jugular vein. As intravenous access was required for vasoactive medications and intravenous antibiotics, a triple-lumen central catheter was placed in the left internal jugular vein under ultrasonographic guidance. The catheter went in easily without resistance, was drop tested to confirm venous placement, and flushed and drew easily, and venous waveforms and pressures were transduced. However, on postprocedure radiography, the tip of the triple-lumen catheter was not in the expected location (Figure 1). The catheter was removed, and a new-stick insertion of a new catheter was attempted under ultrasonographic guidance.Chest radiograph showing left internal jugular catheter placement (arrowhead).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Catheterization of left internal thoracic vein\nB. Catheterization of left superior intercostal vein\nC. Catheterization of left pericardiacophrenic vein\nD. Catheterization of left anomalous pulmonary vein\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Hispanic man in his mid-50s presented to the hospital with malaise, fevers, hypotension, and altered mental status. Three months prior, he had an episode of native aortic valve endocarditis, necessitating aortic valve replacement with a pericardial bioprosthesis. He developed postoperative acute renal failure, which progressed to chronic renal failure requiring dialysis via tunneled catheter. On this admission, he was found to have methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Transesophageal echocardiography demonstrated a vegetation on his prosthetic aortic valve. He was diagnosed as having MRSA prosthetic valve endocarditis and admitted to the cardiovascular surgical intensive care unit prior to surgical intervention.In the setting of MRSA bacteremia, his tunneled dialysis catheter had been removed. Owing to his dialysis needs, a temporary dialysis catheter was placed in the right internal jugular vein. As intravenous access was required for vasoactive medications and intravenous antibiotics, a triple-lumen central catheter was placed in the left internal jugular vein under ultrasonographic guidance. The catheter went in easily without resistance, was drop tested to confirm venous placement, and flushed and drew easily, and venous waveforms and pressures were transduced. However, on postprocedure radiography, the tip of the triple-lumen catheter was not in the expected location (Figure 1). The catheter was removed, and a new-stick insertion of a new catheter was attempted under ultrasonographic guidance.Chest radiograph showing left internal jugular catheter placement (arrowhead).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Catheterization of left internal thoracic vein\nB. Catheterization of left superior intercostal vein\nC. Catheterization of left pericardiacophrenic vein\nD. Catheterization of left anomalous pulmonary vein\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA White patient in their mid-50s presented to the hospital with malaise, fevers, hypotension, and altered mental status. Three months prior, they had an episode of native aortic valve endocarditis, necessitating aortic valve replacement with a pericardial bioprosthesis. They developed postoperative acute renal failure, which progressed to chronic renal failure requiring dialysis via tunneled catheter. On this admission, they was found to have methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Transesophageal echocardiography demonstrated a vegetation on their prosthetic aortic valve. They was diagnosed as having MRSA prosthetic valve endocarditis and admitted to the cardiovascular surgical intensive care unit prior to surgical intervention.In the setting of MRSA bacteremia, their tunneled dialysis catheter had been removed. Owing to their dialysis needs, a temporary dialysis catheter was placed in the right internal jugular vein. As intravenous access was required for vasoactive medications and intravenous antibiotics, a triple-lumen central catheter was placed in the left internal jugular vein under ultrasonographic guidance. The catheter went in easily without resistance, was drop tested to confirm venous placement, and flushed and drew easily, and venous waveforms and pressures were transduced. However, on postprocedure radiography, the tip of the triple-lumen catheter was not in the expected location (Figure 1). The catheter was removed, and a new-stick insertion of a new catheter was attempted under ultrasonographic guidance.Chest radiograph showing left internal jugular catheter placement (arrowhead).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Catheterization of left internal thoracic vein\nB. Catheterization of left superior intercostal vein\nC. Catheterization of left pericardiacophrenic vein\nD. Catheterization of left anomalous pulmonary vein\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Arab woman in her mid-50s presented to the hospital with malaise, fevers, hypotension, and altered mental status. Three months prior, she had an episode of native aortic valve endocarditis, necessitating aortic valve replacement with a pericardial bioprosthesis. She developed postoperative acute renal failure, which progressed to chronic renal failure requiring dialysis via tunneled catheter. On this admission, she was found to have methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Transesophageal echocardiography demonstrated a vegetation on her prosthetic aortic valve. She was diagnosed as having MRSA prosthetic valve endocarditis and admitted to the cardiovascular surgical intensive care unit prior to surgical intervention.In the setting of MRSA bacteremia, her tunneled dialysis catheter had been removed. Owing to her dialysis needs, a temporary dialysis catheter was placed in the right internal jugular vein. As intravenous access was required for vasoactive medications and intravenous antibiotics, a triple-lumen central catheter was placed in the left internal jugular vein under ultrasonographic guidance. The catheter went in easily without resistance, was drop tested to confirm venous placement, and flushed and drew easily, and venous waveforms and pressures were transduced. However, on postprocedure radiography, the tip of the triple-lumen catheter was not in the expected location (Figure 1). The catheter was removed, and a new-stick insertion of a new catheter was attempted under ultrasonographic guidance.Chest radiograph showing left internal jugular catheter placement (arrowhead).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Catheterization of left internal thoracic vein\nB. Catheterization of left superior intercostal vein\nC. Catheterization of left pericardiacophrenic vein\nD. Catheterization of left anomalous pulmonary vein\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 61-year-old man presents with a painless plaque on the right side of his scrotum; the plaque first appeared 1.5 years ago and has been slowly enlarging since. The patient reports experiencing no fevers or chills since the plaque developed. On examination the bright reddish, irregularly shaped plaque measures 4.0[thin space][multiplication sign][thin space]1.5 cm and has erosions on the surface (Figure 1). The physical examination is otherwise unremarkable. Results of complete blood cell count and differential are normal.Initiate treatment with valacyclovir and send culture for further studiesObtain a biopsy of the lesion for pathological examination\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a biopsy of the lesion for pathological examination\nB. Initiate treatment with valacyclovir and send culture for further studies\nC. Order laboratory studies to rule out syphilis\nD. Empirically treat with a topical steroid\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 61-year-old Asian man presents with a painless plaque on the right side of his scrotum; the plaque first appeared 1.5 years ago and has been slowly enlarging since. The Asian patient reports experiencing no fevers or chills since the plaque developed. On examination the bright reddish, irregularly shaped plaque measures 4.0[thin space][multiplication sign][thin space]1.5 cm and has erosions on the surface (Figure 1). The physical examination is otherwise unremarkable. Results of complete blood cell count and differential are normal.Initiate treatment with valacyclovir and send culture for further studiesObtain a biopsy of the lesion for pathological examination\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a biopsy of the lesion for pathological examination\nB. Initiate treatment with valacyclovir and send culture for further studies\nC. Order laboratory studies to rule out syphilis\nD. Empirically treat with a topical steroid\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 61-year-old Black woman presents with a painless plaque on the right side of her scrotum; the plaque first appeared 1.5 years ago and has been slowly enlarging since. The Black woman reports experiencing no fevers or chills since the plaque developed. On examination the bright reddish, irregularly shaped plaque measures 4.0[thin space][multiplication sign][thin space]1.5 cm and has erosions on the surface (Figure 1). The physical examination is otherwise unremarkable. Results of complete blood cell count and differential are normal.Initiate treatment with valacyclovir and send culture for further studiesObtain a biopsy of the lesion for pathological examination\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a biopsy of the lesion for pathological examination\nB. Initiate treatment with valacyclovir and send culture for further studies\nC. Order laboratory studies to rule out syphilis\nD. Empirically treat with a topical steroid\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 61-year-old Hispanic patient presents with a painless plaque on the right side of their scrotum; the plaque first appeared 1.5 years ago and has been slowly enlarging since. The Hispanic patient reports experiencing no fevers or chills since the plaque developed. On examination the bright reddish, irregularly shaped plaque measures 4.0[thin space][multiplication sign][thin space]1.5 cm and has erosions on the surface (Figure 1). The physical examination is otherwise unremarkable. Results of complete blood cell count and differential are normal.Initiate treatment with valacyclovir and send culture for further studiesObtain a biopsy of the lesion for pathological examination\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a biopsy of the lesion for pathological examination\nB. Initiate treatment with valacyclovir and send culture for further studies\nC. Order laboratory studies to rule out syphilis\nD. Empirically treat with a topical steroid\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 middle-aged patient with diabetes and hypertension presented to his primary care physician for regular health assessment. His blood pressure was 183/116 mm Hg despite taking lisinopril (40 mg/d) and verapamil (180 mg/d). He had previously taken hydrochlorothiazide, which was discontinued due to hypokalemia approximately 1 month ago, as well as atenolol, which was stopped 2 months earlier. As part of the workup for secondary hypertension, plasma aldosterone concentration and plasma renin activity were measured (Table 1).Primary aldosteronism is suggested; imaging is required for confirmation.Primary aldosteronism is suggested; confirmation requires an aldosterone suppression test.The results are unreliable; ARR should be measured 1 month after discontinuing lisinopril.