Datasets:

kenza-ily

/

ft_llama3_mcq_v5

like 0

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA White woman in her 50s presented with blurred vision in her right eye greater than in the left. Her medical history included squamous cell carcinoma of the lung diagnosed 1 year prior, which was resected. On examination, her visual acuity was 20/30 OD and 20/25 OS and she had mutton fat keratic precipitates and 1+ cells in both eyes. The vitreous and retina revealed no signs of inflammation. The day before, she 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 White woman with granulomatous anterior iritis, no further laboratory testing was pursued. The White woman 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 White woman returned with loss of vision in her right eye. On examination, her visual acuity was counting fingers OD and 20/30 OS. She had 2+ cells in the anterior chamber and 3+ vitreous haze (Figure 1B). She was treated with prednisone, 60 mg daily, for sarcoid panuveitis. One week later, she had vision loss in both eyes. Her visual acuity was hand motions OD and counting fingers OS. She 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" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow 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 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 Arab patient with granulomatous anterior iritis, no further laboratory testing was pursued. The Arab 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 Arab 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" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Asian patient in their 50s presented with blurred vision in their right eye greater than in the left. Their medical history included squamous cell carcinoma of the lung diagnosed 1 year prior, which was resected. On examination, their visual acuity was 20/30 OD and 20/25 OS and they had mutton fat keratic precipitates and 1+ cells in both eyes. The vitreous and retina revealed no signs of inflammation. The day before, they 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 Asian patient with granulomatous anterior iritis, no further laboratory testing was pursued. The Asian 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 Asian patient returned with loss of vision in their right eye. On examination, their visual acuity was counting fingers OD and 20/30 OS. They had 2+ cells in the anterior chamber and 3+ vitreous haze (Figure 1B). They was treated with prednisone, 60 mg daily, for sarcoid panuveitis. One week later, they had vision loss in both eyes. Their visual acuity was hand motions OD and counting fingers OS. They 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" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will 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 8-year-old otherwise healthy boy presented with a yellow-orange, rough nodule on his medial right thigh (Figure 1). It had evolved from a flat discoloration since the age of 3 years, which continued to slowly enlarge and thicken. The patient denied spontaneous bleeding or ulceration, and he had full range of motion and use of his extremity. Neither he nor his family members reported a history of similar lesions on their body. He did not take any medications, had never been hospitalized, and had never had any major surgical procedures. His upper and lower extremities were otherwise normal. On inspection, there was a 4.5 cm[thin space][multiplication sign][thin space]3.5 cm, verrucous plaque with underlying fullness on the right medial thigh. There were also punctate vessels evident on the hyperkeratotic surface.Close-up of lesion at presentation. A verrucous, vascular plaque with underlying fullness on the right medial thigh. There were also punctate vessels evident on the hyperkeratotic surface.Ultrasonography or magnetic resonance imaging (MRI) allowing for characterization of the lesion and its extentShave biopsy that would confirm squamous cell carcinomaImmediate excision that would permanently resolve the lesionNo treatment or diagnostic tests are necessary at this timeLiquid nitrogen treatment that would destroy culprit cells and is less invasive than excision\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Immediate excision that would permanently resolve the lesion\nB. Ultrasonography or magnetic resonance imaging (MRI) allowing for characterization of the lesion and its extent\nC. Shave biopsy that would confirm squamous cell carcinoma\nD. No treatment or diagnostic tests are necessary at this time\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 8-year-old otherwise healthy Black child presented with a yellow-orange, rough nodule on their medial right thigh (Figure 1). It had evolved from a flat discoloration since the age of 3 years, which continued to slowly enlarge and thicken. The Black patient denied spontaneous bleeding or ulceration, and they had full range of motion and use of their extremity. Neither they nor their family members reported a history of similar lesions on their body. They did not take any medications, had never been hospitalized, and had never had any major surgical procedures. Their upper and lower extremities were otherwise normal. On inspection, there was a 4.5 cm[thin space][multiplication sign][thin space]3.5 cm, verrucous plaque with underlying fullness on the right medial thigh. There were also punctate vessels evident on the hyperkeratotic surface.Close-up of lesion at presentation. A verrucous, vascular plaque with underlying fullness on the right medial thigh. There were also punctate vessels evident on the hyperkeratotic surface.Ultrasonography or magnetic resonance imaging (MRI) allowing for characterization of the lesion and its extentShave biopsy that would confirm squamous cell carcinomaImmediate excision that would permanently resolve the lesionNo treatment or diagnostic tests are necessary at this timeLiquid nitrogen treatment that would destroy culprit cells and is less invasive than excision\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Immediate excision that would permanently resolve the lesion\nB. Ultrasonography or magnetic resonance imaging (MRI) allowing for characterization of the lesion and its extent\nC. Shave biopsy that would confirm squamous cell carcinoma\nD. No treatment or diagnostic tests are necessary at this time\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 8-year-old otherwise healthy Hispanic boy presented with a yellow-orange, rough nodule on his medial right thigh (Figure 1). It had evolved from a flat discoloration since the age of 3 years, which continued to slowly enlarge and thicken. The Hispanic patient denied spontaneous bleeding or ulceration, and he had full range of motion and use of his extremity. Neither he nor his family members reported a history of similar lesions on their body. He did not take any medications, had never been hospitalized, and had never had any major surgical procedures. His upper and lower extremities were otherwise normal. On inspection, there was a 4.5 cm[thin space][multiplication sign][thin space]3.5 cm, verrucous plaque with underlying fullness on the right medial thigh. There were also punctate vessels evident on the hyperkeratotic surface.Close-up of lesion at presentation. A verrucous, vascular plaque with underlying fullness on the right medial thigh. There were also punctate vessels evident on the hyperkeratotic surface.Ultrasonography or magnetic resonance imaging (MRI) allowing for characterization of the lesion and its extentShave biopsy that would confirm squamous cell carcinomaImmediate excision that would permanently resolve the lesionNo treatment or diagnostic tests are necessary at this timeLiquid nitrogen treatment that would destroy culprit cells and is less invasive than excision\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Immediate excision that would permanently resolve the lesion\nB. Ultrasonography or magnetic resonance imaging (MRI) allowing for characterization of the lesion and its extent\nC. Shave biopsy that would confirm squamous cell carcinoma\nD. No treatment or diagnostic tests are necessary at this time\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 8-year-old otherwise healthy White girl presented with a yellow-orange, rough nodule on her medial right thigh (Figure 1). It had evolved from a flat discoloration since the age of 3 years, which continued to slowly enlarge and thicken. The White woman denied spontaneous bleeding or ulceration, and she had full range of motion and use of her extremity. Neither she nor her family members reported a history of similar lesions on their body. She did not take any medications, had never been hospitalized, and had never had any major surgical procedures. Her upper and lower extremities were otherwise normal. On inspection, there was a 4.5 cm[thin space][multiplication sign][thin space]3.5 cm, verrucous plaque with underlying fullness on the right medial thigh. There were also punctate vessels evident on the hyperkeratotic surface.Close-up of lesion at presentation. A verrucous, vascular plaque with underlying fullness on the right medial thigh. There were also punctate vessels evident on the hyperkeratotic surface.Ultrasonography or magnetic resonance imaging (MRI) allowing for characterization of the lesion and its extentShave biopsy that would confirm squamous cell carcinomaImmediate excision that would permanently resolve the lesionNo treatment or diagnostic tests are necessary at this timeLiquid nitrogen treatment that would destroy culprit cells and is less invasive than excision\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Immediate excision that would permanently resolve the lesion\nB. Ultrasonography or magnetic resonance imaging (MRI) allowing for characterization of the lesion and its extent\nC. Shave biopsy that would confirm squamous cell carcinoma\nD. No treatment or diagnostic tests are necessary at this time\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 52-year-old man presented with a 2-day history of nausea and low-grade fever to a local hospital. He had a history of simultaneous pancreas-kidney transplantation 15 years ago and both grafts had been functioning well. Two days prior to presentation, he had a peripheral angiogram done to evaluate a nonhealing left foot ulcer by an interventional cardiologist, at which time a stent graft was deployed to the right common iliac artery for a pseudoaneurysm that was incidentally discovered. On examination, he was in no distress, had a temperature of 37[degree sign] C, and blood pressure of 91/44 mm Hg. Two days after presentation, a computed tomographic scan of the abdomen and pelvis was obtained (Figure). It showed an air-containing abscess and a stent in the common iliac artery.A stent can be seen in the right common iliac artery (A and C, arrowheads). A gas-containing phlegmon was also evident (B and C, asterisks).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Cecal inflammation with abscess\nB. Ruptured acute appendicitis\nC. Iatrogenic pancreas transplant thrombosis\nD. Hematoma\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 52-year-old Arab patient presented with a 2-day history of nausea and low-grade fever to a local hospital. They had a history of simultaneous pancreas-kidney transplantation 15 years ago and both grafts had been functioning well. Two days prior to presentation, they had a peripheral angiogram done to evaluate a nonhealing left foot ulcer by an interventional cardiologist, at which time a stent graft was deployed to the right common iliac artery for a pseudoaneurysm that was incidentally discovered. On examination, they was in no distress, had a temperature of 37[degree sign] C, and blood pressure of 91/44 mm Hg. Two days after presentation, a computed tomographic scan of the abdomen and pelvis was obtained (Figure). It showed an air-containing abscess and a stent in the common iliac artery.A stent can be seen in the right common iliac artery (A and C, arrowheads). A gas-containing phlegmon was also evident (B and C, asterisks).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Cecal inflammation with abscess\nB. Ruptured acute appendicitis\nC. Iatrogenic pancreas transplant thrombosis\nD. Hematoma\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 52-year-old Asian woman presented with a 2-day history of nausea and low-grade fever to a local hospital. She had a history of simultaneous pancreas-kidney transplantation 15 years ago and both grafts had been functioning well. Two days prior to presentation, she had a peripheral angiogram done to evaluate a nonhealing left foot ulcer by an interventional cardiologist, at which time a stent graft was deployed to the right common iliac artery for a pseudoaneurysm that was incidentally discovered. On examination, she was in no distress, had a temperature of 37[degree sign] C, and blood pressure of 91/44 mm Hg. Two days after presentation, a computed tomographic scan of the abdomen and pelvis was obtained (Figure). It showed an air-containing abscess and a stent in the common iliac artery.A stent can be seen in the right common iliac artery (A and C, arrowheads). A gas-containing phlegmon was also evident (B and C, asterisks).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Cecal inflammation with abscess\nB. Ruptured acute appendicitis\nC. Iatrogenic pancreas transplant thrombosis\nD. Hematoma\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 52-year-old Black man presented with a 2-day history of nausea and low-grade fever to a local hospital. He had a history of simultaneous pancreas-kidney transplantation 15 years ago and both grafts had been functioning well. Two days prior to presentation, he had a peripheral angiogram done to evaluate a nonhealing left foot ulcer by an interventional cardiologist, at which time a stent graft was deployed to the right common iliac artery for a pseudoaneurysm that was incidentally discovered. On examination, he was in no distress, had a temperature of 37[degree sign] C, and blood pressure of 91/44 mm Hg. Two days after presentation, a computed tomographic scan of the abdomen and pelvis was obtained (Figure). It showed an air-containing abscess and a stent in the common iliac artery.A stent can be seen in the right common iliac artery (A and C, arrowheads). A gas-containing phlegmon was also evident (B and C, asterisks).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Cecal inflammation with abscess\nB. Ruptured acute appendicitis\nC. Iatrogenic pancreas transplant thrombosis\nD. Hematoma\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 man presents with a slowly enlarging growth in his mouth that appeared more than 20 years ago. He denies pain and discomfort but is concerned because the mass has increased in size during the past year. He does not wear dentures and denies trauma, use of tobacco products, poor nutrition, and risky sexual practices. Family history is noncontributory. Physical examination reveals a healthy appearing male with a nontender, symmetric, nodular bony protuberance on the midline of the hard palate. Two prominent protuberances are also noted at the bilateral maxillary tuberosities (Figure). The remainder of the examination is unremarkable.Obtain a computed tomography scan of the headRefer the patient to an oral surgeon for evaluation and full-mouth dental x-rays\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Refer the patient to an oral surgeon for evaluation and full-mouth dental x-rays\nB. Do not intervene; the condition is benign\nC. Obtain a computed tomography scan of the head\nD. Perform a biopsy of the lesion\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 66-year-old Hispanic woman presents with a slowly enlarging growth in her mouth that appeared more than 20 years ago. She denies pain and discomfort but is concerned because the mass has increased in size during the past year. She does not wear dentures and denies trauma, use of tobacco products, poor nutrition, and risky sexual practices. Family history is noncontributory. Physical examination reveals a healthy appearing Hispanic female with a nontender, symmetric, nodular bony protuberance on the midline of the hard palate. Two prominent protuberances are also noted at the bilateral maxillary tuberosities (Figure). The remainder of the examination is unremarkable.Obtain a computed tomography scan of the headRefer the Hispanic woman to an oral surgeon for evaluation and full-mouth dental x-rays\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Refer the patient to an oral surgeon for evaluation and full-mouth dental x-rays\nB. Do not intervene; the condition is benign\nC. Obtain a computed tomography scan of the head\nD. Perform a biopsy of the lesion\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 66-year-old White man presents with a slowly enlarging growth in his mouth that appeared more than 20 years ago. He denies pain and discomfort but is concerned because the mass has increased in size during the past year. He does not wear dentures and denies trauma, use of tobacco products, poor nutrition, and risky sexual practices. Family history is noncontributory. Physical examination reveals a healthy appearing White male with a nontender, symmetric, nodular bony protuberance on the midline of the hard palate. Two prominent protuberances are also noted at the bilateral maxillary tuberosities (Figure). The remainder of the examination is unremarkable.Obtain a computed tomography scan of the headRefer the White patient to an oral surgeon for evaluation and full-mouth dental x-rays\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Refer the patient to an oral surgeon for evaluation and full-mouth dental x-rays\nB. Do not intervene; the condition is benign\nC. Obtain a computed tomography scan of the head\nD. Perform a biopsy of the lesion\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 66-year-old Arab patient presents with a slowly enlarging growth in their mouth that appeared more than 20 years ago. They denies pain and discomfort but is concerned because the mass has increased in size during the past year. They does not wear dentures and denies trauma, use of tobacco products, poor nutrition, and risky sexual practices. Family history is noncontributory. Physical examination reveals a healthy appearing Arab person with a nontender, symmetric, nodular bony protuberance on the midline of the hard palate. Two prominent protuberances are also noted at the bilateral maxillary tuberosities (Figure). The remainder of the examination is unremarkable.Obtain a computed tomography scan of the headRefer the Arab patient to an oral surgeon for evaluation and full-mouth dental x-rays\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Refer the patient to an oral surgeon for evaluation and full-mouth dental x-rays\nB. Do not intervene; the condition is benign\nC. Obtain a computed tomography scan of the head\nD. Perform a biopsy of the lesion\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 9-week-old girl had a rash on her back that had been present for 7 weeks. The rash was asymptomatic and started as red bumps that then evolved into pustules and blisters. On further questioning, it was discovered that the patient[right single quotation mark]s father worked in a nursing home that had experienced a recent outbreak of scabies. Shortly after the onset of the outbreak, the patient and all family members were treated with 2 once-weekly doses of permethrin, 5%, cream. All other family members had significant improvement with the treatment; however, our patient[right single quotation mark]s lesions continued to worsen during the subsequent 2 weeks. On physical examination, the patient had numerous erythematous macules, papules, and pustules on her back. Many of the lesions had superimposed hemorrhagic crust and surrounding scale. In addition, several grouped papules were noted, including some in a linear array (Figure 1A and B). The rest of her cutaneous examination results were unremarkable except for a few fading pink papules noted on her left abdomen (Figure 1C).Numerous erythematous papules and pustules on the back, many with overlying hemorrhagic crust and surrounding scale (A) and (B), and few erythematous papules on the left lower abdomen (C).