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[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 4-day-old White person 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. They 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 they tested positive for group B streptococcus and received appropriate treatment. They denied a history of sexually transmitted infections, cold sores, or genital lesions. Physical examination of the neonate demonstrated a preterm, nondistressed, healthy-appearing White 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" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow 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 Arab female 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. They 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 they tested positive for group B streptococcus and received appropriate treatment. They denied a history of sexually transmitted infections, cold sores, or genital lesions. Physical examination of the neonate demonstrated a preterm, nondistressed, healthy-appearing Arab woman, 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" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow 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 Asian 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 Asian 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" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow 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 woman with a history of migraine headaches presented to our emergency department with the sudden onset of blurred vision and a frontal headache. She reported a normal eye examination by an optometrist 6 months prior and no history of corrective lens wear. Her visual acuity without correction in each eye was count fingers at 5 ft with pinhole improvement to 20/200. The pupils were 4 mm OU and unreactive. On slitlamp examination, the anterior chambers were shallow and the angles on gonioscopy were closed in each eye (Figure). The undilated fundus examination revealed normal-appearing optic nerves with cup-to-disc ratios of 0.2. Intraocular pressures were 48 mm Hg OD and 49 mm Hg OS. When given a [minus sign]6.50 D sphere trial lens, her visual acuity improved to 20/20 OD and 20/25 OS. When asked about her medications, she reported that she recently discontinued a medication for migraine headaches.Patient at presentation with shallow anterior chambers (A) and closed angles on gonioscopy (B).Obtain a detailed list of the patient[right single quotation mark]s medications\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Proceed directly to choroidal drainage sclerotomy\nB. Administer a miotic agent (ie, pilocarpine)\nC. Perform laser peripheral iridotomy\nD. Obtain a detailed list of the patient[right single quotation mark]s medications\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 30-year-old Black patient with a history of migraine headaches presented to our emergency department with the sudden onset of blurred vision and a frontal headache. They reported a normal eye examination by an optometrist 6 months prior and no history of corrective lens wear. Them visual acuity without correction in each eye was count fingers at 5 ft with pinhole improvement to 20/200. The pupils were 4 mm OU and unreactive. On slitlamp examination, the anterior chambers were shallow and the angles on gonioscopy were closed in each eye (Figure). The undilated fundus examination revealed normal-appearing optic nerves with cup-to-disc ratios of 0.2. Intraocular pressures were 48 mm Hg OD and 49 mm Hg OS. When given a [minus sign]6.50 D sphere trial lens, them visual acuity improved to 20/20 OD and 20/25 OS. When asked about them medications, they reported that they recently discontinued a medication for migraine headaches.Black patient at presentation with shallow anterior chambers (A) and closed angles on gonioscopy (B).Obtain a detailed list of the Black patient[right single quotation mark]s medications\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Proceed directly to choroidal drainage sclerotomy\nB. Administer a miotic agent (ie, pilocarpine)\nC. Perform laser peripheral iridotomy\nD. Obtain a detailed list of the patient[right single quotation mark]s medications\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 30-year-old Hispanic man with a history of migraine headaches presented to our emergency department with the sudden onset of blurred vision and a frontal headache. He reported a normal eye examination by an optometrist 6 months prior and no history of corrective lens wear. Him visual acuity without correction in each eye was count fingers at 5 ft with pinhole improvement to 20/200. The pupils were 4 mm OU and unreactive. On slitlamp examination, the anterior chambers were shallow and the angles on gonioscopy were closed in each eye (Figure). The undilated fundus examination revealed normal-appearing optic nerves with cup-to-disc ratios of 0.2. Intraocular pressures were 48 mm Hg OD and 49 mm Hg OS. When given a [minus sign]6.50 D sphere trial lens, him visual acuity improved to 20/20 OD and 20/25 OS. When asked about him medications, he reported that he recently discontinued a medication for migraine headaches.Hispanic man at presentation with shallow anterior chambers (A) and closed angles on gonioscopy (B).Obtain a detailed list of the Hispanic man[right single quotation mark]s medications\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Proceed directly to choroidal drainage sclerotomy\nB. Administer a miotic agent (ie, pilocarpine)\nC. Perform