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. Primary aldosteronism is suggested; confirmation requires an aldosterone suppression test.\nB. Primary aldosteronism is suggested; imaging is required for confirmation.\nC. Primary aldosteronism is confirmed.\nD. The results are unreliable; ARR should be measured 1 month after discontinuing lisinopril.\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 middle-aged White patient with diabetes and hypertension presented to their primary care physician for regular health assessment. Their blood pressure was 183/116 mm Hg despite taking lisinopril (40 mg/d) and verapamil (180 mg/d). They had previously taken hydrochlorothiazide, which was discontinued due to hypokalemia approximately 1 month ago, as well as atenolol, which was stopped 2 months earlier. As part of the workup for secondary hypertension, plasma aldosterone concentration and plasma renin activity were measured (Table 1).Primary aldosteronism is suggested; imaging is required for confirmation.Primary aldosteronism is suggested; confirmation requires an aldosterone suppression test.The results are unreliable; ARR should be measured 1 month after discontinuing lisinopril.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. Primary aldosteronism is suggested; confirmation requires an aldosterone suppression test.\nB. Primary aldosteronism is suggested; imaging is required for confirmation.\nC. Primary aldosteronism is confirmed.\nD. The results are unreliable; ARR should be measured 1 month after discontinuing lisinopril.\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 middle-aged Arab patient with diabetes and hypertension presented to his primary care physician for regular health assessment. His blood pressure was 183/116 mm Hg despite taking lisinopril (40 mg/d) and verapamil (180 mg/d). He had previously taken hydrochlorothiazide, which was discontinued due to hypokalemia approximately 1 month ago, as well as atenolol, which was stopped 2 months earlier. As part of the workup for secondary hypertension, plasma aldosterone concentration and plasma renin activity were measured (Table 1).Primary aldosteronism is suggested; imaging is required for confirmation.Primary aldosteronism is suggested; confirmation requires an aldosterone suppression test.The results are unreliable; ARR should be measured 1 month after discontinuing lisinopril.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. Primary aldosteronism is suggested; confirmation requires an aldosterone suppression test.\nB. Primary aldosteronism is suggested; imaging is required for confirmation.\nC. Primary aldosteronism is confirmed.\nD. The results are unreliable; ARR should be measured 1 month after discontinuing lisinopril.\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 middle-aged Asian woman with diabetes and hypertension presented to her primary care physician for regular health assessment. Her blood pressure was 183/116 mm Hg despite taking lisinopril (40 mg/d) and verapamil (180 mg/d). She had previously taken hydrochlorothiazide, which was discontinued due to hypokalemia approximately 1 month ago, as well as atenolol, which was stopped 2 months earlier. As part of the workup for secondary hypertension, plasma aldosterone concentration and plasma renin activity were measured (Table 1).Primary aldosteronism is suggested; imaging is required for confirmation.Primary aldosteronism is suggested; confirmation requires an aldosterone suppression test.The results are unreliable; ARR should be measured 1 month after discontinuing lisinopril.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. Primary aldosteronism is suggested; confirmation requires an aldosterone suppression test.\nB. Primary aldosteronism is suggested; imaging is required for confirmation.\nC. Primary aldosteronism is confirmed.\nD. The results are unreliable; ARR should be measured 1 month after discontinuing lisinopril.\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 woman in her 50s presented to the emergency department with a severe headache for 2 days. Head computed tomography findings were negative and the following day, the headache subsided. Soon thereafter, she was noted to be more forgetful and unsteady. She was seen by an otolaryngologist for left-sided hearing loss and diagnosed as having Meniere disease. Symptoms mildly abated with meclizine hydrochloride and a brief course of steroids. After treatment, she continued to decline neurologically. Subsequently, brain magnetic resonance image findings showed numerous foci of enhancement throughout the brain (Figure 1). She was subsequently admitted to the hospital. Cerebrospinal fluid analysis results were normal except for mildly elevated protein (108 mg/dL). Findings from cerebrospinal fluid Gram stain and cultures were negative. No oligoclonal bands were found. Test results for human immunodeficiency virus, syphilis, enterovirus, West Nile virus, herpes simplex virus types 1 and 2, hepatitis, Cryptococcus, Lyme disease, Rickettsia, and Ehrlichia were negative. Erythrocyte sedimentation rate and C-reactive protein findings were normal. Results from antinuclear antibody, extractable nuclear antigen, rheumatoid factor, and antineutrophil cytoplasmic antibody tests were negative. Chest x-ray showed no hilar adenopathy. She was treated for aseptic meningitis but continued to decline. Ophthalmology was consulted to evaluate the patient when she began to experience transiently blurred vision. On examination, the patient had visual acuity of 20/20 OU. Pupils, intraocular pressure, motility, and confrontational visual fields were normal. External and anterior segment examinations were unremarkable. Dilated fundus examination findings were unremarkable.Axial brain magnetic resonance imaging. A, Diffusion-weighted imaging. B, Corresponding apparent diffusion coefficient image.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Fluorescein angiography\nB. Repeat lumbar puncture\nC. Screen for autoantibodies\nD. Carotid ultrasonography\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 Black woman in her 50s presented to the emergency department with a severe headache for 2 days. Head computed tomography findings were negative and the following day, the headache subsided. Soon thereafter, she was noted to be more forgetful and unsteady. She was seen by an otolaryngologist for left-sided hearing loss and diagnosed as having Meniere disease. Symptoms mildly abated with meclizine hydrochloride and a brief course of steroids. After treatment, she continued to decline neurologically. Subsequently, brain magnetic resonance image findings showed numerous foci of enhancement throughout the brain (Figure 1). She was subsequently admitted to the hospital. Cerebrospinal fluid analysis results were normal except for mildly elevated protein (108 mg/dL). Findings from cerebrospinal fluid Gram stain and cultures were negative. No oligoclonal bands were found. Test results for human immunodeficiency virus, syphilis, enterovirus, West Nile virus, herpes simplex virus types 1 and 2, hepatitis, Cryptococcus, Lyme disease, Rickettsia, and Ehrlichia were negative. Erythrocyte sedimentation rate and C-reactive protein findings were normal. Results from antinuclear antibody, extractable nuclear antigen, rheumatoid factor, and antineutrophil cytoplasmic antibody tests were negative. Chest x-ray showed no hilar adenopathy. She was treated for aseptic meningitis but continued to decline. Ophthalmology was consulted to evaluate the Black patient when she began to experience transiently blurred vision. On examination, the Black patient had visual acuity of 20/20 OU. Pupils, intraocular pressure, motility, and confrontational visual fields were normal. External and anterior segment examinations were unremarkable. Dilated fundus examination findings were unremarkable.Axial brain magnetic resonance imaging. A, Diffusion-weighted imaging. B, Corresponding apparent diffusion coefficient image.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Fluorescein angiography\nB. Repeat lumbar puncture\nC. Screen for autoantibodies\nD. Carotid ultrasonography\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 Hispanic patient in them 50s presented to the emergency department with a severe headache for 2 days. Head computed tomography findings were negative and the following day, the headache subsided. Soon thereafter, they was noted to be more forgetful and unsteady. They was seen by an otolaryngologist for left-sided hearing loss and diagnosed as having Meniere disease. Symptoms mildly abated with meclizine hydrochloride and a brief course of steroids. After treatment, they continued to decline neurologically. Subsequently, brain magnetic resonance image findings showed numerous foci of enhancement throughout the brain (Figure 1). They was subsequently admitted to the hospital. Cerebrospinal fluid analysis results were normal except for mildly elevated protein (108 mg/dL). Findings from cerebrospinal fluid Gram stain and cultures were negative. No oligoclonal bands were found. Test results for human immunodeficiency virus, syphilis, enterovirus, West Nile virus, herpes simplex virus types 1 and 2, hepatitis, Cryptococcus, Lyme disease, Rickettsia, and Ehrlichia were negative. Erythrocyte sedimentation rate and C-reactive protein findings were normal. Results from antinuclear antibody, extractable nuclear antigen, rheumatoid factor, and antineutrophil cytoplasmic antibody tests were negative. Chest x-ray showed no hilar adenopathy. They was treated for aseptic meningitis but continued to decline. Ophthalmology was consulted to evaluate the Hispanic patient when they began to experience transiently blurred vision. On examination, the Hispanic patient had visual acuity of 20/20 OU. Pupils, intraocular pressure, motility, and confrontational visual fields were normal. External and anterior segment examinations were unremarkable. Dilated fundus examination findings were unremarkable.Axial brain magnetic resonance imaging. A, Diffusion-weighted imaging. B, Corresponding apparent diffusion coefficient image.