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Contact dermatitis\nB. Scabies\nC. Postscabetic acropustulosis\nD. Langerhans cell histiocytosis\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 9-week-old Asian boy had a rash on him back that had been present for 7 weeks. The rash was asymptomatic and started as red bumps that then evolved into pustules and blisters. On further questioning, it was discovered that the Asian man[right single quotation mark]s father worked in a nursing home that had experienced a recent outbreak of scabies. Shortly after the onset of the outbreak, the Asian man and all family members were treated with 2 once-weekly doses of permethrin, 5%, cream. All other family members had significant improvement with the treatment; however, our Asian man[right single quotation mark]s lesions continued to worsen during the subsequent 2 weeks. On physical examination, the Asian man had numerous erythematous macules, papules, and pustules on him back. Many of the lesions had superimposed hemorrhagic crust and surrounding scale. In addition, several grouped papules were noted, including some in a linear array (Figure 1A and B). The rest of him cutaneous examination results were unremarkable except for a few fading pink papules noted on him left abdomen (Figure 1C).Numerous erythematous papules and pustules on the back, many with overlying hemorrhagic crust and surrounding scale (A) and (B), and few erythematous papules on the left lower abdomen (C).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Contact dermatitis\nB. Scabies\nC. Postscabetic acropustulosis\nD. Langerhans cell histiocytosis\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 9-week-old Black girl had a rash on her back that had been present for 7 weeks. The rash was asymptomatic and started as red bumps that then evolved into pustules and blisters. On further questioning, it was discovered that the Black patient[right single quotation mark]s father worked in a nursing home that had experienced a recent outbreak of scabies. Shortly after the onset of the outbreak, the Black patient and all family members were treated with 2 once-weekly doses of permethrin, 5%, cream. All other family members had significant improvement with the treatment; however, our Black patient[right single quotation mark]s lesions continued to worsen during the subsequent 2 weeks. On physical examination, the Black patient had numerous erythematous macules, papules, and pustules on her back. Many of the lesions had superimposed hemorrhagic crust and surrounding scale. In addition, several grouped papules were noted, including some in a linear array (Figure 1A and B). The rest of her cutaneous examination results were unremarkable except for a few fading pink papules noted on her left abdomen (Figure 1C).Numerous erythematous papules and pustules on the back, many with overlying hemorrhagic crust and surrounding scale (A) and (B), and few erythematous papules on the left lower abdomen (C).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Contact dermatitis\nB. Scabies\nC. Postscabetic acropustulosis\nD. Langerhans cell histiocytosis\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 9-week-old Hispanic child had a rash on them back that had been present for 7 weeks. The rash was asymptomatic and started as red bumps that then evolved into pustules and blisters. On further questioning, it was discovered that the Hispanic patient[right single quotation mark]s father worked in a nursing home that had experienced a recent outbreak of scabies. Shortly after the onset of the outbreak, the Hispanic patient and all family members were treated with 2 once-weekly doses of permethrin, 5%, cream. All other family members had significant improvement with the treatment; however, our Hispanic patient[right single quotation mark]s lesions continued to worsen during the subsequent 2 weeks. On physical examination, the Hispanic patient had numerous erythematous macules, papules, and pustules on them back. Many of the lesions had superimposed hemorrhagic crust and surrounding scale. In addition, several grouped papules were noted, including some in a linear array (Figure 1A and B). The rest of them cutaneous examination results were unremarkable except for a few fading pink papules noted on them left abdomen (Figure 1C).Numerous erythematous papules and pustules on the back, many with overlying hemorrhagic crust and surrounding scale (A) and (B), and few erythematous papules on the left lower abdomen (C).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Contact dermatitis\nB. Scabies\nC. Postscabetic acropustulosis\nD. Langerhans cell histiocytosis\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 56-year-old woman with a history of cirrhosis secondary to hepatitis C (diagnosed in 2011), hypothyroidism, and anemia presented with 6 months of blurred vision in both eyes. Her home medication regimen consisted of ribavirin, rifaximin, lactulose, furosemide, spironolactone, peginterferon alfa-2a, and levothyroxine sodium. Corrected visual acuity was recorded as 20/40 OU. Her pupils, intraocular pressure, motility, and confrontational visual fields were normal in each eye. Anterior slitlamp examination demonstrated mild nuclear sclerotic cataracts in both eyes. Dilated fundus examination (Figure 1) demonstrated multiple peripapillary and macular cotton-wool spots in both eyes, dot hemorrhages in both eyes, peripapillary flame hemorrhage in the right eye, and a disc hemorrhage in the left eye.Fundus photograph of the patient[right single quotation mark]s right eye at presentation.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Discontinue interferon therapy\nB. Check hemoglobin A1c level\nC. Contact patient[right single quotation mark]s hepatologist\nD. Check for hypertension\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 56-year-old White woman with a history of cirrhosis secondary to hepatitis C (diagnosed in 2011), hypothyroidism, and anemia presented with 6 months of blurred vision in both eyes. Her home medication regimen consisted of ribavirin, rifaximin, lactulose, furosemide, spironolactone, peginterferon alfa-2a, and levothyroxine sodium. Corrected visual acuity was recorded as 20/40 OU. Her pupils, intraocular pressure, motility, and confrontational visual fields were normal in each eye. Anterior slitlamp examination demonstrated mild nuclear sclerotic cataracts in both eyes. Dilated fundus examination (Figure 1) demonstrated multiple peripapillary and macular cotton-wool spots in both eyes, dot hemorrhages in both eyes, peripapillary flame hemorrhage in the right eye, and a disc hemorrhage in the left eye.Fundus photograph of the White patient[right single quotation mark]s right eye at presentation.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Discontinue interferon therapy\nB. Check hemoglobin A1c level\nC. Contact patient[right single quotation mark]s hepatologist\nD. Check for hypertension\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 56-year-old Arab patient with a history of cirrhosis secondary to hepatitis C (diagnosed in 2011), hypothyroidism, and anemia presented with 6 months of blurred vision in both eyes. Them home medication regimen consisted of ribavirin, rifaximin, lactulose, furosemide, spironolactone, peginterferon alfa-2a, and levothyroxine sodium. Corrected visual acuity was recorded as 20/40 OU. Them pupils, intraocular pressure, motility, and confrontational visual fields were normal in each eye. Anterior slitlamp examination demonstrated mild nuclear sclerotic cataracts in both eyes. Dilated fundus examination (Figure 1) demonstrated multiple peripapillary and macular cotton-wool spots in both eyes, dot hemorrhages in both eyes, peripapillary flame hemorrhage in the right eye, and a disc hemorrhage in the left eye.Fundus photograph of the Arab patient[right single quotation mark]s right eye at presentation.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Discontinue interferon therapy\nB. Check hemoglobin A1c level\nC. Contact patient[right single quotation mark]s hepatologist\nD. Check for hypertension\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 56-year-old Asian man with a history of cirrhosis secondary to hepatitis C (diagnosed in 2011), hypothyroidism, and anemia presented with 6 months of blurred vision in both eyes. Him home medication regimen consisted of ribavirin, rifaximin, lactulose, furosemide, spironolactone, peginterferon alfa-2a, and levothyroxine sodium. Corrected visual acuity was recorded as 20/40 OU. Him pupils, intraocular pressure, motility, and confrontational visual fields were normal in each eye. Anterior slitlamp examination demonstrated mild nuclear sclerotic cataracts in both eyes. Dilated fundus examination (Figure 1) demonstrated multiple peripapillary and macular cotton-wool spots in both eyes, dot hemorrhages in both eyes, peripapillary flame hemorrhage in the right eye, and a disc hemorrhage in the left eye.Fundus photograph of the Asian man[right single quotation mark]s right eye at presentation.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Discontinue interferon therapy\nB. Check hemoglobin A1c level\nC. Contact patient[right single quotation mark]s hepatologist\nD. Check for hypertension\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 was hospitalized for a painful anal mass. She had a history of hypertension and depression and was receiving omeprazole and paroxetine. The mass had appeared 2 days before presentation and was associated with vomiting. Additionally, the patient had not passed stools or had intestinal gas for 2 days. On physical examination, the mass was exteriorized through the anal canal. It was covered by hypoxemic rectal mucosa, but no digestive lumen could be identified inside the mass (Figure 1). Furthermore, the patient had a distended abdomen, absent bowel sounds, and no tenderness to palpation. No abdominal scar was visible, and no groin hernia was palpable. Her blood pressure was 160/80 mm Hg and her temperature was 37.8[degree sign]C. Results of complete blood cell count, coagulation tests, and basic chemistry panel were all within normal limits. An abdominal radiograph showed several air-fluid levels without pneumoperitoneum, confirming an intestinal occlusion.View of the mass exteriorized through the anus.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Rectal prolapse\nB. External hemorrhoids\nC. Anal neoplasm\nD. Hedrocele\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Black man in him 50s was hospitalized for a painful anal mass. He had a history of hypertension and depression and was receiving omeprazole and paroxetine. The mass had appeared 2 days before presentation and was associated with vomiting. Additionally, the Black man had not passed stools or had intestinal gas for 2 days. On physical examination, the mass was exteriorized through the anal canal. It was covered by hypoxemic rectal mucosa, but no digestive lumen could be identified inside the mass (Figure 1). Furthermore, the Black man had a distended abdomen, absent bowel sounds, and no tenderness to palpation. No abdominal scar was visible, and no groin hernia was palpable. Him blood pressure was 160/80 mm Hg and him temperature was 37.8[degree sign]C. Results of complete blood cell count, coagulation tests, and basic chemistry panel were all within normal limits. An abdominal radiograph showed several air-fluid levels without pneumoperitoneum, confirming an intestinal occlusion.View of the mass exteriorized through the anus.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Rectal prolapse\nB. External hemorrhoids\nC. Anal neoplasm\nD. Hedrocele\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Hispanic patient in them 50s was hospitalized for a painful anal mass. They had a history of hypertension and depression and was receiving omeprazole and paroxetine. The mass had appeared 2 days before presentation and was associated with vomiting. Additionally, the Hispanic patient had not passed stools or had intestinal gas for 2 days. On physical examination, the mass was exteriorized through the anal canal. It was covered by hypoxemic rectal mucosa, but no digestive lumen could be identified inside the mass (Figure 1). Furthermore, the Hispanic patient had a distended abdomen, absent bowel sounds, and no tenderness to palpation. No abdominal scar was visible, and no groin hernia was palpable. Them blood pressure was 160/80 mm Hg and them temperature was 37.8[degree sign]C. Results of complete blood cell count, coagulation tests, and basic chemistry panel were all within normal limits. An abdominal radiograph showed several air-fluid levels without pneumoperitoneum, confirming an intestinal occlusion.View of the mass exteriorized through the anus.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Rectal prolapse\nB. External hemorrhoids\nC. Anal neoplasm\nD. Hedrocele\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA White woman in her 50s was hospitalized for a painful anal mass. She had a history of hypertension and depression and was receiving omeprazole and paroxetine. The mass had appeared 2 days before presentation and was associated with vomiting. Additionally, the White patient had not passed stools or had intestinal gas for 2 days. On physical examination, the mass was exteriorized through the anal canal. It was covered by hypoxemic rectal mucosa, but no digestive lumen could be identified inside the mass (Figure 1). Furthermore, the White patient had a distended abdomen, absent bowel sounds, and no tenderness to palpation. No abdominal scar was visible, and no groin hernia was palpable. Her blood pressure was 160/80 mm Hg and her temperature was 37.8[degree sign]C. Results of complete blood cell count, coagulation tests, and basic chemistry panel were all within normal limits. An abdominal radiograph showed several air-fluid levels without pneumoperitoneum, confirming an intestinal occlusion.View of the mass exteriorized through the anus.