laser peripheral iridotomy\nD. Obtain a detailed list of the patient[right single quotation mark]s medications\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 30-year-old White woman with a history of migraine headaches presented to our emergency department with the sudden onset of blurred vision and a frontal headache. She reported a normal eye examination by an optometrist 6 months prior and no history of corrective lens wear. Her visual acuity without correction in each eye was count fingers at 5 ft with pinhole improvement to 20/200. The pupils were 4 mm OU and unreactive. On slitlamp examination, the anterior chambers were shallow and the angles on gonioscopy were closed in each eye (Figure). The undilated fundus examination revealed normal-appearing optic nerves with cup-to-disc ratios of 0.2. Intraocular pressures were 48 mm Hg OD and 49 mm Hg OS. When given a [minus sign]6.50 D sphere trial lens, her visual acuity improved to 20/20 OD and 20/25 OS. When asked about her medications, she reported that she recently discontinued a medication for migraine headaches.White Patient at presentation with shallow anterior chambers (A) and closed angles on gonioscopy (B).Obtain a detailed list of the White patient[right single quotation mark]s medications\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Proceed directly to choroidal drainage sclerotomy\nB. Administer a miotic agent (ie, pilocarpine)\nC. Perform laser peripheral iridotomy\nD. Obtain a detailed list of the patient[right single quotation mark]s medications\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 5-year-old boy, known to have acute lymphoblastic leukemia since the age of 3 years, presented with a 3-week history of asymptomatic skin lesions primarily affecting the face and to a lesser extent the trunk and extremities (Figure, A and B). He had been undergoing a maintenance chemotherapy regimen consisting of vincristine sulfate, 6-mercaptopurine, methotrexate, and high-dose prednisone. He did not undergo bone marrow or stem cell transplant as part of his treatment. Multiple topical medications including keratolytics were applied to the affected areas without effect.Skin examination and microscopy analysis of punch biopsy specimen. A and B, Multiple tiny, spiny, follicular hyperkeratotic papules on the face. C and D, Microscopy showed abnormal maturation of anagen hair follicles with excessive inner root sheath differentiation (original magnification [multiplication sign]4 [C] and [multiplication sign]40 [D]).Skin examination revealed multiple 1- to 3-mm, spiny, follicular, flesh-colored to erythematous hyperkeratotic papules predominantly on the face and to a lesser extent on the trunk, and extremities, with fine hairlike spicules emanating from most of them (Figure, A and B). Alopecia was also noted involving the eyebrows and the eyelashes, but the scalp was spared. A punch biopsy specimen was taken (Figure, C and D).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Virus-associated trichodysplasia spinulosa\nB. Filiform verrucae\nC. Phrynoderma\nD. Keratosis pilaris\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 5-year-old Arab girl, known to have acute lymphoblastic leukemia since the age of 3 years, presented with a 3-week history of asymptomatic skin lesions primarily affecting the face and to a lesser extent the trunk and extremities (Figure, A and B). She had been undergoing a maintenance chemotherapy regimen consisting of vincristine sulfate, 6-mercaptopurine, methotrexate, and high-dose prednisone. She did not undergo bone marrow or stem cell transplant as part of her treatment. Multiple topical medications including keratolytics were applied to the affected areas without effect.Skin examination and microscopy analysis of punch biopsy specimen. A and B, Multiple tiny, spiny, follicular hyperkeratotic papules on the face. C and D, Microscopy showed abnormal maturation of anagen hair follicles with excessive inner root sheath differentiation (original magnification [multiplication sign]4 [C] and [multiplication sign]40 [D]).Skin examination revealed multiple 1- to 3-mm, spiny, follicular, flesh-colored to erythematous hyperkeratotic papules predominantly on the face and to a lesser extent on the trunk, and extremities, with fine hairlike spicules emanating from most of them (Figure, A and B). Alopecia was also noted involving the eyebrows and the eyelashes, but the scalp was spared. A punch biopsy specimen was taken (Figure, C and D).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Virus-associated trichodysplasia spinulosa\nB. Filiform verrucae\nC. Phrynoderma\nD. Keratosis pilaris\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 5-year-old Asian boy, known to have acute lymphoblastic leukemia since the age of 3 years, presented with a 3-week history of asymptomatic skin lesions primarily affecting the face and to a lesser extent the trunk and extremities (Figure, A and B). He had been undergoing a maintenance chemotherapy regimen consisting of vincristine sulfate, 6-mercaptopurine, methotrexate, and high-dose prednisone. He did not undergo bone marrow or stem cell transplant as part of his treatment. Multiple topical medications including keratolytics were applied to the affected areas without effect.Skin examination and microscopy analysis of punch biopsy specimen. A and B, Multiple tiny, spiny, follicular hyperkeratotic papules on the face. C and D, Microscopy showed abnormal maturation of anagen hair follicles with excessive inner root sheath differentiation (original magnification [multiplication sign]4 [C] and [multiplication sign]40 [D]).Skin examination revealed multiple 1- to 3-mm, spiny, follicular, flesh-colored to erythematous hyperkeratotic papules predominantly on the face and to a lesser extent on the trunk, and extremities, with fine hairlike spicules emanating from most of them (Figure, A and B). Alopecia was also noted involving the eyebrows and the eyelashes, but the scalp was spared. A punch biopsy specimen was taken (Figure, C and D).