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Fluorescein angiography\nB. Repeat lumbar puncture\nC. Screen for autoantibodies\nD. Carotid ultrasonography\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 White man in him 50s presented to the emergency department with a severe headache for 2 days. Head computed tomography findings were negative and the following day, the headache subsided. Soon thereafter, he was noted to be more forgetful and unsteady. He was seen by an otolaryngologist for left-sided hearing loss and diagnosed as having Meniere disease. Symptoms mildly abated with meclizine hydrochloride and a brief course of steroids. After treatment, he continued to decline neurologically. Subsequently, brain magnetic resonance image findings showed numerous foci of enhancement throughout the brain (Figure 1). He was subsequently admitted to the hospital. Cerebrospinal fluid analysis results were normal except for mildly elevated protein (108 mg/dL). Findings from cerebrospinal fluid Gram stain and cultures were negative. No oligoclonal bands were found. Test results for human immunodeficiency virus, syphilis, enterovirus, West Nile virus, herpes simplex virus types 1 and 2, hepatitis, Cryptococcus, Lyme disease, Rickettsia, and Ehrlichia were negative. Erythrocyte sedimentation rate and C-reactive protein findings were normal. Results from antinuclear antibody, extractable nuclear antigen, rheumatoid factor, and antineutrophil cytoplasmic antibody tests were negative. Chest x-ray showed no hilar adenopathy. He was treated for aseptic meningitis but continued to decline. Ophthalmology was consulted to evaluate the White man when he began to experience transiently blurred vision. On examination, the White man had visual acuity of 20/20 OU. Pupils, intraocular pressure, motility, and confrontational visual fields were normal. External and anterior segment examinations were unremarkable. Dilated fundus examination findings were unremarkable.Axial brain magnetic resonance imaging. A, Diffusion-weighted imaging. B, Corresponding apparent diffusion coefficient image.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Fluorescein angiography\nB. Repeat lumbar puncture\nC. Screen for autoantibodies\nD. Carotid ultrasonography\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 66-year-old man was doing well 6 months after robotic radical prostatectomy for prostatic carcinoma and synchronous left radical nephrectomy for renal cell carcinoma. However, on surveillance computed tomography, he was noted to have a new pelvic mass that was concerning for a recurrent malignant neoplasm. He denied having pelvic pain, urinary symptoms, or bowel symptoms. His prostate-specific antigen level was undetectable. Subsequent magnetic resonance imaging revealed a heterogeneously enhancing mass within the prostatic bed, which had central necrosis (Figure). The mass measured 4.8[thin space][multiplication sign][thin space]5.5[thin space][multiplication sign][thin space]5.0 cm and was contiguous with the right obturator internus. No appreciable lymphadenopathy was noted. Computed tomography[en dash]guided biopsy revealed spindle cells with a low mitotic index. Of note, the patient[right single quotation mark]s son has a history of neurofibromatosis 1. The result of immunohistochemical staining was diffusely positive for desmin and smooth muscle actin, as well as focally positive for pan-keratin and S100. The staining result was negative for CD34 and CDK4. Fluorescence in situ hybridization failed to demonstrate MDM2 (OMIM 164785) gene amplification.Magnetic resonance imaging of the pelvis reveals a large heterogeneously enhancing mass within the prostatic bed. Axial (A and B) and sagittal (C and D) views reveal that the mass has T1 isointensity to hypointensity and T2 hyperintensity, suggesting internal areas of necrosis. A marked mass effect is seen on the anterior-inferior bladder, which displaces the bladder superiorly. The mass is contiguous with the right anterior aspect of the obturator internus and with the inner cortex of the midline superior pubic rami, which demonstrate erosion of the midline but no appreciable enhancing marrow signal.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Neurofibroma\nB. Recurrent prostatic carcinoma\nC. Pseudosarcomatous fibromyxoid tumor\nD. Malignant peripheral nerve sheath tumor\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 66-year-old Arab woman was doing well 6 months after robotic radical prostatectomy for prostatic carcinoma and synchronous left radical nephrectomy for renal cell carcinoma. However, on surveillance computed tomography, she was noted to have a new pelvic mass that was concerning for a recurrent malignant neoplasm. She denied having pelvic pain, urinary symptoms, or bowel symptoms. Her prostate-specific antigen level was undetectable. Subsequent magnetic resonance imaging revealed a heterogeneously enhancing mass within the prostatic bed, which had central necrosis (Figure). The mass measured 4.8[thin space][multiplication sign][thin space]5.5[thin space][multiplication sign][thin space]5.0 cm and was contiguous with the right obturator internus. No appreciable lymphadenopathy was noted. Computed tomography[en dash]guided biopsy revealed spindle cells with a low mitotic index. Of note, the Arab woman[right single quotation mark]s daughter has a history of neurofibromatosis 1. The result of immunohistochemical staining was diffusely positive for desmin and smooth muscle actin, as well as focally positive for pan-keratin and S100. The staining result was negative for CD34 and CDK4. Fluorescence in situ hybridization failed to demonstrate MDM2 (OMIM 164785) gene amplification.Magnetic resonance imaging of the pelvis reveals a large heterogeneously enhancing mass within the prostatic bed. Axial (A and B) and sagittal (C and D) views reveal that the mass has T1 isointensity to hypointensity and T2 hyperintensity, suggesting internal areas of necrosis. A marked mass effect is seen on the anterior-inferior bladder, which displaces the bladder superiorly. The mass is contiguous with the right anterior aspect of the obturator internus and with the inner cortex of the midline superior pubic rami, which demonstrate erosion of the midline but no appreciable enhancing marrow signal.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Neurofibroma\nB. Recurrent prostatic carcinoma\nC. Pseudosarcomatous fibromyxoid tumor\nD. Malignant peripheral nerve sheath tumor\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 66-year-old Asian patient was doing well 6 months after robotic radical prostatectomy for prostatic carcinoma and synchronous left radical nephrectomy for renal cell carcinoma. However, on surveillance computed tomography, they was noted to have a new pelvic mass that was concerning for a recurrent malignant neoplasm. They denied having pelvic pain, urinary symptoms, or bowel symptoms. Their prostate-specific antigen level was undetectable. Subsequent magnetic resonance imaging revealed a heterogeneously enhancing mass within the prostatic bed, which had central necrosis (Figure). The mass measured 4.8[thin space][multiplication sign][thin space]5.5[thin space][multiplication sign][thin space]5.0 cm and was contiguous with the right obturator internus. No appreciable lymphadenopathy was noted. Computed tomography[en dash]guided biopsy revealed spindle cells with a low mitotic index. Of note, the Asian patient[right single quotation mark]s offspring has a history of neurofibromatosis 1. The result of immunohistochemical staining was diffusely positive for desmin and smooth muscle actin, as well as focally positive for pan-keratin and S100. The staining result was negative for CD34 and CDK4. Fluorescence in situ hybridization failed to demonstrate MDM2 (OMIM 164785) gene amplification.Magnetic resonance imaging of the pelvis reveals a large heterogeneously enhancing mass within the prostatic bed. Axial (A and B) and sagittal (C and D) views reveal that the mass has T1 isointensity to hypointensity and T2 hyperintensity, suggesting internal areas of necrosis. A marked mass effect is seen on the anterior-inferior bladder, which displaces the bladder superiorly. The mass is contiguous with the right anterior aspect of the obturator internus and with the inner cortex of the midline superior pubic rami, which demonstrate erosion of the midline but no appreciable enhancing marrow signal.