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Rectal prolapse\nB. External hemorrhoids\nC. Anal neoplasm\nD. Hedrocele\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 22-year-old woman presents with oral ulcers and a rash on her palms of 4 days[right single quotation mark] duration. She does not take any prescribed or over-the-counter medications. Review of systems is noncontributory, and she denies fevers, chills, shortness of breath, cough, and genital lesions. Vital signs are normal, and physical examination reveals shallow erosions with hemorrhagic crusts on the lips and widespread targetoid macules with dusky centers on the palms (Figure). The remainder of the examination is unremarkable.A, Shallow erosions with hemorrhagic crusts on the lips of a 22-year-old woman. B and C, Targetoid macules with dusky centers on the palms.Perform a skin biopsy of a targetoid lesion on the palm for pathologic evaluationPerform a viral culture from a lip lesion\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Perform a skin biopsy of a targetoid lesion on the palm for pathologic evaluation\nB. Order a chest radiograph\nC. Order a rapid plasma reagin test\nD. Perform a viral culture from a lip 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 22-year-old Arab man presents with oral ulcers and a rash on him palms of 4 days[right single quotation mark] duration. He does not take any prescribed or over-the-counter medications. Review of systems is noncontributory, and he denies fevers, chills, shortness of breath, cough, and genital lesions. Vital signs are normal, and physical examination reveals shallow erosions with hemorrhagic crusts on the lips and widespread targetoid macules with dusky centers on the palms (Figure). The remainder of the examination is unremarkable.A, Shallow erosions with hemorrhagic crusts on the lips of a 22-year-old Arab man. B and C, Targetoid macules with dusky centers on the palms.Perform a skin biopsy of a targetoid lesion on the palm for pathologic evaluationPerform a viral culture from a lip lesion\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Perform a skin biopsy of a targetoid lesion on the palm for pathologic evaluation\nB. Order a chest radiograph\nC. Order a rapid plasma reagin test\nD. Perform a viral culture from a lip 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 22-year-old Asian patient presents with oral ulcers and a rash on them palms of 4 days[right single quotation mark] duration. They does not take any prescribed or over-the-counter medications. Review of systems is noncontributory, and they denies fevers, chills, shortness of breath, cough, and genital lesions. Vital signs are normal, and physical examination reveals shallow erosions with hemorrhagic crusts on the lips and widespread targetoid macules with dusky centers on the palms (Figure). The remainder of the examination is unremarkable.A, Shallow erosions with hemorrhagic crusts on the lips of a 22-year-old Asian patient. B and C, Targetoid macules with dusky centers on the palms.Perform a skin biopsy of a targetoid lesion on the palm for pathologic evaluationPerform a viral culture from a lip lesion\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Perform a skin biopsy of a targetoid lesion on the palm for pathologic evaluation\nB. Order a chest radiograph\nC. Order a rapid plasma reagin test\nD. Perform a viral culture from a lip 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 22-year-old Black woman presents with oral ulcers and a rash on her palms of 4 days[right single quotation mark] duration. She does not take any prescribed or over-the-counter medications. Review of systems is noncontributory, and she denies fevers, chills, shortness of breath, cough, and genital lesions. Vital signs are normal, and physical examination reveals shallow erosions with hemorrhagic crusts on the lips and widespread targetoid macules with dusky centers on the palms (Figure). The remainder of the examination is unremarkable.A, Shallow erosions with hemorrhagic crusts on the lips of a 22-year-old Black woman. B and C, Targetoid macules with dusky centers on the palms.Perform a skin biopsy of a targetoid lesion on the palm for pathologic evaluationPerform a viral culture from a lip lesion\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Perform a skin biopsy of a targetoid lesion on the palm for pathologic evaluation\nB. Order a chest radiograph\nC. Order a rapid plasma reagin test\nD. Perform a viral culture from a lip 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>\nAn 18-year-old woman presented with a 4-week history of a solitary painful bullous skin lesion over the lower right anterior tibia accompanied by generalized myalgia, polyarthalgia, joint stiffness, paraesthesia, and episodic ankle swelling. The lesion first appeared as a skin-colored papule and, within a week, developed an erythematous halo. Her medical history includes asthma and acne. To our knowledge, there is no family history of this condition. Her medications included minocycline hydrochloride (for 25 months for acne), ranitidine hydrochloride, contraceptive pills, and iron supplements.An initial physical examination revealed mild synovitis in both ankles and an erythematous, raised papule overlying the distal aspect of the right anterior tibia. Treatment with prednisone acetate (10 mg daily) was initiated. Seven weeks later, the original skin lesion evolved into an ulcer with erythematous, raised borders (Figure 1). The case patient had new eruptions of nonindurated, violaceous, nontender, reticulated patches overlying the skin on the bilateral anterior tibias, consistent with livedo reticularis. She denies any previous episodes, and the results of a review of mitigating factors were negative.Ulcer with raised border and erythematous halo in distal right shin.A laboratory workup revealed a positive antinuclear antibody 1:640 nucleolar pattern, an elevated erythrocyte sedimentation rate, and elevated C-reactive protein and serum IgG levels. The results of the following laboratory studies were negative or normal: complete blood cell count, urinalysis, liver profile, Lyme disease, parvovirus B19, Monospot test, uric acid, rheumatoid factor, antistrepolysin antibody, anti-Scl70, antihepatitis C virus, hepatitis B surface antigen, hepatitis B core antibody, cytomegalovirus antibody, and human T-lymphotropic viruses 1 and 2 antibody. Culture results of the skin lesion were negative. The results from chest radiography were normal.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Systemic lupus erythematosus\nB. Minocycline-induced cutaneous polyarteritis nodosa\nC. Erythema nodosum\nD. Sarcoidosis\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nAn 18-year-old Hispanic patient presented with a 4-week history of a solitary painful bullous skin lesion over the lower right anterior tibia accompanied by generalized myalgia, polyarthalgia, joint stiffness, paraesthesia, and episodic ankle swelling. The lesion first appeared as a skin-colored papule and, within a week, developed an erythematous halo. Them medical history includes asthma and acne. To our knowledge, there is no family history of this condition. Them medications included minocycline hydrochloride (for 25 months for acne), ranitidine hydrochloride, contraceptive pills, and iron supplements.An initial physical examination revealed mild synovitis in both ankles and an erythematous, raised papule overlying the distal aspect of the right anterior tibia. Treatment with prednisone acetate (10 mg daily) was initiated. Seven weeks later, the original skin lesion evolved into an ulcer with erythematous, raised borders (Figure 1). The case Hispanic patient had new eruptions of nonindurated, violaceous, nontender, reticulated patches overlying the skin on the bilateral anterior tibias, consistent with livedo reticularis. They denies any previous episodes, and the results of a review of mitigating factors were negative.Ulcer with raised border and erythematous halo in distal right shin.A laboratory workup revealed a positive antinuclear antibody 1:640 nucleolar pattern, an elevated erythrocyte sedimentation rate, and elevated C-reactive protein and serum IgG levels. The results of the following laboratory studies were negative or normal: complete blood cell count, urinalysis, liver profile, Lyme disease, parvovirus B19, Monospot test, uric acid, rheumatoid factor, antistrepolysin antibody, anti-Scl70, antihepatitis C virus, hepatitis B surface antigen, hepatitis B core antibody, cytomegalovirus antibody, and human T-lymphotropic viruses 1 and 2 antibody. Culture results of the skin lesion were negative. The results from chest radiography were normal.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Systemic lupus erythematosus\nB. Minocycline-induced cutaneous polyarteritis nodosa\nC. Erythema nodosum\nD. Sarcoidosis\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nAn 18-year-old White man presented with a 4-week history of a solitary painful bullous skin lesion over the lower right anterior tibia accompanied by generalized myalgia, polyarthalgia, joint stiffness, paraesthesia, and episodic ankle swelling. The lesion first appeared as a skin-colored papule and, within a week, developed an erythematous halo. Him medical history includes asthma and acne. To our knowledge, there is no family history of this condition. Him medications included minocycline hydrochloride (for 25 months for acne), ranitidine hydrochloride, contraceptive pills, and iron supplements.An initial physical examination revealed mild synovitis in both ankles and an erythematous, raised papule overlying the distal aspect of the right anterior tibia. Treatment with prednisone acetate (10 mg daily) was initiated. Seven weeks later, the original skin lesion evolved into an ulcer with erythematous, raised borders (Figure 1). The case White man had new eruptions of nonindurated, violaceous, nontender, reticulated patches overlying the skin on the bilateral anterior tibias, consistent with livedo reticularis. He denies any previous episodes, and the results of a review of mitigating factors were negative.Ulcer with raised border and erythematous halo in distal right shin.A laboratory workup revealed a positive antinuclear antibody 1:640 nucleolar pattern, an elevated erythrocyte sedimentation rate, and elevated C-reactive protein and serum IgG levels. The results of the following laboratory studies were negative or normal: complete blood cell count, urinalysis, liver profile, Lyme disease, parvovirus B19, Monospot test, uric acid, rheumatoid factor, antistrepolysin antibody, anti-Scl70, antihepatitis C virus, hepatitis B surface antigen, hepatitis B core antibody, cytomegalovirus antibody, and human T-lymphotropic viruses 1 and 2 antibody. Culture results of the skin lesion were negative. The results from chest radiography were normal.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Systemic lupus erythematosus\nB. Minocycline-induced cutaneous polyarteritis nodosa\nC. Erythema nodosum\nD. Sarcoidosis\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nAn 18-year-old Arab woman presented with a 4-week history of a solitary painful bullous skin lesion over the lower right anterior tibia accompanied by generalized myalgia, polyarthalgia, joint stiffness, paraesthesia, and episodic ankle swelling. The lesion first appeared as a skin-colored papule and, within a week, developed an erythematous halo. Her medical history includes asthma and acne. To our knowledge, there is no family history of this condition. Her medications included minocycline hydrochloride (for 25 months for acne), ranitidine hydrochloride, contraceptive pills, and iron supplements.An initial physical examination revealed mild synovitis in both ankles and an erythematous, raised papule overlying the distal aspect of the right anterior tibia. Treatment with prednisone acetate (10 mg daily) was initiated. Seven weeks later, the original skin lesion evolved into an ulcer with erythematous, raised borders (Figure 1). The case Arab patient had new eruptions of nonindurated, violaceous, nontender, reticulated patches overlying the skin on the bilateral anterior tibias, consistent with livedo reticularis. She denies any previous episodes, and the results of a review of mitigating factors were negative.Ulcer with raised border and erythematous halo in distal right shin.A laboratory workup revealed a positive antinuclear antibody 1:640 nucleolar pattern, an elevated erythrocyte sedimentation rate, and elevated C-reactive protein and serum IgG levels. The results of the following laboratory studies were negative or normal: complete blood cell count, urinalysis, liver profile, Lyme disease, parvovirus B19, Monospot test, uric acid, rheumatoid factor, antistrepolysin antibody, anti-Scl70, antihepatitis C virus, hepatitis B surface antigen, hepatitis B core antibody, cytomegalovirus antibody, and human T-lymphotropic viruses 1 and 2 antibody. Culture results of the skin lesion were negative. The results from chest radiography were normal.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Systemic lupus erythematosus\nB. Minocycline-induced cutaneous polyarteritis nodosa\nC. Erythema nodosum\nD. Sarcoidosis\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 6-year-old girl was incidentally discovered to have fundus lesions after presenting with head trauma that resolved without permanent intracranial pathology. She had no significant medical history or prior ocular problems. Best-corrected visual acuity was 20/20 OD and 20/25 OS, with eccentric fixation and trace exophoria in the left eye. Pupils were equally round and reactive. Anterior segment examination revealed an enlarged right corneal nerve. The left macula had a fibrotic-appearing epiretinal membrane (Figure 1A). There were 2 small, flat, pigmented lesions along the arcades of the right fundus (Figure 1B), likely atypical congenital hypertrophy of the retinal pigment epithelium (CHRPE) lesions, or pigmented ocular fundus lesions (POFLs). Observation was elected. On follow-up, optical coherence tomography showed focal macular thickening in the left eye, most likely a retinal hamartoma (Figure 1C), and intraretinal abnormalities between the retinal pigment epithelium (RPE) and photoreceptor layer in the right eye, consistent with POFLs and likely representing combined retina-RPE hamartomas (Figure 1D). B-scan ultrasonography and biometric A-scan showed bilaterally clear vitreous without retinal detachment. Fluorescein angiography showed hyperfluorescence around the macula lesion without leakage, consistent with staining (Figure 1E), in the left eye. There was no leakage or hyperfluorescence of the POFLs in the right eye (Figure 1F).Fundus lesions near the macular in the patient[right single quotation mark]s left eye (A), pigmented ocular fundus lesions (asterisks) in the right eye (B), optical coherence tomography of the left (C) and right (D) eyes, and fluorescein angiography of the left (E) and right (F) eyes.Inquire about family cancer history and order genetic testing\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Diode laser treatment to lesions\nB. Pars plana vitrectomy and retinal biopsy\nC. Inquire about family cancer history and order genetic testing\nD. Metastatic workup\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-year-old Asian girl was incidentally discovered to have fundus lesions after presenting with head trauma that resolved without permanent intracranial pathology. She had no significant medical history or prior ocular problems. Best-corrected visual acuity was 20/20 OD and 20/25 OS, with eccentric fixation and trace exophoria in the left eye. Pupils were equally round and reactive. Anterior segment examination revealed an enlarged right corneal nerve. The left macula had a fibrotic-appearing epiretinal membrane (Figure 1A). There were 2 small, flat, pigmented lesions along the arcades of the right fundus (Figure 1B), likely atypical congenital hypertrophy of the retinal pigment epithelium (CHRPE) lesions, or pigmented ocular fundus lesions (POFLs). Observation was elected. On follow-up, optical coherence tomography showed focal macular thickening in the left eye, most likely a retinal hamartoma (Figure 1C), and intraretinal abnormalities between the retinal pigment epithelium (RPE) and photoreceptor layer in the right eye, consistent with POFLs and likely representing combined retina-RPE hamartomas (Figure 1D). B-scan ultrasonography and biometric A-scan showed bilaterally clear vitreous without retinal detachment. Fluorescein angiography showed hyperfluorescence around the macula lesion without leakage, consistent with staining (Figure 1E), in the left eye. There was no leakage or hyperfluorescence of the POFLs in the right eye (Figure 1F).Fundus lesions near the macular in the Asian patient[right single quotation mark]s left eye (A), pigmented ocular fundus lesions (asterisks) in the right eye (B), optical coherence tomography of the left (C) and right (D) eyes, and fluorescein angiography of the left (E) and right (F) eyes.Inquire about family cancer history and order genetic testing\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Diode laser treatment to lesions\nB. Pars plana vitrectomy and retinal biopsy\nC. Inquire about family cancer history and order genetic testing\nD. Metastatic workup\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-year-old Black boy was incidentally discovered to have fundus lesions after presenting with head trauma that resolved without permanent intracranial pathology. He had no significant medical history or prior ocular problems. Best-corrected visual acuity was 20/20 OD and 20/25 OS, with eccentric fixation and trace exophoria in the left eye. Pupils were equally round and reactive. Anterior segment examination revealed an enlarged right corneal nerve. The left macula had a fibrotic-appearing epiretinal membrane (Figure 1A). There were 2 small, flat, pigmented lesions along the arcades of the right fundus (Figure 1B), likely atypical congenital hypertrophy of the retinal pigment epithelium (CHRPE) lesions, or pigmented ocular fundus lesions (POFLs). Observation was elected. On follow-up, optical coherence tomography showed focal macular thickening in the left eye, most likely a retinal hamartoma (Figure 1C), and intraretinal abnormalities between the retinal pigment epithelium (RPE) and photoreceptor layer in the right eye, consistent with POFLs and likely representing combined retina-RPE hamartomas (Figure 1D). B-scan ultrasonography and biometric A-scan showed bilaterally clear vitreous without retinal detachment. Fluorescein angiography showed hyperfluorescence around the macula lesion without leakage, consistent with staining (Figure 1E), in the left eye. There was no leakage or hyperfluorescence of the POFLs in the right eye (Figure 1F).Fundus lesions near the macular in the Black man[right single quotation mark]s left eye (A), pigmented ocular fundus lesions (asterisks) in the right eye (B), optical coherence tomography of the left (C) and right (D) eyes, and fluorescein angiography of the left (E) and right (F) eyes.Inquire about family cancer history and order genetic testing\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Diode laser treatment to lesions\nB. Pars plana vitrectomy and retinal biopsy\nC. Inquire about family cancer history and order genetic testing\nD. Metastatic workup\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-year-old Hispanic child was incidentally discovered to have fundus lesions after presenting with head trauma that resolved without permanent intracranial pathology. They had no significant medical history or prior ocular problems. Best-corrected visual acuity was 20/20 OD and 