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Virus-associated trichodysplasia spinulosa\nB. Filiform verrucae\nC. Phrynoderma\nD. Keratosis pilaris\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 5-year-old Black child, known to have acute lymphoblastic leukemia since the age of 3 years, presented with a 3-week history of asymptomatic skin lesions primarily affecting the face and to a lesser extent the trunk and extremities (Figure, A and B). They had been undergoing a maintenance chemotherapy regimen consisting of vincristine sulfate, 6-mercaptopurine, methotrexate, and high-dose prednisone. They did not undergo bone marrow or stem cell transplant as part of their treatment. Multiple topical medications including keratolytics were applied to the affected areas without effect.Skin examination and microscopy analysis of punch biopsy specimen. A and B, Multiple tiny, spiny, follicular hyperkeratotic papules on the face. C and D, Microscopy showed abnormal maturation of anagen hair follicles with excessive inner root sheath differentiation (original magnification [multiplication sign]4 [C] and [multiplication sign]40 [D]).Skin examination revealed multiple 1- to 3-mm, spiny, follicular, flesh-colored to erythematous hyperkeratotic papules predominantly on the face and to a lesser extent on the trunk, and extremities, with fine hairlike spicules emanating from most of them (Figure, A and B). Alopecia was also noted involving the eyebrows and the eyelashes, but the scalp was spared. A punch biopsy specimen was taken (Figure, C and D).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Virus-associated trichodysplasia spinulosa\nB. Filiform verrucae\nC. Phrynoderma\nD. Keratosis pilaris\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 89-year-old woman presented to her geriatrician with abdominal pain for 2 days. The pain was localized to her right abdomen, both upper and lower quadrants, with acute tenderness to palpation. She had some nausea and vomiting. Ultrasonographic findings gave concern for acute cholecystitis. A computed tomographic scan was ordered by her primary care physician after admission to the hospital (Figure).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Acute cholecystitis\nB. Gallbladder volvulus\nC. Gallbladder cancer\nD. Gallbladder polyp\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 89-year-old Hispanic woman presented to her geriatrician with abdominal pain for 2 days. The pain was localized to her right abdomen, both upper and lower quadrants, with acute tenderness to palpation. She had some nausea and vomiting. Ultrasonographic findings gave concern for acute cholecystitis. A computed tomographic scan was ordered by her primary care physician after admission to the hospital (Figure).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Acute cholecystitis\nB. Gallbladder volvulus\nC. Gallbladder cancer\nD. Gallbladder polyp\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 89-year-old White man presented to him geriatrician with abdominal pain for 2 days. The pain was localized to him right abdomen, both upper and lower quadrants, with acute tenderness to palpation. He had some nausea and vomiting. Ultrasonographic findings gave concern for acute cholecystitis. A computed tomographic scan was ordered by him primary care physician after admission to the hospital (Figure).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Acute cholecystitis\nB. Gallbladder volvulus\nC. Gallbladder cancer\nD. Gallbladder polyp\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 89-year-old Arab patient presented to them geriatrician with abdominal pain for 2 days. The pain was localized to them right abdomen, both upper and lower quadrants, with acute tenderness to palpation. They had some nausea and vomiting. Ultrasonographic findings gave concern for acute cholecystitis. A computed tomographic scan was ordered by them primary care physician after admission to the hospital (Figure).\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Acute cholecystitis\nB. Gallbladder volvulus\nC. Gallbladder cancer\nD. Gallbladder polyp\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 28-year-old previously healthy man developed constant mid-epigastric and supraumbilical abdominal pain. One day after the onset of pain, he presented to the emergency department. The patient described his pain intensity as 8 on a scale of 1 to 10. He also described having some nausea but no anorexia, and he experienced a single episode of emesis in the emergency department. He was afebrile, and his heart rate was 86 beats/min; blood pressure, 128/86 mm Hg; and body mass index, 28 (calculated as weight in kilograms divided by height in meters squared). Bilateral lower abdominal and supraumbilical tenderness was present, as was lower abdominal voluntary guarding to palpation. Deep palpation of the left lower quadrant did not elicit pain over the right lower quadrant (ie, negative Rovsing sign). Internal and external rotation of the flexed right leg did not elicit pain (ie, negative obturator sign). Dorsiflexion of the right thigh against the examiner[right single quotation mark]s hand resulted in right lower quadrant pain (ie, positive psoas sign). Rectal examination was unrevealing. Levels of liver function enzymes, amylase, and bilirubin were normal, as was a complete blood cell count, except for leukocytosis of 14[thin space]000 cells/mm3. Urinalysis was unremarkable. A computed tomography (CT) scan was obtained (Figure 1).Computed tomography scan in the case patient. A, Axial view. B, Coronal view. C, Sagittal view.