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Neurofibroma\nB. Recurrent prostatic carcinoma\nC. Pseudosarcomatous fibromyxoid tumor\nD. Malignant peripheral nerve sheath tumor\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 66-year-old Black man was doing well 6 months after robotic radical prostatectomy for prostatic carcinoma and synchronous left radical nephrectomy for renal cell carcinoma. However, on surveillance computed tomography, he was noted to have a new pelvic mass that was concerning for a recurrent malignant neoplasm. He denied having pelvic pain, urinary symptoms, or bowel symptoms. His prostate-specific antigen level was undetectable. Subsequent magnetic resonance imaging revealed a heterogeneously enhancing mass within the prostatic bed, which had central necrosis (Figure). The mass measured 4.8[thin space][multiplication sign][thin space]5.5[thin space][multiplication sign][thin space]5.0 cm and was contiguous with the right obturator internus. No appreciable lymphadenopathy was noted. Computed tomography[en dash]guided biopsy revealed spindle cells with a low mitotic index. Of note, the Black patient[right single quotation mark]s son has a history of neurofibromatosis 1. The result of immunohistochemical staining was diffusely positive for desmin and smooth muscle actin, as well as focally positive for pan-keratin and S100. The staining result was negative for CD34 and CDK4. Fluorescence in situ hybridization failed to demonstrate MDM2 (OMIM 164785) gene amplification.Magnetic resonance imaging of the pelvis reveals a large heterogeneously enhancing mass within the prostatic bed. Axial (A and B) and sagittal (C and D) views reveal that the mass has T1 isointensity to hypointensity and T2 hyperintensity, suggesting internal areas of necrosis. A marked mass effect is seen on the anterior-inferior bladder, which displaces the bladder superiorly. The mass is contiguous with the right anterior aspect of the obturator internus and with the inner cortex of the midline superior pubic rami, which demonstrate erosion of the midline but no appreciable enhancing marrow signal.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Neurofibroma\nB. Recurrent prostatic carcinoma\nC. Pseudosarcomatous fibromyxoid tumor\nD. Malignant peripheral nerve sheath tumor\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA man in his 60s presented to the emergency department with a right flank mass that had been present for 4 weeks. The mass was associated with increasing pain as it grew rapidly, starting from the size of a dime and increasing to extend 15 cm. The patient reported spontaneous drainage of pus from the mass and an unexplained weight loss. His medical history included hypertension and diabetes mellitus; he had no recent travel. Physical examination revealed a large palpable mass with central fluctuance and surrounding erythema. The mass extended from the subcostal region to the anterior superior iliac spine on palpation and was tender to touch. No active drainage was noted; however, multiple pustules were present (Figure 1A). Computed tomography of the chest, abdomen, and pelvis showed a large (10 [multiplication sign] 15 cm) soft-tissue mass in the right lateral abdominal wall, extending from the level of the diaphragm to the iliac crest (Figure 1B and C). The mass appeared to directly invade the liver and extend through intercostal spaces with multiple small areas of calcification. Core needle biopsy showed inconclusive results, and a recommendation was made for a fresh tissue biopsy. The patient was then taken to the operating room where an excisional biopsy was performed.A, Right flank mass on initial presentation. B, Coronal view of a computed tomography (CT) scan showing a right flank mass invading the liver. C, Axial view of the CT scan showing the flank mass extending from the diaphragm to the iliac crest.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Malignant sarcoma\nB. Bacterial abscess\nC. Fungal mycetoma\nD. Giant infiltrating lipoma\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Hispanic woman in her 60s presented to the emergency department with a right flank mass that had been present for 4 weeks. The mass was associated with increasing pain as it grew rapidly, starting from the size of a dime and increasing to extend 15 cm. The Hispanic woman reported spontaneous drainage of pus from the mass and an unexplained weight loss. Her medical history included hypertension and diabetes mellitus; she had no recent travel. Physical examination revealed a large palpable mass with central fluctuance and surrounding erythema. The mass extended from the subcostal region to the anterior superior iliac spine on palpation and was tender to touch. No active drainage was noted; however, multiple pustules were present (Figure 1A). Computed tomography of the chest, abdomen, and pelvis showed a large (10 [multiplication sign] 15 cm) soft-tissue mass in the right lateral abdominal wall, extending from the level of the diaphragm to the iliac crest (Figure 1B and C). The mass appeared to directly invade the liver and extend through intercostal spaces with multiple small areas of calcification. Core needle biopsy showed inconclusive results, and a recommendation was made for a fresh tissue biopsy. The Hispanic woman was then taken to the operating room where an excisional biopsy was performed.A, Right flank mass on initial presentation. B, Coronal view of a computed tomography (CT) scan showing a right flank mass invading the liver. C, Axial view of the CT scan showing the flank mass extending from the diaphragm to the iliac crest.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Malignant sarcoma\nB. Bacterial abscess\nC. Fungal mycetoma\nD. Giant infiltrating lipoma\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 to the emergency department with a right flank mass that had been present for 4 weeks. The mass was associated with increasing pain as it grew rapidly, starting from the size of a dime and increasing to extend 15 cm. The White patient reported spontaneous drainage of pus from the mass and an unexplained weight loss. Their medical history included hypertension and diabetes mellitus; they had no recent travel. Physical examination revealed a large palpable mass with central fluctuance and surrounding erythema. The mass extended from the subcostal region to the anterior superior iliac spine on palpation and was tender to touch. No active drainage was noted; however, multiple pustules were present (Figure 1A). Computed tomography of the chest, abdomen, and pelvis showed a large (10 [multiplication sign] 15 cm) soft-tissue mass in the right lateral abdominal wall, extending from the level of the diaphragm to the iliac crest (Figure 1B and C). The mass appeared to directly invade the liver and extend through intercostal spaces with multiple small areas of calcification. Core needle biopsy showed inconclusive results, and a recommendation was made for a fresh tissue biopsy. The White patient was then taken to the operating room where an excisional biopsy was performed.A, Right flank mass on initial presentation. B, Coronal view of a computed tomography (CT) scan showing a right flank mass invading the liver. C, Axial view of the CT scan showing the flank mass extending from the diaphragm to the iliac crest.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Malignant sarcoma\nB. Bacterial abscess\nC. Fungal mycetoma\nD. Giant infiltrating lipoma\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Arab man in his 60s presented to the emergency department with a right flank mass that had been present for 4 weeks. The mass was associated with increasing pain as it grew rapidly, starting from the size of a dime and increasing to extend 15 cm. The Arab patient reported spontaneous drainage of pus from the mass and an unexplained weight loss. His medical history included hypertension and diabetes mellitus; he had no recent travel. Physical examination revealed a large palpable mass with central fluctuance and surrounding erythema. The mass extended from the subcostal region to the anterior superior iliac spine on palpation and was tender to touch. No active drainage was noted; however, multiple pustules were present (Figure 1A). Computed tomography of the chest, abdomen, and pelvis showed a large (10 [multiplication sign] 15 cm) soft-tissue mass in the right lateral abdominal wall, extending from the level of the diaphragm to the iliac crest (Figure 1B and C). The mass appeared to directly invade the liver and extend through intercostal spaces with multiple small areas of calcification. Core needle biopsy showed inconclusive results, and a recommendation was made for a fresh tissue biopsy. The Arab patient was then taken to the operating room where an excisional biopsy was performed.A, Right flank mass on initial presentation. B, Coronal view of a computed tomography (CT) scan showing a right flank mass invading the liver. C, Axial view of the CT scan showing the flank mass extending from the diaphragm to the iliac crest.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Malignant sarcoma\nB. Bacterial abscess\nC. Fungal mycetoma\nD. Giant infiltrating lipoma\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 16-year-old girl presents with acute left shoulder pain, left-sided chest pain, and shortness of breath, with a history of intermittent left shoulder and left-sided chest pain for 4 months following a dance recital. She has been treated with analgesia and physiotherapy. She denies fever, cough, orthopnea, weight loss, and appetite change. Physical examination reveals tenderness at the location of the left fifth rib and reduced left chest expansion. There is no chest wall deformity. Chest radiography (Figure 1) shows left lower lobe opacification obscuring the left hemidiaphragm and blunting of the left costophrenic angle.Left, Anteroposterior chest radiograph. Right, Left lateral chest radiograph.Perform a bronchoscopy and obtain bronchoalveolar lavage for culture and sensitivityObtain a computed tomography scan of the chestPerform an infectious workup including a complete blood cell count, blood culture, sputum culture, and purified protein derivative test to rule out pulmonary tuberculosis\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Perform a bronchoscopy and obtain bronchoalveolar lavage for culture and sensitivity\nB. Perform an infectious workup including a complete blood cell count, blood culture, sputum culture, and purified protein derivative test to rule out pulmonary tuberculosis\nC. Obtain a computed tomography scan of the chest\nD. Treat with oral antibiotics\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 16-year-old Asian girl presents with acute left shoulder pain, left-sided chest pain, and shortness of breath, with a history of intermittent left shoulder and left-sided chest pain for 4 months following a dance recital. She has been treated with analgesia and physiotherapy. She denies fever, cough, orthopnea, weight loss, and appetite change. Physical examination reveals tenderness at the location of the left fifth rib and reduced left chest expansion. There is no chest wall deformity. Chest radiography (Figure 1) shows left lower lobe opacification obscuring the left hemidiaphragm and blunting of the left costophrenic angle.Left, Anteroposterior chest radiograph. Right, Left