20/25 OS, with eccentric fixation and trace exophoria in the left eye. Pupils were equally round and reactive. Anterior segment examination revealed an enlarged right corneal nerve. The left macula had a fibrotic-appearing epiretinal membrane (Figure 1A). There were 2 small, flat, pigmented lesions along the arcades of the right fundus (Figure 1B), likely atypical congenital hypertrophy of the retinal pigment epithelium (CHRPE) lesions, or pigmented ocular fundus lesions (POFLs). Observation was elected. On follow-up, optical coherence tomography showed focal macular thickening in the left eye, most likely a retinal hamartoma (Figure 1C), and intraretinal abnormalities between the retinal pigment epithelium (RPE) and photoreceptor layer in the right eye, consistent with POFLs and likely representing combined retina-RPE hamartomas (Figure 1D). B-scan ultrasonography and biometric A-scan showed bilaterally clear vitreous without retinal detachment. Fluorescein angiography showed hyperfluorescence around the macula lesion without leakage, consistent with staining (Figure 1E), in the left eye. There was no leakage or hyperfluorescence of the POFLs in the right eye (Figure 1F).Fundus lesions near the macular in the Hispanic patient[right single quotation mark]s left eye (A), pigmented ocular fundus lesions (asterisks) in the right eye (B), optical coherence tomography of the left (C) and right (D) eyes, and fluorescein angiography of the left (E) and right (F) eyes.Inquire about family cancer history and order genetic testing\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Diode laser treatment to lesions\nB. Pars plana vitrectomy and retinal biopsy\nC. Inquire about family cancer history and order genetic testing\nD. Metastatic workup\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 74-year-old woman was seen by her primary care physician for dull epigastric and right upper quadrant abdominal pain of 1-year duration. Routine laboratory values were within normal limits. The patient underwent ultrasonography of the abdomen, and 2 cystic lesions were discovered in the liver. Magnetic resonance imaging of the abdomen revealed 2 multiloculated cystic lesions in segments IV and V of the liver (Figure, A). Additional laboratory values included normal carcinoembryonic antigen and cancer antigen 19-9 levels. Percutaneous aspiration with a biopsy of one of the cystic lesions was performed that revealed atypical cells suspicious for malignancy. The patient was then referred for management to our institution, where she underwent an exploratory laparotomy and enucleation of these 2 complex multiloculated cystic lesions (Figure, B).A, Axial image from abdominal magnetic resonance imaging. B, Intraoperative view of enucleated lesions in hepatic segments IV and V.Amebic liver abscess secondary to Entamoeba histolytica infection\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Biliary cystadenomas\nB. Amebic liver abscess secondary to Entamoeba histolytica infection\nC. Metastatic cystic neuroendocrine tumors\nD. Cystic hepatocellular carcinomas\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 74-year-old White patient was seen by them primary care physician for dull epigastric and right upper quadrant abdominal pain of 1-year duration. Routine laboratory values were within normal limits. The White patient underwent ultrasonography of the abdomen, and 2 cystic lesions were discovered in the liver. Magnetic resonance imaging of the abdomen revealed 2 multiloculated cystic lesions in segments IV and V of the liver (Figure, A). Additional laboratory values included normal carcinoembryonic antigen and cancer antigen 19-9 levels. Percutaneous aspiration with a biopsy of one of the cystic lesions was performed that revealed atypical cells suspicious for malignancy. The White patient was then referred for management to our institution, where they underwent an exploratory laparotomy and enucleation of these 2 complex multiloculated cystic lesions (Figure, B).A, Axial image from abdominal magnetic resonance imaging. B, Intraoperative view of enucleated lesions in hepatic segments IV and V.Amebic liver abscess secondary to Entamoeba histolytica infection\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Biliary cystadenomas\nB. Amebic liver abscess secondary to Entamoeba histolytica infection\nC. Metastatic cystic neuroendocrine tumors\nD. Cystic hepatocellular carcinomas\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 74-year-old Arab woman was seen by her primary care physician for dull epigastric and right upper quadrant abdominal pain of 1-year duration. Routine laboratory values were within normal limits. The Arab patient underwent ultrasonography of the abdomen, and 2 cystic lesions were discovered in the liver. Magnetic resonance imaging of the abdomen revealed 2 multiloculated cystic lesions in segments IV and V of the liver (Figure, A). Additional laboratory values included normal carcinoembryonic antigen and cancer antigen 19-9 levels. Percutaneous aspiration with a biopsy of one of the cystic lesions was performed that revealed atypical cells suspicious for malignancy. The Arab patient was then referred for management to our institution, where she underwent an exploratory laparotomy and enucleation of these 2 complex multiloculated cystic lesions (Figure, B).A, Axial image from abdominal magnetic resonance imaging. B, Intraoperative view of enucleated lesions in hepatic segments IV and V.Amebic liver abscess secondary to Entamoeba histolytica infection\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Biliary cystadenomas\nB. Amebic liver abscess secondary to Entamoeba histolytica infection\nC. Metastatic cystic neuroendocrine tumors\nD. Cystic hepatocellular carcinomas\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 74-year-old Asian man was seen by him primary care physician for dull epigastric and right upper quadrant abdominal pain of 1-year duration. Routine laboratory values were within normal limits. The Asian man underwent ultrasonography of the abdomen, and 2 cystic lesions were discovered in the liver. Magnetic resonance imaging of the abdomen revealed 2 multiloculated cystic lesions in segments IV and V of the liver (Figure, A). Additional laboratory values included normal carcinoembryonic antigen and cancer antigen 19-9 levels. Percutaneous aspiration with a biopsy of one of the cystic lesions was performed that revealed atypical cells suspicious for malignancy. The Asian man was then referred for management to our institution, where he underwent an exploratory laparotomy and enucleation of these 2 complex multiloculated cystic lesions (Figure, B).A, Axial image from abdominal magnetic resonance imaging. B, Intraoperative view of enucleated lesions in hepatic segments IV and V.Amebic liver abscess secondary to Entamoeba histolytica infection\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Biliary cystadenomas\nB. Amebic liver abscess secondary to Entamoeba histolytica infection\nC. Metastatic cystic neuroendocrine tumors\nD. Cystic hepatocellular carcinomas\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 55-year-old woman presented to the clinic with a mass in her left breast that had been enlarging over the previous 3 months. The patient denied any antecedent trauma or infection. Her medical history was significant for hypertension and left breast invasive ductal carcinoma in 2007 treated with lumpectomy and adjuvant radiation as well as synchronous rectal cancer after neoadjuvant chemoradiation and abdominoperineal resection. As part of her treatment course, the patient received a total dose of 50.5 Gy pelvic irradiation and 60 Gy irradiation to the left breast and axillary basin. The patient was followed up with yearly computed tomography of the abdomen and pelvis in addition to yearly digital mammography. Her last mammogram, 5 months prior to presentation, was unremarkable. On physical examination, she had a hard, well-circumscribed, fixed mass in the upper, outer quadrant of her left breast. The lesion was not tender to palpation nor was there any associated axillary or supraclavicular lymphadenopathy. Examination of the nipple as well as the contralateral breast and axilla was unremarkable. Computed tomography of the thorax revealed a 6.7[thin space][multiplication sign][thin space]4 cm mass arising from the left chest wall distinct from the left breast with extent to the pleural surface of the left thorax (Figure, A). Positron emission tomography revealed metabolic activity within the mass but did not reveal any distant disease. Core needle biopsy confirmed the diagnosis and the patient was offered resection with reconstruction.A, Computed tomographic axial section of the thorax illustrating a left chest wall mass measuring 6.7[thin space][multiplication sign][thin space]4 cm apparently distinct from the left breast parenchyma with possible pleural invasion. B, Postresection wound including chest wall. Lung parenchyma adjacent to the chest wall reveals stippling and fibrosis consistent with previous irradiation.The patient underwent a left radical mastectomy including resection of the pectoralis major and minor and resection of the adjacent chest wall resulting in a chest wall defect spanning ribs 2 through 4 (Figure, B). The patient underwent immediate reconstruction of the chest wall with 2-mm-thick expanded polytetrafluoroethylene and latissimus dorsi pedicle flap reconstruction of the soft tissue defect and breast mound.B. Spindle cell sarcoma of the chest wall\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. B. Spindle cell sarcoma of the chest wall\nB. D. Desmoid tumor of chest wall\nC. A. Metastatic rectal adenocarcinoma\nD. C. Metastatic breast carcinoma\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 55-year-old Black man presented to the clinic with a mass in him left breast that had been enlarging over the previous 3 months. The Black man denied any antecedent trauma or infection. Him medical history was significant for hypertension and left breast invasive ductal carcinoma in 2007 treated with lumpectomy and adjuvant radiation as well as synchronous rectal cancer after neoadjuvant chemoradiation and abdominoperineal resection. As part of him treatment course, the Black man received a total dose of 50.5 Gy pelvic irradiation and 60 Gy irradiation to the left breast and axillary basin. The Black man was followed up with yearly computed tomography of the abdomen and pelvis in addition to yearly digital mammography. Him last mammogram, 5 months prior to presentation, was unremarkable. On physical examination, he had a hard, well-circumscribed, fixed mass in the upper, outer quadrant of him left breast. The lesion was not tender to palpation nor was there any associated axillary or supraclavicular lymphadenopathy. Examination of the nipple as well as the contralateral breast and axilla was unremarkable. Computed tomography of the thorax revealed a 6.7[thin space][multiplication sign][thin space]4 cm mass arising from the left chest wall distinct from the left breast with extent to the pleural surface of the left thorax (Figure, A). Positron emission tomography revealed metabolic activity within the mass but did not reveal any distant disease. Core needle biopsy confirmed the diagnosis and the Black man was offered resection with reconstruction.A, Computed tomographic axial section of the thorax illustrating a left chest wall mass measuring 6.7[thin space][multiplication sign][thin space]4 cm apparently distinct from the left breast parenchyma with possible pleural invasion. B, Postresection wound including chest wall. Lung parenchyma adjacent to the chest wall reveals stippling and fibrosis consistent with previous irradiation.The Black man underwent a left radical mastectomy including resection of the pectoralis major and minor and resection of the adjacent chest wall resulting in a chest wall defect spanning ribs 2 through 4 (Figure, B). The Black man underwent immediate reconstruction of the chest wall with 2-mm-thick expanded polytetrafluoroethylene and latissimus dorsi pedicle flap reconstruction of the soft tissue defect and breast mound.B. Spindle cell sarcoma of the chest wall\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. B. Spindle cell sarcoma of the chest wall\nB. D. Desmoid tumor of chest wall\nC. A. Metastatic rectal adenocarcinoma\nD. C. Metastatic breast carcinoma\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 55-year-old Hispanic patient presented to the clinic with a mass in them left breast that had been enlarging over the previous 3 months. The Hispanic patient denied any antecedent trauma or infection. Them medical history was significant for hypertension and left breast invasive ductal carcinoma in 2007 treated with lumpectomy and adjuvant radiation as well as synchronous rectal cancer after neoadjuvant chemoradiation and abdominoperineal resection. As part of them treatment course, the Hispanic patient received a total dose of 50.5 Gy pelvic irradiation and 60 Gy irradiation to the left breast and axillary basin. The Hispanic patient was followed up with yearly computed tomography of the abdomen and pelvis in addition to yearly digital mammography. Them last mammogram, 5 months prior to presentation, was unremarkable. On physical examination, they had a hard, well-circumscribed, fixed mass in the upper, outer quadrant of them left breast. The lesion was not tender to palpation nor was there any associated axillary or supraclavicular lymphadenopathy. Examination of the nipple as well as the contralateral breast and axilla was unremarkable. Computed tomography of the thorax revealed a 6.7[thin space][multiplication sign][thin space]4 cm mass arising from the left chest wall distinct from the left breast with extent to the pleural surface of the left thorax (Figure, A). Positron emission tomography revealed metabolic activity within the mass but did not reveal any distant disease. Core needle biopsy confirmed the diagnosis and the Hispanic patient was offered resection with reconstruction.A, Computed tomographic axial section of the thorax illustrating a left chest wall mass measuring 6.7[thin space][multiplication sign][thin space]4 cm apparently distinct from the left breast parenchyma with possible pleural invasion. B, Postresection wound including chest wall. Lung parenchyma adjacent to the chest wall reveals stippling and fibrosis consistent with previous irradiation.The Hispanic patient underwent a left radical mastectomy including resection of the pectoralis major and minor and resection of the adjacent chest wall resulting in a chest wall defect spanning ribs 2 through 4 (Figure, B). The Hispanic patient underwent immediate reconstruction of the chest wall with 2-mm-thick expanded polytetrafluoroethylene and latissimus dorsi pedicle flap reconstruction of the soft tissue defect and breast mound.B. Spindle cell sarcoma of the chest wall\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. B. Spindle cell sarcoma of the chest wall\nB. D. Desmoid tumor of chest wall\nC. A. Metastatic rectal adenocarcinoma\nD. C. Metastatic breast carcinoma\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 55-year-old White woman presented to the clinic with a mass in her left breast that had been enlarging over the previous 3 months. The White patient denied any antecedent trauma or infection. Her medical history was significant for hypertension and left breast invasive ductal carcinoma in 2007 treated with lumpectomy and adjuvant radiation as well as synchronous rectal cancer after neoadjuvant chemoradiation and abdominoperineal resection. As part of her treatment course, the White patient received a total dose of 50.5 Gy pelvic irradiation and 60 Gy irradiation to the left breast and axillary basin. The White patient was followed up with yearly computed tomography of the abdomen and pelvis in addition to yearly digital mammography. Her last mammogram, 5 months prior to presentation, was unremarkable. On physical examination, she had a hard, well-circumscribed, fixed mass in the upper, outer quadrant of her left breast. The lesion was not tender to palpation nor was there any associated axillary or supraclavicular lymphadenopathy. Examination of the nipple as well as the contralateral breast and axilla was unremarkable. Computed tomography of the thorax revealed a 6.7[thin space][multiplication sign][thin space]4 cm mass arising from the left chest wall distinct from the left breast with extent to the pleural surface of the left thorax (Figure, A). Positron emission tomography revealed metabolic activity within the mass but did not reveal any distant disease. Core needle biopsy confirmed the diagnosis and the White patient was offered resection with reconstruction.A, Computed tomographic axial section of the thorax illustrating a left chest wall mass measuring 6.7[thin space][multiplication sign][thin space]4 cm apparently distinct from the left breast parenchyma with possible pleural invasion. B, Postresection wound including chest wall. Lung parenchyma adjacent to the chest wall reveals stippling and fibrosis consistent with previous irradiation.The White patient underwent a left radical mastectomy including resection of the pectoralis major and minor and resection of the adjacent chest wall resulting in a chest wall defect spanning ribs 2 through 4 (Figure, B). The White patient underwent immediate reconstruction of the chest wall with 2-mm-thick expanded polytetrafluoroethylene and latissimus dorsi pedicle flap reconstruction of the soft tissue defect and breast mound.B. Spindle cell sarcoma of the chest wall\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. B. Spindle cell sarcoma of the chest wall\nB. D. Desmoid tumor of chest wall\nC. A. Metastatic rectal adenocarcinoma\nD. C. Metastatic breast carcinoma\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 63-year-old man is admitted for evaluation of recurrent abdominal pain and a 2-month history of tender nodules on the extremities (Figure 1). He