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Initiate broad-spectrum antibiotics and serial abdominal examinations\nB. Admit the patient for observation\nC. Perform laparoscopic appendectomy\nD. Obtain an abdominal ultrasound\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 28-year-old previously healthy Asian woman developed constant mid-epigastric and supraumbilical abdominal pain. One day after the onset of pain, she presented to the emergency department. The Asian woman described her pain intensity as 8 on a scale of 1 to 10. She also described having some nausea but no anorexia, and she experienced a single episode of emesis in the emergency department. She was afebrile, and her heart rate was 86 beats/min; blood pressure, 128/86 mm Hg; and body mass index, 28 (calculated as weight in kilograms divided by height in meters squared). Bilateral lower abdominal and supraumbilical tenderness was present, as was lower abdominal voluntary guarding to palpation. Deep palpation of the left lower quadrant did not elicit pain over the right lower quadrant (ie, negative Rovsing sign). Internal and external rotation of the flexed right leg did not elicit pain (ie, negative obturator sign). Dorsiflexion of the right thigh against the examiner[right single quotation mark]s hand resulted in right lower quadrant pain (ie, positive psoas sign). Rectal examination was unrevealing. Levels of liver function enzymes, amylase, and bilirubin were normal, as was a complete blood cell count, except for leukocytosis of 14[thin space]000 cells/mm3. Urinalysis was unremarkable. A computed tomography (CT) scan was obtained (Figure 1).Computed tomography scan in the case Asian woman. A, Axial view. B, Coronal view. C, Sagittal view.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Initiate broad-spectrum antibiotics and serial abdominal examinations\nB. Admit the patient for observation\nC. Perform laparoscopic appendectomy\nD. Obtain an abdominal ultrasound\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 28-year-old previously healthy Black patient developed constant mid-epigastric and supraumbilical abdominal pain. One day after the onset of pain, they presented to the emergency department. The Black patient described their pain intensity as 8 on a scale of 1 to 10. They also described having some nausea but no anorexia, and they experienced a single episode of emesis in the emergency department. They was afebrile, and their heart rate was 86 beats/min; blood pressure, 128/86 mm Hg; and body mass index, 28 (calculated as weight in kilograms divided by height in meters squared). Bilateral lower abdominal and supraumbilical tenderness was present, as was lower abdominal voluntary guarding to palpation. Deep palpation of the left lower quadrant did not elicit pain over the right lower quadrant (ie, negative Rovsing sign). Internal and external rotation of the flexed right leg did not elicit pain (ie, negative obturator sign). Dorsiflexion of the right thigh against the examiner[right single quotation mark]s hand resulted in right lower quadrant pain (ie, positive psoas sign). Rectal examination was unrevealing. Levels of liver function enzymes, amylase, and bilirubin were normal, as was a complete blood cell count, except for leukocytosis of 14[thin space]000 cells/mm3. Urinalysis was unremarkable. A computed tomography (CT) scan was obtained (Figure 1).Computed tomography scan in the case Black patient. A, Axial view. B, Coronal view. C, Sagittal view.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Initiate broad-spectrum antibiotics and serial abdominal examinations\nB. Admit the patient for observation\nC. Perform laparoscopic appendectomy\nD. Obtain an abdominal ultrasound\n</options>" }, { "role": "assistant", "content": "C" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA 28-year-old previously healthy Hispanic man developed constant mid-epigastric and supraumbilical abdominal pain. One day after the onset of pain, he presented to the emergency department. The Hispanic patient described his pain intensity as 8 on a scale of 1 to 10. He also described having some nausea but no anorexia, and he experienced a single episode of emesis in the emergency department. He was afebrile, and his heart rate was 86 beats/min; blood pressure, 128/86 mm Hg; and body mass index, 28 (calculated as weight in kilograms divided by height in meters squared). Bilateral lower abdominal and supraumbilical tenderness was present, as was lower abdominal voluntary guarding to palpation. Deep palpation of the left lower quadrant did not elicit pain over the right lower quadrant (ie, negative Rovsing sign). Internal and external rotation of the flexed right leg did not elicit pain (ie, negative obturator sign). Dorsiflexion of the right thigh against the examiner[right single quotation mark]s hand resulted in right lower quadrant pain (ie, positive psoas sign). Rectal examination was unrevealing. Levels of liver function enzymes, amylase, and bilirubin were normal, as was a complete blood cell count, except for leukocytosis of 14[thin space]000 cells/mm3. Urinalysis was unremarkable. A computed tomography (CT) scan was obtained (Figure 1).Computed tomography scan in the case Hispanic patient. A, Axial view. B, Coronal view. C, Sagittal view.