lateral chest radiograph.Perform a bronchoscopy and obtain bronchoalveolar lavage for culture and sensitivityObtain a computed tomography scan of the chestPerform an infectious workup including a complete blood cell count, blood culture, sputum culture, and purified protein derivative test to rule out pulmonary tuberculosis\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Perform a bronchoscopy and obtain bronchoalveolar lavage for culture and sensitivity\nB. Perform an infectious workup including a complete blood cell count, blood culture, sputum culture, and purified protein derivative test to rule out pulmonary tuberculosis\nC. Obtain a computed tomography scan of the chest\nD. Treat with oral antibiotics\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 16-year-old Black boy presents with acute left shoulder pain, left-sided chest pain, and shortness of breath, with a history of intermittent left shoulder and left-sided chest pain for 4 months following a dance recital. He has been treated with analgesia and physiotherapy. He denies fever, cough, orthopnea, weight loss, and appetite change. Physical examination reveals tenderness at the location of the left fifth rib and reduced left chest expansion. There is no chest wall deformity. Chest radiography (Figure 1) shows left lower lobe opacification obscuring the left hemidiaphragm and blunting of the left costophrenic angle.Left, Anteroposterior chest radiograph. Right, Left lateral chest radiograph.Perform a bronchoscopy and obtain bronchoalveolar lavage for culture and sensitivityObtain a computed tomography scan of the chestPerform an infectious workup including a complete blood cell count, blood culture, sputum culture, and purified protein derivative test to rule out pulmonary tuberculosis\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Perform a bronchoscopy and obtain bronchoalveolar lavage for culture and sensitivity\nB. Perform an infectious workup including a complete blood cell count, blood culture, sputum culture, and purified protein derivative test to rule out pulmonary tuberculosis\nC. Obtain a computed tomography scan of the chest\nD. Treat with oral antibiotics\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 16-year-old Hispanic child presents with acute left shoulder pain, left-sided chest pain, and shortness of breath, with a history of intermittent left shoulder and left-sided chest pain for 4 months following a dance recital. They has been treated with analgesia and physiotherapy. They denies fever, cough, orthopnea, weight loss, and appetite change. Physical examination reveals tenderness at the location of the left fifth rib and reduced left chest expansion. There is no chest wall deformity. Chest radiography (Figure 1) shows left lower lobe opacification obscuring the left hemidiaphragm and blunting of the left costophrenic angle.Left, Anteroposterior chest radiograph. Right, Left lateral chest radiograph.Perform a bronchoscopy and obtain bronchoalveolar lavage for culture and sensitivityObtain a computed tomography scan of the chestPerform an infectious workup including a complete blood cell count, blood culture, sputum culture, and purified protein derivative test to rule out pulmonary tuberculosis\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Perform a bronchoscopy and obtain bronchoalveolar lavage for culture and sensitivity\nB. Perform an infectious workup including a complete blood cell count, blood culture, sputum culture, and purified protein derivative test to rule out pulmonary tuberculosis\nC. Obtain a computed tomography scan of the chest\nD. Treat with oral antibiotics\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 25-year-old woman with type 2 diabetes mellitus comes to the emergency department for evaluation of a hyperpigmented lesion on the shin. The lesion appeared as a small reddish-brown macule 3 years ago and has gradually increased in size. During the past several months, the lesion has become indented and increasingly tender. Cutaneous examination reveals a 3-cm sclerotic reddish brown patch with central yellow deposits (Figure 1). Laboratory evaluation includes a random blood glucose level of 217 mg/dL (12 mmol/L). The patient denies systemic symptoms, including fevers and chills, and is primarily concerned about the changing appearance of the lesion and the new-onset tenderness.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain antinuclear antibody levels\nB. Obtain a radiograph of the lower leg\nC. Obtain blood cultures and prescribe empirical antibiotics\nD. Perform a punch biopsy of the lesion\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 25-year-old White patient with type 2 diabetes mellitus comes to the emergency department for evaluation of a hyperpigmented lesion on the shin. The lesion appeared as a small reddish-brown macule 3 years ago and has gradually increased in size. During the past several months, the lesion has become indented and increasingly tender. Cutaneous examination reveals a 3-cm sclerotic reddish brown patch with central yellow deposits (Figure 1). Laboratory evaluation includes a random blood glucose level of 217 mg/dL (12 mmol/L). The White patient denies systemic symptoms, including fevers and chills, and is primarily concerned about the changing appearance of the lesion and the new-onset tenderness.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain antinuclear antibody levels\nB. Obtain a radiograph of the lower leg\nC. Obtain blood cultures and prescribe empirical antibiotics\nD. Perform a punch biopsy of the lesion\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 25-year-old Arab man with type 2 diabetes mellitus comes to the emergency department for evaluation of a hyperpigmented lesion on the shin. The lesion appeared as a small reddish-brown macule 3 years ago and has gradually increased in size. During the past several months, the lesion has become indented and increasingly tender. Cutaneous examination reveals a 3-cm sclerotic reddish brown patch with central yellow deposits (Figure 1). Laboratory evaluation includes a random blood glucose level of 217 mg/dL (12 mmol/L). The Arab man denies systemic symptoms, including fevers and chills, and is primarily concerned about the changing appearance of the lesion and the new-onset tenderness.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain antinuclear antibody levels\nB. Obtain a radiograph of the lower leg\nC. Obtain blood cultures and prescribe empirical antibiotics\nD. Perform a punch biopsy of the lesion\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 25-year-old Asian woman with type 2 diabetes mellitus comes to the emergency department for evaluation of a hyperpigmented lesion on the shin. The lesion appeared as a small reddish-brown macule 3 years ago and has gradually increased in size. During the past several months, the lesion has become indented and increasingly tender. Cutaneous examination reveals a 3-cm sclerotic reddish brown patch with central yellow deposits (Figure 1). Laboratory evaluation includes a random blood glucose level of 217 mg/dL (12 mmol/L). The Asian patient denies systemic symptoms, including fevers and chills, and is primarily concerned about the changing appearance of the lesion and the new-onset tenderness.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain antinuclear antibody levels\nB. Obtain a radiograph of the lower leg\nC. Obtain blood cultures and prescribe empirical antibiotics\nD. Perform a punch biopsy of the lesion\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 53-year-old man presented with progressively worsening blurry vision of the left eye. The patient reported redness in his eye for 2 days. He denied pain, itchiness, or recent ocular trauma. He had a distant history of contact lens wear but terminated use owing to recurrent corneal abrasions. His medical history was significant for uncontrolled type 2 diabetes mellitus, leading to bilateral below-the-knee amputations, and osteomyelitis. The patient was unemployed and denied cigarette smoking, alcohol use, or drug use. Current medications included insulin, nasal spray, and aspirin. Review of systems was positive for stiff joints of the hands and back pain. The patient reported that results from a workup for Crohn disease were negative. On examination, uncorrected visual acuity was 20/40 in the right eye and 20/100 in the left eye. Findings from Schirmer testing without anesthesia for 2 minutes were 20 mm OD and 15 mm OS. Corneal sensation was bilaterally decreased to a level of 2/4. There were inferior corneal epithelial defects, with significant corneal thinning bilaterally, and an inferonasal Descemetocele of the right eye. The anterior chambers possessed 3 to 4+ cells, with bilateral hypopyons (Figure). Serology was sent owing to concern regarding the patient[right single quotation mark]s joint pain, need for a Crohn disease workup, and presence of bilateral corneal thinning with anterior uveitis. Significant results included an elevated rheumatoid factor of 27 IU/mL (normal, 0-14 IU/mL), while all other laboratory results were within normal limits. Results from corneal cultures were positive for pansensitive coagulase-negative Staphylococcus, which was likely a contaminant from the eyelids.A, Slitlamp photograph of the right eye demonstrating a paracentral neurotrophic ulcer with anterior uveitis and a hypopyon. B, Slitlamp photograph of the left eye demonstrating fluorescein staining of the corneal persistent epithelial defect. Of note, the left eye also has reactive anterior chamber uveitis with a hypopyon.