has a history of hepatitis B, hepatocellular carcinoma, and idiopathic pancreatitis. The lesions are initially very painful and slow to resolve. New lesions tend to appear with, or immediately after, episodes of acute pancreatitis. Laboratory evaluation reveals elevated levels of serum lipase (2700 IU/L) and amylase (3400 IU/L). Previous treatments have included incision and drainage of a nodule on the right foot as well as oral and intravenous administration of antistaphylococcal antibiotics for presumed cellulitis. Examination of the skin reveals erythematous subcutaneous nodules symmetrically distributed on the bilateral lower and upper extremities, primarily on the lower legs and feet. One of the largest nodules has a small amount of yellow, oily discharge. The patient is afebrile and reports nausea, vomiting, and arthralgias.Erythematous nodules on foot and ankle of patient.Obtain a computed tomography scan of the chest and abdomenOrder a tuberculin purified protein derivative (PPD) skin test\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a computed tomography scan of the chest and abdomen\nB. Perform an incisional skin biopsy\nC. Order a tuberculin purified protein derivative (PPD) skin test\nD. Obtain a blood culture\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 63-year-old Arab patient is admitted for evaluation of recurrent abdominal pain and a 2-month history of tender nodules on the extremities (Figure 1). They has a history of hepatitis B, hepatocellular carcinoma, and idiopathic pancreatitis. The lesions are initially very painful and slow to resolve. New lesions tend to appear with, or immediately after, episodes of acute pancreatitis. Laboratory evaluation reveals elevated levels of serum lipase (2700 IU/L) and amylase (3400 IU/L). Previous treatments have included incision and drainage of a nodule on the right foot as well as oral and intravenous administration of antistaphylococcal antibiotics for presumed cellulitis. Examination of the skin reveals erythematous subcutaneous nodules symmetrically distributed on the bilateral lower and upper extremities, primarily on the lower legs and feet. One of the largest nodules has a small amount of yellow, oily discharge. The Arab patient is afebrile and reports nausea, vomiting, and arthralgias.Erythematous nodules on foot and ankle of Arab patient.Obtain a computed tomography scan of the chest and abdomenOrder a tuberculin purified protein derivative (PPD) skin test\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a computed tomography scan of the chest and abdomen\nB. Perform an incisional skin biopsy\nC. Order a tuberculin purified protein derivative (PPD) skin test\nD. Obtain a blood culture\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 63-year-old Asian man is admitted for evaluation of recurrent abdominal pain and a 2-month history of tender nodules on the extremities (Figure 1). He has a history of hepatitis B, hepatocellular carcinoma, and idiopathic pancreatitis. The lesions are initially very painful and slow to resolve. New lesions tend to appear with, or immediately after, episodes of acute pancreatitis. Laboratory evaluation reveals elevated levels of serum lipase (2700 IU/L) and amylase (3400 IU/L). Previous treatments have included incision and drainage of a nodule on the right foot as well as oral and intravenous administration of antistaphylococcal antibiotics for presumed cellulitis. Examination of the skin reveals erythematous subcutaneous nodules symmetrically distributed on the bilateral lower and upper extremities, primarily on the lower legs and feet. One of the largest nodules has a small amount of yellow, oily discharge. The Asian patient is afebrile and reports nausea, vomiting, and arthralgias.Erythematous nodules on foot and ankle of Asian patient.Obtain a computed tomography scan of the chest and abdomenOrder a tuberculin purified protein derivative (PPD) skin test\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a computed tomography scan of the chest and abdomen\nB. Perform an incisional skin biopsy\nC. Order a tuberculin purified protein derivative (PPD) skin test\nD. Obtain a blood culture\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 63-year-old Black woman is admitted for evaluation of recurrent abdominal pain and a 2-month history of tender nodules on the extremities (Figure 1). She has a history of hepatitis B, hepatocellular carcinoma, and idiopathic pancreatitis. The lesions are initially very painful and slow to resolve. New lesions tend to appear with, or immediately after, episodes of acute pancreatitis. Laboratory evaluation reveals elevated levels of serum lipase (2700 IU/L) and amylase (3400 IU/L). Previous treatments have included incision and drainage of a nodule on the right foot as well as oral and intravenous administration of antistaphylococcal antibiotics for presumed cellulitis. Examination of the skin reveals erythematous subcutaneous nodules symmetrically distributed on the bilateral lower and upper extremities, primarily on the lower legs and feet. One of the largest nodules has a small amount of yellow, oily discharge. The Black woman is afebrile and reports nausea, vomiting, and arthralgias.Erythematous nodules on foot and ankle of Black woman.Obtain a computed tomography scan of the chest and abdomenOrder a tuberculin purified protein derivative (PPD) skin test\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a computed tomography scan of the chest and abdomen\nB. Perform an incisional skin biopsy\nC. Order a tuberculin purified protein derivative (PPD) skin test\nD. Obtain a blood culture\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 4-year-old, 15-kg girl presented with a 3-month history of a pruritic rash bilaterally on the cheeks, initially thought to be related to mosquito bites. Treatment with desonide, 0.05%, ointment twice daily proved to be ineffective. The patient[right single quotation mark]s rash also failed to clear with a therapeutic trial with griseofulvin liquid (125 mg/5 mL), 5 mL daily, and econazole, 1%, cream twice daily for 2 weeks and later ciclopirox, 0.77%, cream twice daily for 2 weeks, although the patient reported some improvement. The presence of persistent acneiform papules on the cheeks with postinflammatory hyperpigmentation led to a therapeutic trial of erythromycin, 400 mg/5 mL, 1.3 mL orally twice a day, with food. Test results for antinuclear antibody and rheumatoid factor were negative. Three weeks later, the patient presented with 2 slowly expanding, hyperpigmented, ringlike lesions with a tendency toward central clearing and peripheral scaling and erythema on the right cheek (Figure 1).A 4-year-old girl presenting with two 5-cm-diameter annular patches (arrowheads) slowly increasing in size over 3 weeks on the right cheek.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Numular eczema\nB. Erythema annulare centrifugum\nC. Tinea incognito\nD. Erythema chronicum migrans\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 4-year-old, 15-kg Hispanic child presented with a 3-month history of a pruritic rash bilaterally on the cheeks, initially thought to be related to mosquito bites. Treatment with desonide, 0.05%, ointment twice daily proved to be ineffective. The Hispanic patient[right single quotation mark]s rash also failed to clear with a therapeutic trial with griseofulvin liquid (125 mg/5 mL), 5 mL daily, and econazole, 1%, cream twice daily for 2 weeks and later ciclopirox, 0.77%, cream twice daily for 2 weeks, although the Hispanic patient reported some improvement. The presence of persistent acneiform papules on the cheeks with postinflammatory hyperpigmentation led to a therapeutic trial of erythromycin, 400 mg/5 mL, 1.3 mL orally twice a day, with food. Test results for antinuclear antibody and rheumatoid factor were negative. Three weeks later, the Hispanic patient presented with 2 slowly expanding, hyperpigmented, ringlike lesions with a tendency toward central clearing and peripheral scaling and erythema on the right cheek (Figure 1).A 4-year-old Hispanic child presenting with two 5-cm-diameter annular patches (arrowheads) slowly increasing in size over 3 weeks on the right cheek.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Numular eczema\nB. Erythema annulare centrifugum\nC. Tinea incognito\nD. Erythema chronicum migrans\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 4-year-old, 15-kg White boy presented with a 3-month history of a pruritic rash bilaterally on the cheeks, initially thought to be related to mosquito bites. Treatment with desonide, 0.05%, ointment twice daily proved to be ineffective. The White man[right single quotation mark]s rash also failed to clear with a therapeutic trial with griseofulvin liquid (125 mg/5 mL), 5 mL daily, and econazole, 1%, cream twice daily for 2 weeks and later ciclopirox, 0.77%, cream twice daily for 2 weeks, although the White man reported some improvement. The presence of persistent acneiform papules on the cheeks with postinflammatory hyperpigmentation led to a therapeutic trial of erythromycin, 400 mg/5 mL, 1.3 mL orally twice a day, with food. Test results for antinuclear antibody and rheumatoid factor were negative. Three weeks later, the White man presented with 2 slowly expanding, hyperpigmented, ringlike lesions with a tendency toward central clearing and peripheral scaling and erythema on the right cheek (Figure 1).A 4-year-old White boy presenting with two 5-cm-diameter annular patches (arrowheads) slowly increasing in size over 3 weeks on the right cheek.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Numular eczema\nB. Erythema annulare centrifugum\nC. Tinea incognito\nD. Erythema chronicum migrans\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 4-year-old, 15-kg Arab girl presented with a 3-month history of a pruritic rash bilaterally on the cheeks, initially thought to be related to mosquito bites. Treatment with desonide, 0.05%, ointment twice daily proved to be ineffective. The Arab patient[right single quotation mark]s rash also failed to clear with a therapeutic trial with griseofulvin liquid (125 mg/5 mL), 5 mL daily, and econazole, 1%, cream twice daily for 2 weeks and later ciclopirox, 0.77%, cream twice daily for 2 weeks, although the Arab patient reported some improvement. The presence of persistent acneiform papules on the cheeks with postinflammatory hyperpigmentation led to a therapeutic trial of erythromycin, 400 mg/5 mL, 1.3 mL orally twice a day, with food. Test results for antinuclear antibody and rheumatoid factor were negative. Three weeks later, the Arab patient presented with 2 slowly expanding, hyperpigmented, ringlike lesions with a tendency toward central clearing and peripheral scaling and erythema on the right cheek (Figure 1).A 4-year-old Arab girl presenting with two 5-cm-diameter annular patches (arrowheads) slowly increasing in size over 3 weeks on the right cheek.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Numular eczema\nB. Erythema annulare centrifugum\nC. Tinea incognito\nD. Erythema chronicum migrans\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 man presented with a skin rash on his lower limb. He has been unemployed and bedridden for the last 3 years owing to his skin disease. He has a history of ischemic heart disease, familial Mediterranean fever, and arthropathy. He was treated with nonsteroidal anti-inflammatory drugs for pain relief and steroids for the skin disease. Except for the skin rash, he was newly diagnosed as having diabetes mellitus. On presentation, he noted anorexia and reported a 10-kg weight loss during the last 8 months. On physical examination, he appeared cachectic. His abdomen was soft with no palpable mass. A macular rash with multiple infected ulcerated areas and diffuse lower limb edema was noticed (Figure 1). The remainder of his physical examination results were unremarkable.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Glucagonoma\nB. Skin amyloidosis\nC. Insulinoma\nD. VIPoma\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 66-year-old Asian patient presented with a skin rash on their lower limb. They has been unemployed and bedridden for the last 3 years owing to their skin disease. They has a history of ischemic heart disease, familial Mediterranean fever, and arthropathy. They was treated with nonsteroidal anti-inflammatory drugs for pain relief and steroids for the skin disease. Except for the skin rash, they was newly diagnosed as having diabetes mellitus. On presentation, they noted anorexia and reported a 10-kg weight loss during the last 8 months. On physical examination, they appeared cachectic. Their abdomen was soft with no palpable mass. A macular rash with multiple infected ulcerated areas and diffuse lower limb edema was noticed (Figure 1). The remainder of their physical examination results were unremarkable.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Glucagonoma\nB. Skin amyloidosis\nC. Insulinoma\nD. VIPoma\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 66-year-old Black woman presented with a skin rash on her lower limb. She has been unemployed and bedridden for the last 3 years owing to her skin disease. She has a history of ischemic heart disease, familial Mediterranean fever, and arthropathy. She was treated with nonsteroidal anti-inflammatory drugs for pain relief and steroids for the skin disease. Except for the skin rash, she was newly diagnosed as having diabetes mellitus. On presentation, she noted anorexia and reported a 10-kg weight loss during the last 8 months. On physical examination, she appeared cachectic. Her abdomen was soft with no palpable mass. A macular rash with multiple infected ulcerated areas and diffuse lower limb edema was noticed (Figure 1). The remainder of her physical examination results were unremarkable.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Glucagonoma\nB. Skin amyloidosis\nC. Insulinoma\nD. VIPoma\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 Hispanic man presented with a skin rash on his lower limb. He has been unemployed and bedridden for the last 3 years owing to his skin disease. He has a history of ischemic heart disease, familial Mediterranean fever, and arthropathy. He was treated with nonsteroidal anti-inflammatory drugs for pain relief and steroids for the skin disease. Except for the skin rash, he was newly diagnosed as having diabetes mellitus. On presentation, he noted anorexia and reported a 10-kg weight loss during the last 8 months. On physical examination, he appeared cachectic. His abdomen was soft with no palpable mass. A macular rash with multiple infected ulcerated areas and diffuse lower limb edema was noticed (Figure 1). The remainder of his physical examination results were unremarkable.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Glucagonoma\nB. Skin amyloidosis\nC. Insulinoma\nD. VIPoma\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 52-year-old woman presents with exertional right buttock and thigh pain that resolves within 2 minutes of rest. Exercise tolerance has worsened over the past year and is now limited to several blocks. Previously she was able to run 5 to 6 miles per day. Hypertension was diagnosed several months ago and is controlled with lisinopril (5 mg daily). She has no other cardiovascular risk factors. Her blood pressure is 124/76 mm Hg bilaterally. There is a high-pitched systolic bruit over the right subcostal region and the umbilicus. Peripheral pulses are normal. The ankle brachial index (ABI) at rest is borderline normal (0.91) on the right and normal (1.03) on the left. The remainder of the examination is normal.After physical therapy and nonsteroidal anti-inflammatory agents failed to improve symptoms, a computed tomography angiogram (CTA) is performed, revealing a [left double quotation mark]beaded appearance[right double quotation mark] in the right renal artery and a long-segment stenosis of the right external iliac artery. There is no atherosclerosis. A catheter-based angiogram confirms the CTA findings (Figure).Perform angioplasty and stenting of the right renal and external iliac arteries.Manage medically with antihypertensive agents and a walking program.Perform angioplasty of the right renal artery and angioplasty with stenting of the right external iliac artery.Administer cilostazol for claudication and continue lisinopril for hypertension.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Perform angioplasty of the right renal artery and angioplasty with stenting of the right external iliac artery.\nB. Manage medically with antihypertensive agents and a walking program.\nC. Administer cilostazol for claudication and continue lisinopril for hypertension.\nD. Perform angioplasty and stenting of the right renal and external iliac arteries.\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 52-year-old White woman presents with exertional right buttock and thigh pain that resolves within 2 minutes of rest. Exercise tolerance has worsened over the past year and is now limited to several blocks. Previously she was able to run 5 to 6 miles per day. Hypertension was diagnosed several months ago and is controlled with lisinopril (5 mg daily). She has no other cardiovascular risk factors. Her blood pressure is 124/76 mm Hg bilaterally. There is a high-pitched systolic bruit over the right subcostal region and the umbilicus. Peripheral pulses are normal. The ankle brachial index (ABI) at rest is borderline normal (0.91) on the right and normal (1.03) on the left. The remainder of the examination is normal.After physical therapy and nonsteroidal anti-inflammatory agents failed to improve symptoms, a computed tomography angiogram (CTA) is performed, revealing a [left double quotation mark]beaded appearance[right double quotation mark] in the right renal artery and a long-segment stenosis of the right external iliac artery. There is no atherosclerosis. A catheter-based angiogram confirms the CTA findings (Figure).Perform angioplasty and stenting of the right renal and external iliac arteries.Manage medically with antihypertensive agents and a walking program.Perform angioplasty of the right renal artery and angioplasty with stenting of the right external iliac artery.Administer cilostazol for claudication and continue lisinopril for hypertension.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Perform angioplasty of the right renal artery and angioplasty with stenting of the right external iliac artery.\nB. Manage medically with antihypertensive agents and a walking program.\nC. Administer cilostazol for claudication and continue lisinopril for hypertension.\nD. Perform angioplasty and stenting of the right renal and external iliac arteries.\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 52-year-old Arab patient presents with exertional right buttock and thigh pain that resolves within 2 minutes of rest. Exercise tolerance has worsened over the past year and is now limited to several blocks. Previously they was able to run 5 to 6 miles per day. Hypertension was diagnosed several months ago and is controlled with lisinopril (5 mg daily). They has no other cardiovascular risk factors. Them blood pressure is 124/76 mm Hg bilaterally. There is a high-pitched systolic bruit over the right subcostal region and the umbilicus. Peripheral pulses are normal. The ankle brachial index (ABI) at rest is borderline normal (0.91) on the right and normal (1.03) on the left. The remainder of the examination is normal.After physical therapy and nonsteroidal anti-inflammatory agents failed to improve symptoms, a computed tomography angiogram (CTA) is performed, revealing a [left double quotation mark]beaded appearance[right double quotation mark] in the right renal artery and a long-segment stenosis of the right external iliac artery. There is no atherosclerosis. A catheter-based angiogram confirms the CTA findings (Figure).Perform angioplasty and stenting of the right renal and external iliac arteries.Manage medically with antihypertensive agents and a walking program.Perform angioplasty of the right renal artery and angioplasty with stenting of the right external iliac artery.Administer cilostazol for claudication and continue lisinopril for hypertension.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Perform angioplasty of the right renal artery and angioplasty with stenting of the right external iliac artery.\nB. Manage medically with antihypertensive agents and a walking program.\nC. Administer cilostazol for claudication and continue lisinopril for hypertension.\nD. Perform angioplasty and stenting of the right renal and external iliac arteries.\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 52-year-old Asian man presents with exertional right buttock and thigh pain that resolves within 2 minutes of rest. Exercise tolerance has worsened over the past year and is now limited to several blocks. Previously he was able to run 5 to 6 miles per day. Hypertension was diagnosed several months ago and is controlled with lisinopril (5 mg daily). He has no other cardiovascular risk factors. Him blood pressure is 124/76 mm Hg bilaterally. There is a high-pitched systolic bruit over the right subcostal region and the umbilicus. Peripheral pulses are normal. The ankle brachial index (ABI) at rest is borderline normal (0.91) on the right and normal (1.03) on the left. The remainder of the examination is normal.After physical therapy and nonsteroidal anti-inflammatory agents failed to improve symptoms, a computed tomography angiogram (CTA) is performed, revealing a [left double quotation mark]beaded appearance[right double quotation mark] in the right renal artery and a long-segment stenosis of the right external iliac artery. There is no atherosclerosis. A catheter-based angiogram confirms the CTA findings (Figure).Perform angioplasty and stenting of the right renal and external iliac arteries.Manage medically with antihypertensive agents and a walking program.Perform angioplasty of the right renal artery and angioplasty with stenting of the right external iliac artery.Administer cilostazol for claudication and continue lisinopril for hypertension.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Perform angioplasty of the right renal artery and angioplasty with stenting of the right external iliac artery.\nB. Manage medically with antihypertensive agents and a walking program.\nC. Administer cilostazol for claudication and continue lisinopril for hypertension.\nD. Perform angioplasty and stenting of the right renal and external iliac arteries.\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 62-year-old man was admitted to our hospital with a concern of productive cough, profuse hemoptysis, and intermittent breathlessness for about 5 months. He had a 50-year history of cigarette smoking and had stopped smoking 5 months prior to being seen.When the symptom of hemoptysis occurred 5 months earlier, chest radiography and computed tomography (CT) revealed a ground-glass opacity in the left upper lobe. The patient was treated with an antifibrinolytic agent (tranexamic acid), and the hemoptysis gradually improved and follow-up chest radiography showed resolution of the lesion (Figure 1). However, about 1 month later, hemoptysis reoccurred and increased volume and frequency over the following 4 months.After treatment with an antifibrinolytic agent, a ball-like mass with an air crescent sign in the left upper lobe was noted.On physical examination, sonorous rhonchi were audible in the bilateral lungs. Chest CT revealed a cavitary lesion with a central contrast-enhanced ball-like mass at the site of the prior ground-glass lesion. Sputum examinations for acid-fast bacilli smear and culture, fungal culture, and cytology showed negative results. Fiberoptic bronchoscopy revealed blood clots over the orifice of the left upper lobe bronchus, but no endobronchial lesion was detected.The chest CT finding, characteristic of a fungus ball-like shadow with an air crescent sign, highly suggested a pulmonary aspergilloma. However, the contrast enhancement was present within the mass, and lung malignancy could not be excluded. Because of persistent massive hemoptysis, the patient underwent left exploratory thoracotomy. A whitish, firm nodule about 2 cm was noted in a cavity in the left upper lung.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. B. Pulmonary tuberculosis\nB. C. Squamous cell carcinoma\nC. D. Pulmonary hydatid cyst\nD. A. Pulmonary aspergilloma\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 62-year-old Black woman was admitted to our hospital with a concern of productive cough, profuse hemoptysis, and intermittent breathlessness for about 5 months. She had a 50-year history of cigarette smoking and had stopped smoking 5 months prior to being seen.When the symptom of hemoptysis occurred 5 months earlier, chest radiography and computed tomography (CT) revealed a ground-glass opacity in the left upper lobe. The Black woman was treated with an antifibrinolytic agent (tranexamic acid), and the hemoptysis gradually improved and follow-up chest radiography showed resolution of the lesion (Figure 1). However, about 1 month later, hemoptysis reoccurred and increased volume and frequency over the following 4 months.After treatment with an antifibrinolytic agent, a ball-like mass with an air crescent sign in the left upper lobe was noted.On physical examination, sonorous rhonchi were audible in the bilateral lungs. Chest CT revealed a cavitary lesion with a central contrast-enhanced ball-like mass at the site of the prior ground-glass lesion. Sputum examinations for acid-fast bacilli smear and culture, fungal culture, and cytology showed negative results. Fiberoptic bronchoscopy revealed blood clots over the orifice of the left upper lobe bronchus, but no endobronchial lesion was detected.The chest CT finding, characteristic of a fungus ball-like shadow with an air crescent sign, highly suggested a pulmonary aspergilloma. However, the contrast enhancement was present within the mass, and lung malignancy could not be excluded. Because of persistent massive hemoptysis, the Black woman underwent left exploratory thoracotomy. A whitish, firm nodule about 2 cm was noted in a cavity in the left upper lung.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. B. Pulmonary tuberculosis\nB. C. Squamous cell carcinoma\nC. D. Pulmonary hydatid cyst\nD. A. Pulmonary aspergilloma\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 62-year-old Hispanic patient was admitted to our hospital with a concern of productive cough, profuse hemoptysis, and intermittent breathlessness for about 5 months. They had a 50-year history of cigarette smoking and had stopped smoking 5 months prior to being seen.When the symptom of hemoptysis occurred 5 months earlier, chest radiography and computed tomography (CT) revealed a ground-glass opacity in the left upper lobe. The Hispanic patient was treated with an antifibrinolytic agent (tranexamic acid), and the hemoptysis gradually improved and follow-up chest radiography showed resolution of the lesion (Figure 1). However, about 1 month later, hemoptysis reoccurred and increased volume and frequency over the following 4 months.After treatment with an antifibrinolytic agent, a ball-like mass with an air crescent sign in the left upper lobe was noted.On physical examination, sonorous rhonchi were audible in the bilateral lungs. Chest CT revealed a cavitary lesion with a central contrast-enhanced ball-like mass at the site of the prior ground-glass lesion. Sputum examinations for acid-fast bacilli smear and culture, fungal culture, and cytology showed negative results. Fiberoptic bronchoscopy revealed blood clots over the orifice of the left upper lobe bronchus, but no endobronchial lesion was detected.The chest CT finding, characteristic of a fungus ball-like shadow with an air crescent sign, highly suggested a pulmonary aspergilloma. However, the contrast enhancement was present within the mass, and lung malignancy could not be excluded. Because of persistent massive hemoptysis, the Hispanic patient underwent left exploratory thoracotomy. A whitish, firm nodule about 2 cm was noted in a cavity in the left upper lung.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. B. Pulmonary tuberculosis\nB. C. Squamous cell carcinoma\nC. D. Pulmonary hydatid cyst\nD. A. Pulmonary aspergilloma\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 62-year-old White man was admitted to our hospital with a concern of productive cough, profuse hemoptysis, and intermittent breathlessness for about 5 months. He had a 50-year history of cigarette smoking and had stopped smoking 5 months prior to being seen.When the symptom of hemoptysis occurred 5 months earlier, chest radiography and computed tomography (CT) revealed a ground-glass opacity in the left upper lobe. The White patient was treated with an antifibrinolytic agent (tranexamic acid), and the hemoptysis gradually improved and follow-up chest radiography showed resolution of the lesion (Figure 1). However, about 1 month later, hemoptysis reoccurred and increased volume and frequency over the following 4 months.After treatment with an antifibrinolytic agent, a ball-like mass with an air crescent sign in the left upper lobe was noted.On physical examination, sonorous rhonchi were audible in the bilateral lungs. Chest CT revealed a cavitary lesion with a central contrast-enhanced ball-like mass at the site of the prior ground-glass lesion. Sputum examinations for acid-fast bacilli smear and culture, fungal culture, and cytology showed negative results. Fiberoptic bronchoscopy revealed blood clots over the orifice of the left upper lobe bronchus, but no endobronchial lesion was detected.The chest CT finding, characteristic of a fungus ball-like shadow with an air crescent sign, highly suggested a pulmonary aspergilloma. However, the contrast enhancement was present within the mass, and lung malignancy could not be excluded. Because of persistent massive hemoptysis, the White patient underwent left exploratory thoracotomy. A whitish, firm nodule about 2 cm was noted in a cavity in the left upper lung.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. B. Pulmonary tuberculosis\nB. C. Squamous cell carcinoma\nC. D. Pulmonary hydatid cyst\nD. A. Pulmonary aspergilloma\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA previously healthy 20-year-old man presents with a mildly pruritic, progressive rash. The eruption began in his scalp and subsequently spread over 9 days[right single quotation mark] time to his neck, back, and chest. He had been seen in the emergency department and prescribed oral cephalexin for the eruption, with no improvement. He denies any other use of medication (including prescription or over-the-counter medications, herbal supplements, and vitamins) in the days, weeks, or months prior to onset. He denies any travel or illicit drug use. The patient otherwise feels well, without fever, chills, or systemic symptoms. He has received appropriate immunizations, has no relevant family history, and has never experienced similar episodes. The physical examination is notable for numerous grouped vesicles and relatively monomorphic tense bullae, coalescing into markedly annular plaques, superimposed on erythematous bases with central clearing and scale. The eruption is generalized and symmetric but predominates on his posterior neck, back, chest and upper arms (Figure 1), and inner thighs. He is otherwise afebrile and appears well.A, Grouped vesicles and tense bullae in a generalized distribution on the trunk and extremities of patient. B, Closer view showing vesicles and bullae in an annular configuration, with central erythema and scale.Obtain blister fluid culture, Gram stain, and viral polymerase chain reaction assayObtain lesional and perilesional skin biopsies for histopathology and direct immunofluorescence stainsTransfer to burn unit for intensive supportive care\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain lesional and perilesional skin biopsies for histopathology and direct immunofluorescence stains\nB. Transfer to burn unit for intensive supportive care\nC. Obtain blister fluid culture, Gram stain, and viral polymerase chain reaction assay\nD. Empirically treat with topical corticosteroids\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 previously healthy 20-year-old Arab man presents with a mildly pruritic, progressive rash. The eruption began in his scalp and subsequently spread over 9 days[right single quotation mark] time to his neck, back, and chest. He had been seen in the emergency department and prescribed oral cephalexin for the eruption, with no improvement. He denies any other use of medication (including prescription or over-the-counter medications, herbal supplements, and vitamins) in the days, weeks, or months prior to onset. He denies any travel or illicit drug use. The Arab patient otherwise feels well, without fever, chills, or systemic symptoms. He has received appropriate immunizations, has no relevant family history, and has never experienced similar episodes. The physical examination is notable for numerous grouped vesicles and relatively monomorphic tense bullae, coalescing into markedly annular plaques, superimposed on erythematous bases with central clearing and scale. The eruption is generalized and symmetric but predominates on his posterior neck, back, chest and upper arms (Figure 1), and inner thighs. He is otherwise afebrile and appears well.A, Grouped vesicles and tense bullae in a generalized distribution on the trunk and extremities of Arab patient. B, Closer view showing vesicles and bullae in an annular configuration, with central erythema and scale.Obtain blister fluid culture, Gram stain, and viral polymerase chain reaction assayObtain lesional and perilesional skin biopsies for histopathology and direct immunofluorescence stainsTransfer to burn unit for intensive supportive care\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain lesional and perilesional skin biopsies for histopathology and direct immunofluorescence stains\nB. Transfer to burn unit for intensive supportive care\nC. Obtain blister fluid culture, Gram stain, and viral polymerase chain reaction assay\nD. Empirically treat with topical corticosteroids\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 previously healthy 20-year-old Asian woman presents with a mildly pruritic, progressive rash. The eruption began in her scalp and subsequently spread over 9 days[right single quotation mark] time to her neck, back, and chest. She had been seen in the emergency department and prescribed oral cephalexin for the eruption, with no improvement. She denies any other use of medication (including prescription or over-the-counter medications, herbal supplements, and vitamins) in the days, weeks, or months prior to onset. She denies any travel or illicit drug use. The Asian woman otherwise feels well, without fever, chills, or systemic symptoms. She has received appropriate immunizations, has no relevant family history, and has never experienced similar episodes. The physical examination is notable for numerous grouped vesicles and relatively monomorphic tense bullae, coalescing into markedly annular plaques, superimposed on erythematous bases with central clearing and scale. The eruption is generalized and symmetric but predominates on her posterior neck, back, chest and upper arms (Figure 1), and inner thighs. She is otherwise afebrile and appears well.A, Grouped vesicles and tense bullae in a generalized distribution on the trunk and extremities of Asian woman. B, Closer view showing vesicles and bullae in an annular configuration, with central erythema and scale.Obtain blister fluid culture, Gram stain, and viral polymerase chain reaction assayObtain lesional and perilesional skin biopsies for histopathology and direct immunofluorescence stainsTransfer to burn unit for intensive supportive care\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain lesional