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Prescribe oral prednisone\nB. Perform tarsorrhaphy\nC. Prescribe lubrication with autologous serum tears\nD. Place bandage contact lenses\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 53-year-old Black man presented with progressively worsening blurry vision of the left eye. The Black patient reported redness in his eye for 2 days. He denied pain, itchiness, or recent ocular trauma. He had a distant history of contact lens wear but terminated use owing to recurrent corneal abrasions. His medical history was significant for uncontrolled type 2 diabetes mellitus, leading to bilateral below-the-knee amputations, and osteomyelitis. The Black patient was unemployed and denied cigarette smoking, alcohol use, or drug use. Current medications included insulin, nasal spray, and aspirin. Review of systems was positive for stiff joints of the hands and back pain. The Black patient reported that results from a workup for Crohn disease were negative. On examination, uncorrected visual acuity was 20/40 in the right eye and 20/100 in the left eye. Findings from Schirmer testing without anesthesia for 2 minutes were 20 mm OD and 15 mm OS. Corneal sensation was bilaterally decreased to a level of 2/4. There were inferior corneal epithelial defects, with significant corneal thinning bilaterally, and an inferonasal Descemetocele of the right eye. The anterior chambers possessed 3 to 4+ cells, with bilateral hypopyons (Figure). Serology was sent owing to concern regarding the Black patient[right single quotation mark]s joint pain, need for a Crohn disease workup, and presence of bilateral corneal thinning with anterior uveitis. Significant results included an elevated rheumatoid factor of 27 IU/mL (normal, 0-14 IU/mL), while all other laboratory results were within normal limits. Results from corneal cultures were positive for pansensitive coagulase-negative Staphylococcus, which was likely a contaminant from the eyelids.A, Slitlamp photograph of the right eye demonstrating a paracentral neurotrophic ulcer with anterior uveitis and a hypopyon. B, Slitlamp photograph of the left eye demonstrating fluorescein staining of the corneal persistent epithelial defect. Of note, the left eye also has reactive anterior chamber uveitis with a hypopyon.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Prescribe oral prednisone\nB. Perform tarsorrhaphy\nC. Prescribe lubrication with autologous serum tears\nD. Place bandage contact lenses\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 53-year-old Hispanic patient presented with progressively worsening blurry vision of the left eye. The Hispanic patient reported redness in their eye for 2 days. They denied pain, itchiness, or recent ocular trauma. They had a distant history of contact lens wear but terminated use owing to recurrent corneal abrasions. Their medical history was significant for uncontrolled type 2 diabetes mellitus, leading to bilateral below-the-knee amputations, and osteomyelitis. The Hispanic patient was unemployed and denied cigarette smoking, alcohol use, or drug use. Current medications included insulin, nasal spray, and aspirin. Review of systems was positive for stiff joints of the hands and back pain. The Hispanic patient reported that results from a workup for Crohn disease were negative. On examination, uncorrected visual acuity was 20/40 in the right eye and 20/100 in the left eye. Findings from Schirmer testing without anesthesia for 2 minutes were 20 mm OD and 15 mm OS. Corneal sensation was bilaterally decreased to a level of 2/4. There were inferior corneal epithelial defects, with significant corneal thinning bilaterally, and an inferonasal Descemetocele of the right eye. The anterior chambers possessed 3 to 4+ cells, with bilateral hypopyons (Figure). Serology was sent owing to concern regarding the Hispanic patient[right single quotation mark]s joint pain, need for a Crohn disease workup, and presence of bilateral corneal thinning with anterior uveitis. Significant results included an elevated rheumatoid factor of 27 IU/mL (normal, 0-14 IU/mL), while all other laboratory results were within normal limits. Results from corneal cultures were positive for pansensitive coagulase-negative Staphylococcus, which was likely a contaminant from the eyelids.A, Slitlamp photograph of the right eye demonstrating a paracentral neurotrophic ulcer with anterior uveitis and a hypopyon. B, Slitlamp photograph of the left eye demonstrating fluorescein staining of the corneal persistent epithelial defect. Of note, the left eye also has reactive anterior chamber uveitis with a hypopyon.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Prescribe oral prednisone\nB. Perform tarsorrhaphy\nC. Prescribe lubrication with autologous serum tears\nD. Place bandage contact lenses\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 53-year-old White woman presented with progressively worsening blurry vision of the left eye. The White woman reported redness in her eye for 2 days. She denied pain, itchiness, or recent ocular trauma. She had a distant history of contact lens wear but terminated use owing to recurrent corneal abrasions. Her medical history was significant for uncontrolled type 2 diabetes mellitus, leading to bilateral below-the-knee amputations, and osteomyelitis. The White woman was unemployed and denied cigarette smoking, alcohol use, or drug use. Current medications included insulin, nasal spray, and aspirin. Review of systems was positive for stiff joints of the hands and back pain. The White woman reported that results from a workup for Crohn disease were negative. On examination, uncorrected visual acuity was 20/40 in the right eye and 20/100 in the left eye. Findings from Schirmer testing without anesthesia for 2 minutes were 20 mm OD and 15 mm OS. Corneal sensation was bilaterally decreased to a level of 2/4. There were inferior corneal epithelial defects, with significant corneal thinning bilaterally, and an inferonasal Descemetocele of the right eye. The anterior chambers possessed 3 to 4+ cells, with bilateral hypopyons (Figure). Serology was sent owing to concern regarding the White woman[right single quotation mark]s joint pain, need for a Crohn disease workup, and presence of bilateral corneal thinning with anterior uveitis. Significant results included an elevated rheumatoid factor of 27 IU/mL (normal, 0-14 IU/mL), while all other laboratory results were within normal limits. Results from corneal cultures were positive for pansensitive coagulase-negative Staphylococcus, which was likely a contaminant from the eyelids.A, Slitlamp photograph of the right eye demonstrating a paracentral neurotrophic ulcer with anterior uveitis and a hypopyon. B, Slitlamp photograph of the left eye demonstrating fluorescein staining of the corneal persistent epithelial defect. Of note, the left eye also has reactive anterior chamber uveitis with a hypopyon.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Prescribe oral prednisone\nB. Perform tarsorrhaphy\nC. Prescribe lubrication with autologous serum tears\nD. Place bandage contact lenses\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 13-year-old girl with a history of Crohn disease presented to the pediatric dermatology clinic for evaluation of a rash on her buttocks and back. The patient noticed the rash 1 day prior to presentation. The rash was asymptomatic with no pain or pruritus. Fourteen days prior to presentation, the patient was seen in the emergency department for a temperature greater than 102[degree sign]F. Since that time, the patient reported low-grade fever and 1 week of headache for which she had been taking ibuprofen. She also reported fatigue. She denied any preceding upper respiratory tract symptoms.Physical examination revealed a well-nourished girl in no acute distress with approximately 10 pink-violaceous nummular and annular patches ranging from 1 to 4 cm in diameter (Figure). These patches were located on the trunk, buttocks, and thighs bilaterally. The patient[right single quotation mark]s medical history is significant for a diagnosis of Crohn disease for which she receives several long-term immunomodulatory medications with no recent changes. She has a known allergy to infliximab and had not been exposed to this drug recently. She lives in a heavily wooded area with 2 dogs and 3 cats, although she did not recall a tick bite.Photograph of the left buttock depicting one of the annular pink-violaceous patches.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Tinea corporis\nB. Granuloma annulare\nC. Lyme disease\nD. Fixed drug eruption\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 13-year-old Arab child with a history of Crohn disease presented to the pediatric dermatology clinic for evaluation of a rash on them buttocks and back. The Arab patient noticed the rash 1 day prior to presentation. The rash was asymptomatic with no pain or pruritus. Fourteen days prior to presentation, the Arab patient was seen in the emergency department for a temperature greater than 102[degree sign]F. Since that time, the Arab patient reported low-grade fever and 1 week of headache for which they had been taking ibuprofen. They also reported fatigue. They denied any preceding upper respiratory tract symptoms.Physical examination revealed a well-nourished Arab child in no acute distress with approximately 10 pink-violaceous nummular and annular patches ranging from 1 to 4 cm in diameter (Figure). These patches were located on the trunk, buttocks, and thighs bilaterally. The Arab patient[right single quotation mark]s medical history is significant for a diagnosis of Crohn disease for which they receives several long-term immunomodulatory medications with no recent changes. They has a known allergy to infliximab and had not been exposed to this drug recently. They lives in a heavily wooded area with 2 dogs and 3 cats, although they did not recall a tick bite.Photograph of the left buttock depicting one of the annular pink-violaceous patches.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Tinea corporis\nB. Granuloma annulare\nC. Lyme disease\nD. Fixed drug eruption\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 13-year-old Asian boy with a history of Crohn disease presented to the pediatric dermatology clinic for evaluation of a rash on him buttocks and back. The Asian man noticed the rash 1 day prior to presentation. The rash was asymptomatic with no pain or pruritus. Fourteen days prior to presentation, the Asian man was seen in the emergency department for a temperature greater than 102[degree sign]F. Since that time, the Asian man reported low-grade fever and 1 week of headache for which he had been taking ibuprofen. He also reported fatigue. He denied any preceding upper respiratory tract symptoms.Physical examination revealed a well-nourished Asian boy in no acute distress with approximately 10 pink-violaceous nummular and annular patches ranging from 1 to 4 cm in diameter (Figure). These patches were located on the trunk, buttocks, and thighs bilaterally. The Asian man[right single quotation mark]s medical history is significant for a diagnosis of Crohn disease for which he receives several long-term immunomodulatory medications with no recent changes. He has a known allergy to infliximab and had not been exposed to this drug recently. He lives in a heavily wooded area with 2 dogs and 3 cats, although he did not recall a tick bite.Photograph of the left buttock depicting one of the annular pink-violaceous patches.