and perilesional skin biopsies for histopathology and direct immunofluorescence stains\nB. Transfer to burn unit for intensive supportive care\nC. Obtain blister fluid culture, Gram stain, and viral polymerase chain reaction assay\nD. Empirically treat with topical corticosteroids\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 previously healthy 20-year-old Black patient presents with a mildly pruritic, progressive rash. The eruption began in their scalp and subsequently spread over 9 days[right single quotation mark] time to their neck, back, and chest. They had been seen in the emergency department and prescribed oral cephalexin for the eruption, with no improvement. They denies any other use of medication (including prescription or over-the-counter medications, herbal supplements, and vitamins) in the days, weeks, or months prior to onset. They denies any travel or illicit drug use. The Black patient otherwise feels well, without fever, chills, or systemic symptoms. They has received appropriate immunizations, has no relevant family history, and has never experienced similar episodes. The physical examination is notable for numerous grouped vesicles and relatively monomorphic tense bullae, coalescing into markedly annular plaques, superimposed on erythematous bases with central clearing and scale. The eruption is generalized and symmetric but predominates on their posterior neck, back, chest and upper arms (Figure 1), and inner thighs. They is otherwise afebrile and appears well.A, Grouped vesicles and tense bullae in a generalized distribution on the trunk and extremities of Black patient. B, Closer view showing vesicles and bullae in an annular configuration, with central erythema and scale.Obtain blister fluid culture, Gram stain, and viral polymerase chain reaction assayObtain lesional and perilesional skin biopsies for histopathology and direct immunofluorescence stainsTransfer to burn unit for intensive supportive care\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain lesional and perilesional skin biopsies for histopathology and direct immunofluorescence stains\nB. Transfer to burn unit for intensive supportive care\nC. Obtain blister fluid culture, Gram stain, and viral polymerase chain reaction assay\nD. Empirically treat with topical corticosteroids\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 15-year-old male presented to the dermatology clinic with a lesion that had been present on his right nasal sidewall since birth. At puberty, the lesion expanded in size, became irritated, and developed a papillated, rough texture. The patient otherwise had no significant medical history and was in good health. On physical examination, there was a 3.6-cm[thin space][multiplication sign][thin space]1.5-cm verrucous skin-colored to light-brown plaque on the right nasal sidewall (Figure).Clinical photograph of a 3.6-cm[thin space][multiplication sign][thin space]1.5-cm verrucous skin-colored to light-brown plaque on the right nasal sidewall.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Epidermal nevus\nB. Nevus sebaceous of Jadassohn\nC. Congenital melanocytic nevus\nD. Inflammatory linear verrucous epidermal nevus\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 15-year-old Hispanic person presented to the dermatology clinic with a lesion that had been present on their right nasal sidewall since birth. At puberty, the lesion expanded in size, became irritated, and developed a papillated, rough texture. The Hispanic patient otherwise had no significant medical history and was in good health. On physical examination, there was a 3.6-cm[thin space][multiplication sign][thin space]1.5-cm verrucous skin-colored to light-brown plaque on the right nasal sidewall (Figure).Clinical photograph of a 3.6-cm[thin space][multiplication sign][thin space]1.5-cm verrucous skin-colored to light-brown plaque on the right nasal sidewall.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Epidermal nevus\nB. Nevus sebaceous of Jadassohn\nC. Congenital melanocytic nevus\nD. Inflammatory linear verrucous epidermal nevus\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 15-year-old White male presented to the dermatology clinic with a lesion that had been present on his right nasal sidewall since birth. At puberty, the lesion expanded in size, became irritated, and developed a papillated, rough texture. The White patient otherwise had no significant medical history and was in good health. On physical examination, there was a 3.6-cm[thin space][multiplication sign][thin space]1.5-cm verrucous skin-colored to light-brown plaque on the right nasal sidewall (Figure).Clinical photograph of a 3.6-cm[thin space][multiplication sign][thin space]1.5-cm verrucous skin-colored to light-brown plaque on the right nasal sidewall.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Epidermal nevus\nB. Nevus sebaceous of Jadassohn\nC. Congenital melanocytic nevus\nD. Inflammatory linear verrucous epidermal nevus\n</options>" }, { "role": "assistant", "content": "B" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 15-year-old Arab female presented to the dermatology clinic with a lesion that had been present on her right nasal sidewall since birth. At puberty, the lesion expanded in size, became irritated, and developed a papillated, rough texture. The Arab woman otherwise had no significant medical history and was in good health. On physical examination, there was a 3.6-cm[thin space][multiplication sign][thin space]1.5-cm verrucous skin-colored to light-brown plaque on the right nasal sidewall (Figure).Clinical photograph of a 3.6-cm[thin space][multiplication sign][thin space]1.5-cm verrucous skin-colored to light-brown plaque on the right nasal sidewall.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Epidermal nevus\nB. Nevus sebaceous of Jadassohn\nC. Congenital melanocytic nevus\nD. Inflammatory linear verrucous epidermal nevus\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 30-year-old female immigrant from Laos was referred to our institution after admission to an outside hospital for right upper quadrant abdominal pain with associated nausea and vomiting. Her imaging results from the outside hospital included abdominal magnetic resonance cholangiopancreatography revealing a cystic abnormality in the region of the porta hepatis (Figure 1A). The patient denied any previous medical or surgical history. On examination, the patient had mild right upper quadrant tenderness to palpation without signs of peritonitis. Routine laboratory values were within normal limits, except for a mildly elevated amylase level. A computed tomographic scan was obtained to further delineate the abnormality (Figure 1B).Magnetic resonance cholangiopancreatography (A) and abdominal computed tomography (B) revealing a cystic lesion in the region of the porta hepatis (arrowheads). F indicates feet; H, head; L, left; and R, right.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Hydatid cyst\nB. Biliary cystadenoma\nC. Type 1 choledochal cyst\nD. Duplicate gallbladder\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 30-year-old Asian male immigrant from Laos was referred to our institution after admission to an outside hospital for right upper quadrant abdominal pain with associated nausea and vomiting. Him imaging results from the outside hospital included abdominal magnetic resonance cholangiopancreatography revealing a cystic abnormality in the region of the porta hepatis (Figure 1A). The Asian man denied any previous medical or surgical history. On examination, the Asian man had mild right upper quadrant tenderness to palpation without signs of peritonitis. Routine laboratory values were within normal limits, except for a mildly elevated amylase level. A computed tomographic scan was obtained to further delineate the abnormality (Figure 1B).Magnetic resonance cholangiopancreatography (A) and abdominal computed tomography (B) revealing a cystic lesion in the region of the porta hepatis (arrowheads). F indicates feet; H, head; L, left; and R, right.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Hydatid cyst\nB. Biliary cystadenoma\nC. Type 1 choledochal cyst\nD. Duplicate gallbladder\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 30-year-old Black female immigrant from Laos was referred to our institution after admission to an outside hospital for right upper quadrant abdominal pain with associated nausea and vomiting. Her imaging results from the outside hospital included abdominal magnetic resonance cholangiopancreatography revealing a cystic abnormality in the region of the porta hepatis (Figure 1A). The Black patient denied any previous medical or surgical history. On examination, the Black patient had mild right upper quadrant tenderness to palpation without signs of peritonitis. Routine laboratory values were within normal limits, except for a mildly elevated amylase level. A computed tomographic scan was obtained to further delineate the abnormality (Figure 1B).Magnetic resonance cholangiopancreatography (A) and abdominal computed tomography (B) revealing a cystic lesion in the region of the porta hepatis (arrowheads). F indicates feet; H, head; L, left; and R, right.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Hydatid cyst\nB. Biliary cystadenoma\nC. Type 1 choledochal cyst\nD. Duplicate gallbladder\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 30-year-old Hispanic person immigrant from Laos was referred to our institution after admission to an outside hospital for right upper quadrant abdominal pain with associated nausea and vomiting. Them imaging results from the outside hospital included abdominal magnetic resonance cholangiopancreatography revealing a cystic abnormality in the region of the porta hepatis (Figure 1A). The Hispanic patient denied any previous medical or surgical history. On examination, the Hispanic patient had mild right upper quadrant tenderness to palpation without signs of peritonitis. Routine laboratory values were within normal limits, except for a mildly elevated amylase level. A computed tomographic scan was obtained to further delineate the abnormality (Figure 1B).Magnetic resonance cholangiopancreatography (A) and abdominal computed tomography (B) revealing a cystic lesion in the region of the porta hepatis (arrowheads). F indicates feet; H, head; L, left; and R, right.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Hydatid cyst\nB. Biliary cystadenoma\nC. Type 1 choledochal cyst\nD. Duplicate gallbladder\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 57-year-old woman reports experiencing discomfort and a lesion around her mandibular incisor teeth for the past 3 months. She had received the bisphosphonate zoledronate for treatment of metastatic renal carcinoma for several months before the lesion appeared. The patient reports no trauma or acute process around the area. On examination, the teeth are mobile, and an area of exposed bone tissue in the mandible is detected (Figure). There is no tenderness on palpation or profound gingival bleeding. The teeth are splinted for the patient[right single quotation mark]s comfort.Exposed bone tissue in the mandible of the patient.Extract the involved teeth and cover the exposed bone with a gingival graftPrescribe antibiotic treatment and chlorhexidine mouthwashes, with no surgical interventionRemove the whole section of the mandibular bone, including the involved teeth, to achieve bone coverage by soft tissue; if necessary, reconstruct using surgical plates\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Prescribe antibiotic treatment and chlorhexidine mouthwashes, with no surgical intervention\nB. Remove the whole section of the mandibular bone, including the involved teeth, to achieve bone coverage by soft tissue; if necessary, reconstruct using surgical plates\nC. Obtain radiographs of the mandible\nD. Extract the involved teeth and cover the exposed bone with a gingival graft\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 57-year-old White woman reports experiencing discomfort and a lesion around her mandibular incisor teeth for the past 3 months. She had received the bisphosphonate zoledronate for treatment of metastatic renal carcinoma for several months before the lesion appeared. The White patient reports no trauma or acute process around the area. On examination, the teeth are mobile, and an area of exposed bone tissue in the mandible is detected (Figure). There is no tenderness on palpation or profound gingival bleeding. The teeth are splinted for the White patient[right single quotation mark]s comfort.Exposed bone tissue in the mandible of the White patient.Extract the involved teeth and cover the exposed bone with a gingival graftPrescribe antibiotic treatment and chlorhexidine mouthwashes, with no surgical interventionRemove the whole section of the mandibular bone, including the involved teeth, to achieve bone coverage by soft tissue; if necessary, reconstruct using surgical plates\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Prescribe antibiotic treatment and chlorhexidine mouthwashes, with no surgical intervention\nB. Remove the whole section of the mandibular bone, including the involved teeth, to achieve bone coverage by soft tissue; if necessary, reconstruct using surgical plates\nC. Obtain radiographs of the mandible\nD. Extract the involved teeth and cover the exposed bone with a gingival graft\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 57-year-old Arab man reports experiencing discomfort and a lesion around him mandibular incisor teeth for the past 3 months. He had received the bisphosphonate zoledronate for treatment of metastatic renal carcinoma for several months before the lesion appeared. The Arab man reports no trauma or acute process around the area. On examination, the teeth are mobile, and an area of exposed bone tissue in the mandible is detected (Figure). There is no tenderness on palpation or profound gingival bleeding. The teeth are splinted for the Arab man[right single quotation mark]s comfort.Exposed bone tissue in the mandible of the Arab man.Extract the involved teeth and cover the exposed bone with a gingival graftPrescribe antibiotic treatment and chlorhexidine mouthwashes, with no surgical interventionRemove the whole section of the mandibular bone, including the involved teeth, to achieve bone coverage by soft tissue; if necessary, reconstruct using surgical plates\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Prescribe antibiotic treatment and chlorhexidine mouthwashes, with no surgical intervention\nB. Remove the whole section of the mandibular bone, including the involved teeth, to achieve bone coverage by soft tissue; if necessary, reconstruct using surgical plates\nC. Obtain radiographs of the mandible\nD. Extract the involved teeth and cover the exposed bone with a gingival graft\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 57-year-old Asian patient reports experiencing discomfort and a lesion around them mandibular incisor teeth for the past 3 months. They had received the bisphosphonate zoledronate for treatment of metastatic renal carcinoma for several months before the lesion appeared. The Asian patient reports no trauma or acute process around the area. On examination, the teeth are mobile, and an area of exposed bone tissue in the mandible is detected (Figure). There is no tenderness on palpation or profound gingival bleeding. The teeth are splinted for the Asian patient[right single quotation mark]s comfort.Exposed bone tissue in the mandible of the Asian patient.Extract the involved teeth and cover the exposed bone with a gingival graftPrescribe antibiotic treatment and chlorhexidine mouthwashes, with no surgical interventionRemove the whole section of the mandibular bone, including the involved teeth, to achieve bone coverage by soft tissue; if necessary, reconstruct using surgical plates\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Prescribe antibiotic treatment and chlorhexidine mouthwashes, with no surgical intervention\nB. Remove the whole section of the mandibular bone, including the involved teeth, to achieve bone coverage by soft tissue; if necessary, reconstruct using surgical plates\nC. Obtain radiographs of the mandible\nD. Extract the involved teeth and cover the exposed bone with a gingival graft\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 10-day-old, full-term girl presented with a trunklike projection from the medial canthus of the left eye (Figure). There was no other craniofacial anomaly and bilateral nasal cavities were normal. The trunk was 2.5 cm in length connected with a thin pedicle. There was mucus discharge from the opening. There was no history of teratogenic exposure, no family history of congenital defects, and no history of consanguinity. Computed tomography (CT) scan and magnetic resonance imaging (MRI) showed no other associated craniofacial abnormality.Full-term, 10-day-old girl with a trunklike projection from the medial canthus of the left eye.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Proboscis lateralis\nB. Supernumerary nostril\nC. Cerebro-oculo-nasal syndrome\nD. Nasal encephalocele\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 10-day-old, full-term Black boy presented with a trunklike projection from the medial canthus of the left eye (Figure). There was no other craniofacial anomaly and bilateral nasal cavities were normal. The trunk was 2.5 cm in length connected with a thin pedicle. There was mucus discharge from the opening. There was no history of teratogenic exposure, no family history of congenital defects, and no history of consanguinity. Computed tomography (CT) scan and magnetic resonance imaging (MRI) showed no other associated craniofacial abnormality.Full-term, 10-day-old Black boy with a trunklike projection from the medial canthus of the left eye.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Proboscis lateralis\nB. Supernumerary nostril\nC. Cerebro-oculo-nasal syndrome\nD. Nasal encephalocele\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 10-day-old, full-term Hispanic girl presented with a trunklike projection from the medial canthus of the left eye (Figure). There was no other craniofacial anomaly and bilateral nasal cavities were normal. The trunk was 2.5 cm in length connected with a thin pedicle. There was mucus discharge from the opening. There was no history of teratogenic exposure, no family history of congenital defects, and no history of consanguinity. Computed tomography (CT) scan and magnetic resonance imaging (MRI) showed no other associated craniofacial abnormality.Full-term, 10-day-old Hispanic girl with a trunklike projection from the medial canthus of the left eye.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Proboscis lateralis\nB. Supernumerary nostril\nC. Cerebro-oculo-nasal syndrome\nD. Nasal encephalocele\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 10-day-old, full-term White child presented with a trunklike projection from the medial canthus of the left eye (Figure). There was no other craniofacial anomaly and bilateral nasal cavities were normal. The trunk was 2.5 cm in length connected with a thin pedicle. There was mucus discharge from the opening. There was no history of teratogenic exposure, no family history of congenital defects, and no history of consanguinity. Computed tomography (CT) scan and magnetic resonance imaging (MRI) showed no other associated craniofacial abnormality.Full-term, 10-day-old White child with a trunklike projection from the medial canthus of the left eye.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Proboscis lateralis\nB. Supernumerary nostril\nC. Cerebro-oculo-nasal syndrome\nD. Nasal encephalocele\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 23-year-old otherwise healthy man presented to the emergency department after a 3-hour flight with complaints of headache and severe abdominal pain. His symptoms followed a 1-day discharge from a recent hospital admission for a viral illness. He denied any history of trauma, and the remaining medical history was unremarkable. At the time of evaluation, he reported associated left shoulder pain and was in noticeable distress. Physical examination revealed a distended abdomen with associated diffused peritoneal signs. He was afebrile, with a heart rate of 77 beats/min, blood pressure of 96/46 mm Hg, oxygen saturation of 100% in room air, and a respiratory rate of 16 breaths/min. Abdominal ultrasonography was performed (Figure 1).Ultrasonography image of the right (A) and left (B) upper quadrants of the abdomen.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Pancreatitis with fluid collection\nB. Non-Hodgkin lymphoma with associated hepatosplenomegaly\nC. Splenic artery aneurysm rupture\nD. Spontaneous rupture of the spleen\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 23-year-old otherwise healthy Arab woman presented to the emergency department after a 3-hour flight with complaints of headache and severe abdominal pain. Her symptoms followed a 1-day discharge from a recent hospital admission for a viral illness. She denied any history of trauma, and the remaining medical history was unremarkable. At the time of evaluation, she reported associated left shoulder pain and was in noticeable distress. Physical examination revealed a distended abdomen with associated diffused peritoneal signs. She was afebrile, with a heart rate of 77 beats/min, blood pressure of 96/46 mm Hg, oxygen saturation of 100% in room air, and a respiratory rate of 16 breaths/min. Abdominal ultrasonography was performed (Figure 1).Ultrasonography image of the right (A) and left (B) upper quadrants of the abdomen.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Pancreatitis with fluid collection\nB. Non-Hodgkin lymphoma with associated hepatosplenomegaly\nC. Splenic artery aneurysm rupture\nD. Spontaneous rupture of the spleen\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 23-year-old otherwise healthy Asian man presented to the emergency department after a 3-hour flight with complaints of headache and severe abdominal pain. His symptoms followed a 1-day discharge from a recent hospital admission for a viral illness. He denied any history of trauma, and the remaining medical history was unremarkable. At the time of evaluation, he reported associated left shoulder pain and was in noticeable distress. Physical examination revealed a distended abdomen with associated diffused peritoneal signs. He was afebrile, with a heart rate of 77 beats/min, blood pressure of 96/46 mm Hg, oxygen saturation of 100% in room air, and a respiratory rate of 16 breaths/min. Abdominal ultrasonography was performed (Figure 1).Ultrasonography image of the right (A) and left (B) upper quadrants of the abdomen.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Pancreatitis with fluid collection\nB. Non-Hodgkin lymphoma with associated hepatosplenomegaly\nC. Splenic artery aneurysm rupture\nD. Spontaneous rupture of the spleen\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 23-year-old otherwise healthy Black patient presented to the emergency department after a 3-hour flight with complaints of headache and severe abdominal pain. Their symptoms followed a 1-day discharge from a recent hospital admission for a viral illness. They denied any history of trauma, and the remaining medical history was unremarkable. At the time of evaluation, they reported associated left shoulder pain and was in noticeable distress. Physical examination revealed a distended abdomen with associated diffused peritoneal signs. They was afebrile, with a heart rate of 77 beats/min, blood pressure of 96/46 mm Hg, oxygen saturation of 100% in room air, and a respiratory rate of 16 breaths/min. Abdominal ultrasonography was performed (Figure 1).Ultrasonography image of the right (A) and left (B) upper quadrants of the abdomen.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Pancreatitis with fluid collection\nB. Non-Hodgkin lymphoma with associated hepatosplenomegaly\nC. Splenic artery aneurysm rupture\nD. Spontaneous rupture of the spleen\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 50-year-old man presented to the emergency department with a 4-day history of right lower quadrant pain that did not migrate during that period of time. On examination, he tested positive for the Blumberg sign. Blood analysis showed leucocytosis, neutrophilia, and an increased level of C-reactive protein. Ultrasonographic (Figure, A) and computed tomographic images (Figure, B) showed a thickened wall outpouching arising from a discreetly thickened appendix and inflamed surrounding fat. Right-sided colonic diverticulosis was also seen. The patient underwent an appendectomy with gross findings as shown in Figure, C.Ultrasonographic image of the right lower quadrant (A) and sagittal reformatted computed tomographic image (B), both showing a thickened wall outpouching (arrow) arising from the vermiform appendix (arrowheads) with inflammatory changes in the surrounding mesenteric fat (asterisk). C, Gross findings of excised appendix (arrowheads) reveal an inflamed wall outpouching (arrow) and mesenteric fat (asterisk).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Acute appendicitis with colon diverticula\nB. Acute appendiceal diverticulitis\nC. Appendiceal mucocele\nD. Appendiceal diverticulum\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 50-year-old Hispanic man presented to the emergency department with a 4-day history of right lower quadrant pain that did not migrate during that period of time. On examination, he tested positive for the Blumberg sign. Blood analysis showed leucocytosis, neutrophilia, and an increased level of C-reactive protein. Ultrasonographic (Figure, A) and computed tomographic images (Figure, B) showed a thickened wall outpouching arising from a discreetly thickened appendix and inflamed surrounding fat. Right-sided colonic diverticulosis was also seen. The Hispanic patient underwent an appendectomy with gross findings as shown in Figure, C.Ultrasonographic image of the right lower quadrant (A) and sagittal reformatted computed tomographic image (B), both showing a thickened wall outpouching (arrow) arising from the vermiform appendix (arrowheads) with inflammatory changes in the surrounding mesenteric fat (asterisk). C, Gross findings of excised appendix (arrowheads) reveal an inflamed wall outpouching (arrow) and mesenteric fat (asterisk).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Acute appendicitis with colon diverticula\nB. Acute appendiceal diverticulitis\nC. Appendiceal mucocele\nD. Appendiceal diverticulum\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 50-year-old White patient presented to the emergency department with a 4-day history of right lower quadrant pain that did not migrate during that period of time. On examination, they tested positive for the Blumberg sign. Blood analysis showed leucocytosis, neutrophilia, and an increased level of C-reactive protein. Ultrasonographic (Figure, A) and computed tomographic images (Figure, B) showed a thickened wall outpouching arising from a discreetly thickened appendix and inflamed surrounding fat. Right-sided colonic diverticulosis was also seen. The White patient underwent an appendectomy with gross findings as shown in Figure, C.Ultrasonographic image of the right lower quadrant (A) and sagittal reformatted computed tomographic image (B), both showing a thickened wall outpouching (arrow) arising from the vermiform appendix (arrowheads) with inflammatory changes in the surrounding mesenteric fat (asterisk). C, Gross findings of excised appendix (arrowheads) reveal an inflamed wall outpouching (arrow) and mesenteric fat (asterisk).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Acute appendicitis with colon diverticula\nB. Acute appendiceal diverticulitis\nC. Appendiceal mucocele\nD. Appendiceal diverticulum\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 50-year-old Arab woman presented to the emergency department with a 4-day history of right lower quadrant pain that did not migrate during that period of time. On examination, she tested positive for the Blumberg sign. Blood analysis showed leucocytosis, neutrophilia, and an increased level of C-reactive protein. Ultrasonographic (Figure, A) and computed tomographic images (Figure, B) showed a thickened wall outpouching arising from a discreetly thickened appendix and inflamed surrounding fat. Right-sided colonic diverticulosis was also seen. The Arab woman underwent an appendectomy with gross findings as shown in Figure, C.Ultrasonographic image of the right lower quadrant (A) and sagittal reformatted computed tomographic image (B), both showing a thickened wall outpouching (arrow) arising from the vermiform appendix (arrowheads) with inflammatory changes in the surrounding mesenteric fat (asterisk). C, Gross findings of excised appendix (arrowheads) reveal an inflamed wall outpouching (arrow) and mesenteric fat (asterisk).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Acute appendicitis with colon diverticula\nB. Acute appendiceal diverticulitis\nC. Appendiceal mucocele\nD. Appendiceal diverticulum\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 85-year-old man with lung cancer (stage IV, adenocarcinoma) was treated with the epidermal growth factor receptor [EGFR] inhibitor gefitinib (250 mg/d). One month later, he developed a few erythematous follicular papules with focal scaling on the scalp, which intermittently improved and worsened and were reasonably well controlled with topical corticosteroids. Neither pustules nor hair loss was noted. The cancer was well controlled for 31 months, when his tumor recurred and he was switched to erlotinib (150 mg/d). Subsequently, the number of scalp lesions increased, accompanied by pustules and hair loss. Numerous pustules with an erythematous base were observed on the scalp vertex (Figure 1). Paronychia, pruritus, and dry skin were also present, but the pustular eruption was limited to the scalp. Neither fever nor other constitutional symptoms were noted. Testing of the scalp lesions using a potassium hydroxide (KOH) preparation produced negative results.Do nothing; the rash usually resolves over time\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a Tzanck smear from the pustules\nB. Obtain a skin biopsy from the pustules\nC. Obtain a bacterial culture from the pustules\nD. Do nothing; the rash usually resolves over time\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 85-year-old Asian man with lung cancer (stage IV, adenocarcinoma) was treated with the epidermal growth factor receptor [EGFR] inhibitor gefitinib (250 mg/d). One month later, he developed a few erythematous follicular papules with focal scaling on the scalp, which intermittently improved and worsened and were reasonably well controlled with topical corticosteroids. Neither pustules nor hair loss was noted. The cancer was well controlled for 31 months, when his tumor recurred and he was switched to erlotinib (150 mg/d). Subsequently, the number of scalp lesions increased, accompanied by pustules and hair loss. Numerous pustules with an erythematous base were observed on the scalp vertex (Figure 1). Paronychia, pruritus, and dry skin were also present, but the pustular eruption was limited to the scalp. Neither fever nor other constitutional symptoms were noted. Testing of the scalp lesions using a potassium hydroxide (KOH) preparation produced negative results.Do nothing; the rash usually resolves over time\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a Tzanck smear from the pustules\nB. Obtain a skin biopsy from the pustules\nC. Obtain a bacterial culture from the pustules\nD. Do nothing; the rash usually resolves over time\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 85-year-old Black patient with lung cancer (stage IV, adenocarcinoma) was treated with the epidermal growth factor receptor [EGFR] inhibitor gefitinib (250 mg/d). One month later, they developed a few erythematous follicular papules with focal scaling on the scalp, which intermittently improved and worsened and were reasonably well controlled with topical corticosteroids. Neither pustules nor hair loss was noted. The cancer was well controlled for 31 months, when their tumor recurred and they was switched to erlotinib (150 mg/d). Subsequently, the number of scalp lesions increased, accompanied by pustules and hair loss. Numerous pustules with an erythematous base were observed on the scalp vertex (Figure 1). Paronychia, pruritus, and dry skin were also present, but the pustular eruption was limited to the scalp. Neither fever nor other constitutional symptoms were noted. Testing of the scalp lesions using a potassium hydroxide (KOH) preparation produced negative results.Do nothing; the rash usually resolves over time\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a Tzanck smear from the pustules\nB. Obtain a skin biopsy from the pustules\nC. Obtain a bacterial culture from the pustules\nD. Do nothing; the rash usually resolves over time\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 85-year-old Hispanic woman with lung cancer (stage IV, adenocarcinoma) was treated with the epidermal growth factor receptor [EGFR] inhibitor gefitinib (250 mg/d). One month later, she developed a few erythematous follicular papules with focal scaling on the scalp, which intermittently improved and worsened and were reasonably well controlled with topical corticosteroids. Neither pustules nor hair loss was noted. The cancer was well controlled for 31 months, when her tumor recurred and she was switched to erlotinib (150 mg/d). Subsequently, the number of scalp lesions increased, accompanied by pustules and hair loss. Numerous pustules with an erythematous base were observed on the scalp vertex (Figure 1). Paronychia, pruritus, and dry skin were also present, but the pustular eruption was limited to the scalp. Neither fever nor other constitutional symptoms were noted. Testing of the scalp lesions using a potassium hydroxide (KOH) preparation produced negative results.Do nothing; the rash usually resolves over time\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Obtain a Tzanck smear from the pustules\nB. Obtain a skin biopsy from the pustules\nC. Obtain a bacterial culture from the pustules\nD. Do nothing; the rash usually resolves over time\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 4-day-old male neonate born at 36 weeks via cesarean delivery because of breech positioning presented with a vesicular rash that developed hours after birth. The mother was 22 years old, gravida 3, para 3, without significant comorbid conditions. She received prenatal care during the pregnancy and was negative for hepatitis B surface antigen, human immunodeficiency virus, and reactive rapid plasma reagin. During prenatal care she tested positive for group B streptococcus and received appropriate treatment. She denied a history of sexually transmitted infections, cold sores, or genital lesions. Physical examination of the neonate demonstrated a preterm, nondistressed, healthy-appearing patient, with normal vital signs. Multiple 7- to 8-mm vesicles with erythematous bases, some with hemorrhagic crusting and others filled with clear fluid, were scattered over the chest, back, and extremities (Figure 1). Oropharyngeal lesions and neurologic deficits were not present. The remainder of the examination was unremarkable.Widespread vesicles, some with hemorrhagic crusting, on the back of a 4-day-old neonate.Obtain a skin biopsy of a vesicle for pathologic evaluationPerform rapid direct fluorescence antibody testing from a vesicle\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Perform rapid direct fluorescence antibody testing from a vesicle\nB. Do nothing; the lesions will resolve spontaneously\nC. Administer broad-spectrum antibiotics\nD. Obtain a skin biopsy of a vesicle for pathologic evaluation\n</options>" }, { "role": "assistant", "content": "A" } ]