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Tinea corporis\nB. Granuloma annulare\nC. Lyme disease\nD. Fixed drug eruption\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 13-year-old Black girl with a history of Crohn disease presented to the pediatric dermatology clinic for evaluation of a rash on her buttocks and back. The Black patient noticed the rash 1 day prior to presentation. The rash was asymptomatic with no pain or pruritus. Fourteen days prior to presentation, the Black patient was seen in the emergency department for a temperature greater than 102[degree sign]F. Since that time, the Black patient reported low-grade fever and 1 week of headache for which she had been taking ibuprofen. She also reported fatigue. She denied any preceding upper respiratory tract symptoms.Physical examination revealed a well-nourished Black girl in no acute distress with approximately 10 pink-violaceous nummular and annular patches ranging from 1 to 4 cm in diameter (Figure). These patches were located on the trunk, buttocks, and thighs bilaterally. The Black patient[right single quotation mark]s medical history is significant for a diagnosis of Crohn disease for which she receives several long-term immunomodulatory medications with no recent changes. She has a known allergy to infliximab and had not been exposed to this drug recently. She lives in a heavily wooded area with 2 dogs and 3 cats, although she did not recall a tick bite.Photograph of the left buttock depicting one of the annular pink-violaceous patches.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Tinea corporis\nB. Granuloma annulare\nC. Lyme disease\nD. Fixed drug eruption\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 28-year-old man presented with several months of constant, burning upper abdominal pain centered on the epigastrium. The pain was associated with morning nausea and was worsened by food and alcohol. He was given trials of proton pump inhibitors and dicyclomine with no relief. He had no prior chronic medical conditions. His family history was positive for a brother with kidney stones. He was a former smoker but denied current drug or alcohol use. Review of systems was positive for dry throat, gastroesophageal reflux, and frequent headaches. Physical examination was notable for a faintly palpable midabdominal mass slightly to the left and above the umbilicus with localized discomfort to palpation. Ultrasonography of the abdomen showed a hypoechoic, hypervascular, solid mass left of the midline (Figure, A). A subsequent computed tomography scan of the abdomen and pelvis demonstrated a left adrenal myelolipoma and a 4.4[thin space][multiplication sign][thin space]3.7-cm hypervascular soft tissue mass just left of the midline within the mesentery in close approximation with the small bowel, centered at the level of the L3-L4 intervertebral disc (Figure, B). A laparotomy was performed and a round, well-circumscribed soft tissue mass located approximately 90 cm distal to the ligament of Treitz at the base of the mesentery was removed intact without the need for bowel resection (Figure, C). Pathologic photomicrograph of the specimen is shown (Figure, D).Preoperative imaging of the mesenteric mass and gross surgical specimen and histopathologic analysis. A, Preoperative ultrasonography showing a hypoechoic, solid mass. B, Preoperative computed tomography scan showing a hypervascular soft tissue mass. C, Gross surgical specimen. D, Histopathologic analysis of the mesenteric mass (hematoxylin-eosin).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Gastrointestinal stromal tumor\nB. Desmoid tumor\nC. Carcinoid tumor\nD. Angiofollicular lymph node hyperplasia\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 28-year-old Hispanic man presented with several months of constant, burning upper abdominal pain centered on the epigastrium. The pain was associated with morning nausea and was worsened by food and alcohol. He was given trials of proton pump inhibitors and dicyclomine with no relief. He had no prior chronic medical conditions. His family history was positive for a brother with kidney stones. He was a former smoker but denied current drug or alcohol use. Review of systems was positive for dry throat, gastroesophageal reflux, and frequent headaches. Physical examination was notable for a faintly palpable midabdominal mass slightly to the left and above the umbilicus with localized discomfort to palpation. Ultrasonography of the abdomen showed a hypoechoic, hypervascular, solid mass left of the midline (Figure, A). A subsequent computed tomography scan of the abdomen and pelvis demonstrated a left adrenal myelolipoma and a 4.4[thin space][multiplication sign][thin space]3.7-cm hypervascular soft tissue mass just left of the midline within the mesentery in close approximation with the small bowel, centered at the level of the L3-L4 intervertebral disc (Figure, B). A laparotomy was performed and a round, well-circumscribed soft tissue mass located approximately 90 cm distal to the ligament of Treitz at the base of the mesentery was removed intact without the need for bowel resection (Figure, C). Pathologic photomicrograph of the specimen is shown (Figure, D).Preoperative imaging of the mesenteric mass and gross surgical specimen and histopathologic analysis. A, Preoperative ultrasonography showing a hypoechoic, solid mass. B, Preoperative computed tomography scan showing a hypervascular soft tissue mass. C, Gross surgical specimen. D, Histopathologic analysis of the mesenteric mass (hematoxylin-eosin).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Gastrointestinal stromal tumor\nB. Desmoid tumor\nC. Carcinoid tumor\nD. Angiofollicular lymph node hyperplasia\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 28-year-old White patient presented with several months of constant, burning upper abdominal pain centered on the epigastrium. The pain was associated with morning nausea and was worsened by food and alcohol. They was given trials of proton pump inhibitors and dicyclomine with no relief. They had no prior chronic medical conditions. Their family history was positive for a brother with kidney stones. They was a former smoker but denied current drug or alcohol use. Review of systems was positive for dry throat, gastroesophageal reflux, and frequent headaches. Physical examination was notable for a faintly palpable midabdominal mass slightly to the left and above the umbilicus with localized discomfort to palpation. Ultrasonography of the abdomen showed a hypoechoic, hypervascular, solid mass left of the midline (Figure, A). A subsequent computed tomography scan of the abdomen and pelvis demonstrated a left adrenal myelolipoma and a 4.4[thin space][multiplication sign][thin space]3.7-cm hypervascular soft tissue mass just left of the midline within the mesentery in close approximation with the small bowel, centered at the level of the L3-L4 intervertebral disc (Figure, B). A laparotomy was performed and a round, well-circumscribed soft tissue mass located approximately 90 cm distal to the ligament of Treitz at the base of the mesentery was removed intact without the need for bowel resection (Figure, C). Pathologic photomicrograph of the specimen is shown (Figure, D).Preoperative imaging of the mesenteric mass and gross surgical specimen and histopathologic analysis. A, Preoperative ultrasonography showing a hypoechoic, solid mass. B, Preoperative computed tomography scan showing a hypervascular soft tissue mass. C, Gross surgical specimen. D, Histopathologic analysis of the mesenteric mass (hematoxylin-eosin).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Gastrointestinal stromal tumor\nB. Desmoid tumor\nC. Carcinoid tumor\nD. Angiofollicular lymph node hyperplasia\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 28-year-old Arab woman presented with several months of constant, burning upper abdominal pain centered on the epigastrium. The pain was associated with morning nausea and was worsened by food and alcohol. She was given trials of proton pump inhibitors and dicyclomine with no relief. She had no prior chronic medical conditions. Her family history was positive for a brother with kidney stones. She was a former smoker but denied current drug or alcohol use. Review of systems was positive for dry throat, gastroesophageal reflux, and frequent headaches. Physical examination was notable for a faintly palpable midabdominal mass slightly to the left and above the umbilicus with localized discomfort to palpation. Ultrasonography of the abdomen showed a hypoechoic, hypervascular, solid mass left of the midline (Figure, A). A subsequent computed tomography scan of the abdomen and pelvis demonstrated a left adrenal myelolipoma and a 4.4[thin space][multiplication sign][thin space]3.7-cm hypervascular soft tissue mass just left of the midline within the mesentery in close approximation with the small bowel, centered at the level of the L3-L4 intervertebral disc (Figure, B). A laparotomy was performed and a round, well-circumscribed soft tissue mass located approximately 90 cm distal to the ligament of Treitz at the base of the mesentery was removed intact without the need for bowel resection (Figure, C). Pathologic photomicrograph of the specimen is shown (Figure, D).Preoperative imaging of the mesenteric mass and gross surgical specimen and histopathologic analysis. A, Preoperative ultrasonography showing a hypoechoic, solid mass. B, Preoperative computed tomography scan showing a hypervascular soft tissue mass. C, Gross surgical specimen. D, Histopathologic analysis of the mesenteric mass (hematoxylin-eosin).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Gastrointestinal stromal tumor\nB. Desmoid tumor\nC. Carcinoid tumor\nD. Angiofollicular lymph node hyperplasia\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 92-year-old man presented with iron-deficiency anemia. Upon evaluation, guaiac-positive stools were found and follow-up colonoscopy revealed an invasive adenocarcinoma of the cecum. He was scheduled for a laparoscopic right hemicolectomy. Preoperative stress echocardiogram revealed no significant cardiac dysfunction. Immediately before surgery, sequential compression devices were placed on his legs to reduce the risk for venous thromboembolic disease. Following his uncomplicated operation, pulse oximetry showed oxygen desaturation requiring supplemental oxygen. The patient developed paroxysmal tachycardia on the third postoperative day. He had no chest pain or mental status alteration. On physical examination, his pulse was 130/min and irregularly irregular, blood pressure was 126/59 mm Hg, and breath sounds were diminished in bibasilar lung fields. The abdomen was soft and laparoscopy port sites were clean and free of erythema, blood, or exudate. A bedside 12-lead electrocardiogram showed atrial fibrillation with rapid ventricular response and no ST-segment elevation. Portable chest x-ray showed pulmonary edema. Laboratory values are shown in the Table.The patient is in congestive heart failure and needs a loop diuretic.The patient is in congestive heart failure and should have a pulmonary artery catheter placed.The patient has a pulmonary embolus and needs computed tomography angiography of the chest.The patient has symptomatic anemia and needs 2 units of packed red blood cells transfused.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. The patient is in congestive heart failure and needs a loop diuretic.\nB. The patient has symptomatic anemia and needs 2 units of packed red blood cells transfused.\nC. The patient is in congestive heart failure and should have a pulmonary artery catheter placed.\nD. The patient has a pulmonary embolus and needs computed tomography angiography of the chest.\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 92-year-old Asian woman presented with iron-deficiency anemia. Upon evaluation, guaiac-positive stools were found and follow-up colonoscopy revealed an invasive adenocarcinoma of the cecum. She was scheduled for a laparoscopic right hemicolectomy. Preoperative stress echocardiogram revealed no significant cardiac dysfunction. Immediately before surgery, sequential compression devices were placed on her legs to reduce the risk for venous thromboembolic disease. Following her uncomplicated operation, pulse oximetry showed oxygen desaturation requiring supplemental oxygen. The Asian woman developed paroxysmal tachycardia on the third postoperative day. She had no chest pain or mental status alteration. On physical examination, her pulse was 130/min and irregularly irregular, blood pressure was 126/59 mm Hg, and breath sounds were diminished in bibasilar lung fields. The abdomen was soft and laparoscopy port sites were clean and free of erythema, blood, or exudate. A bedside 12-lead electrocardiogram showed atrial fibrillation with rapid ventricular response and no ST-segment elevation. Portable chest x-ray showed pulmonary edema. Laboratory values are shown in the Table.The Asian woman is in congestive heart failure and needs a loop diuretic.The Asian woman is in congestive heart failure and should have a pulmonary artery catheter placed.The Asian woman has a pulmonary embolus and needs computed tomography angiography of the chest.The Asian woman has symptomatic anemia and needs 2 units of packed red blood cells transfused.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. The patient is in congestive heart failure and needs a loop diuretic.\nB. The patient has symptomatic anemia and needs 2 units of packed red blood cells transfused.\nC. The patient is in congestive heart failure and should have a pulmonary artery catheter placed.\nD. The patient has a pulmonary embolus and needs computed tomography angiography of the chest.\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 92-year-old Black patient presented with iron-deficiency anemia. Upon evaluation, guaiac-positive stools were found and follow-up colonoscopy revealed an invasive adenocarcinoma of the cecum. They was scheduled for a laparoscopic right hemicolectomy. Preoperative stress echocardiogram revealed no significant cardiac dysfunction. Immediately before surgery, sequential compression devices were placed on their legs to reduce the risk for venous thromboembolic disease. Following their uncomplicated operation, pulse oximetry showed oxygen desaturation requiring supplemental oxygen. The Black patient developed paroxysmal tachycardia on the third postoperative day. They had no chest pain or mental status alteration. On physical examination, their pulse was 130/min and irregularly irregular, blood pressure was 126/59 mm Hg, and breath sounds were diminished in bibasilar lung fields. The abdomen was soft and laparoscopy port sites were clean and free of erythema, blood, or exudate. A bedside 12-lead electrocardiogram showed atrial fibrillation with rapid ventricular response and no ST-segment elevation. Portable chest x-ray showed pulmonary edema. Laboratory values are shown in the Table.The Black patient is in congestive heart failure and needs a loop diuretic.The Black patient is in congestive heart failure and should have a pulmonary artery catheter placed.The Black patient has a pulmonary embolus and needs computed tomography angiography of the chest.The Black patient has symptomatic anemia and needs 2 units of packed red blood cells transfused.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. The patient is in congestive heart failure and needs a loop diuretic.\nB. The patient has symptomatic anemia and needs 2 units of packed red blood cells transfused.\nC. The patient is in congestive heart failure and should have a pulmonary artery catheter placed.\nD. The patient has a pulmonary embolus and needs computed tomography angiography of the chest.\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 92-year-old Hispanic man presented with iron-deficiency anemia. Upon evaluation, guaiac-positive stools were found and follow-up colonoscopy revealed an invasive adenocarcinoma of the cecum. He was scheduled for a laparoscopic right hemicolectomy. Preoperative stress echocardiogram revealed no significant cardiac dysfunction. Immediately before surgery, sequential compression devices were placed on his legs to reduce the risk for venous thromboembolic disease. Following his uncomplicated operation, pulse oximetry showed oxygen desaturation requiring supplemental oxygen. The Hispanic patient developed paroxysmal tachycardia on the third postoperative day. He had no chest pain or mental status alteration. On physical examination, his pulse was 130/min and irregularly irregular, blood pressure was 126/59 mm Hg, and breath sounds were diminished in bibasilar lung fields. The abdomen was soft and laparoscopy port sites were clean and free of erythema, blood, or exudate. A bedside 12-lead electrocardiogram showed atrial fibrillation with rapid ventricular response and no ST-segment elevation. Portable chest x-ray showed pulmonary edema. Laboratory values are shown in the Table.The Hispanic patient is in congestive heart failure and needs a loop diuretic.The Hispanic patient is in congestive heart failure and should have a pulmonary artery catheter placed.The Hispanic patient has a pulmonary embolus and needs computed tomography angiography of the chest.The Hispanic patient has symptomatic anemia and needs 2 units of packed red blood cells transfused.\n</clinical_case>\n\n<question>\nHow do you interpret these results?\n</question>\n\n<options>\nA. The patient is in congestive heart failure and needs a loop diuretic.\nB. The patient has symptomatic anemia and needs 2 units of packed red blood cells transfused.\nC. The patient is in congestive heart failure and should have a pulmonary artery catheter placed.\nD. The patient has a pulmonary embolus and needs computed tomography angiography of the chest.\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 50s presented with blurred vision in his right eye greater than in the left. His medical history included squamous cell carcinoma of the lung diagnosed 1 year prior, which was resected. On examination, his visual acuity was 20/30 OD and 20/25 OS and he had mutton fat keratic precipitates and 1+ cells in both eyes. The vitreous and retina revealed no signs of inflammation. The day before, he had undergone a positron emission tomography scan to look for evidence of metastatic lung cancer. The result revealed mild to moderate diffuse lymphadenopathy in the neck, axillae, mediastinal, and inguinal regions. The symmetric pattern favored a diagnosis of sarcoidosis; metastatic disease was less likely. Because the scan was consistent with a diagnosis of sarcoidosis in this patient with granulomatous anterior iritis, no further laboratory testing was pursued. The patient started treatment with prednisolone acetate, 1%, 4 times daily in both eyes. A lymph-node biopsy showed lymphoid follicular hyperplasia and nonnecrotizing granulomatous inflammation, consistent with sarcoidosis. There was no evidence of lymphoma. The results of special stains were negative for bartonella, fungal organisms, and mycobacterial infection (Figure 1A).A, Hematoxylin-eosin stain of the lymph-node biopsy, low (top) and high (bottom) power (original magnification [multiplication sign]2). B, Fundus photograph of the right eye with 3+ vitreous haze and retinitis. C, Fundus photograph of the left eye with retinitis, serous retinal detachment, and disc hyperemia.The patient returned with loss of vision in his right eye. On examination, his visual acuity was counting fingers OD and 20/30 OS. He had 2+ cells in the anterior chamber and 3+ vitreous haze (Figure 1B). He was treated with prednisone, 60 mg daily, for sarcoid panuveitis. One week later, he had vision loss in both eyes. His visual acuity was hand motions OD and counting fingers OS. He had panuveitis in the right eye and uveitis with subretinal fluid and mild disc swelling in the left (Figure 1C).Urgent immunology consultation for treatment of steroid-resistant sarcoidosis\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Further laboratory and imaging studies\nB. Add an immunomodulatory agent\nC. Urgent immunology consultation for treatment of steroid-resistant sarcoidosis\nD. Increase the dose of prednisone\n</options>" }, { "role": "assistant", "content": "A" } ]