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Initiate broad-spectrum antibiotics and serial abdominal examinations\nB. Admit the patient for observation\nC. Perform laparoscopic appendectomy\nD. Obtain an abdominal ultrasound\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 73-year-old man with a 2- to 3-week history of herpes zoster in the left T11-T12 dermatomes developed a painful, progressive bulge in his left flank. The bulge was more prominent on standing, coughing, and straining. Antiviral agents were not administered when he first developed zoster because the diagnosis was established more than 72 hours after first presentation of the disease. Neither fever nor chills were reported. The patient[right single quotation mark]s medical history was notable for a 30-year history of hypertension and diabetes. Physical examination revealed a reducible protrusion in the left flank, with several red to light brown macules on the overlying skin (Figure). Computed tomography (CT) of the abdomen showed convexity of the left lower abdominal wall compared with the right and did not reveal any mass, hernia, or accumulation of fluid in the abdominal cavity.A, Lateral view showing hyperpigmented macules on the overlying skin of the left flank bulge. B, Posterior view showing the left flank protrusion.Proceed with expectant treatment over the next few months\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Treat with oral acyclovir\nB. Perform emergency laparoscopy\nC. Request a lower gastrointestinal series\nD. Proceed with expectant treatment over the next few months\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 73-year-old White man with a 2- to 3-week history of herpes zoster in the left T11-T12 dermatomes developed a painful, progressive bulge in his left flank. The bulge was more prominent on standing, coughing, and straining. Antiviral agents were not administered when he first developed zoster because the diagnosis was established more than 72 hours after first presentation of the disease. Neither fever nor chills were reported. The White patient[right single quotation mark]s medical history was notable for a 30-year history of hypertension and diabetes. Physical examination revealed a reducible protrusion in the left flank, with several red to light brown macules on the overlying skin (Figure). Computed tomography (CT) of the abdomen showed convexity of the left lower abdominal wall compared with the right and did not reveal any mass, hernia, or accumulation of fluid in the abdominal cavity.A, Lateral view showing hyperpigmented macules on the overlying skin of the left flank bulge. B, Posterior view showing the left flank protrusion.Proceed with expectant treatment over the next few months\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Treat with oral acyclovir\nB. Perform emergency laparoscopy\nC. Request a lower gastrointestinal series\nD. Proceed with expectant treatment over the next few months\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 73-year-old Arab woman with a 2- to 3-week history of herpes zoster in the left T11-T12 dermatomes developed a painful, progressive bulge in her left flank. The bulge was more prominent on standing, coughing, and straining. Antiviral agents were not administered when she first developed zoster because the diagnosis was established more than 72 hours after first presentation of the disease. Neither fever nor chills were reported. The Arab woman[right single quotation mark]s medical history was notable for a 30-year history of hypertension and diabetes. Physical examination revealed a reducible protrusion in the left flank, with several red to light brown macules on the overlying skin (Figure). Computed tomography (CT) of the abdomen showed convexity of the left lower abdominal wall compared with the right and did not reveal any mass, hernia, or accumulation of fluid in the abdominal cavity.A, Lateral view showing hyperpigmented macules on the overlying skin of the left flank bulge. B, Posterior view showing the left flank protrusion.Proceed with expectant treatment over the next few months\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Treat with oral acyclovir\nB. Perform emergency laparoscopy\nC. Request a lower gastrointestinal series\nD. Proceed with expectant treatment over the next few months\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 73-year-old Asian patient with a 2- to 3-week history of herpes zoster in the left T11-T12 dermatomes developed a painful, progressive bulge in their left flank. The bulge was more prominent on standing, coughing, and straining. Antiviral agents were not administered when they first developed zoster because the diagnosis was established more than 72 hours after first presentation of the disease. Neither fever nor chills were reported. The Asian patient[right single quotation mark]s medical history was notable for a 30-year history of hypertension and diabetes. Physical examination revealed a reducible protrusion in the left flank, with several red to light brown macules on the overlying skin (Figure). Computed tomography (CT) of the abdomen showed convexity of the left lower abdominal wall compared with the right and did not reveal any mass, hernia, or accumulation of fluid in the abdominal cavity.A, Lateral view showing hyperpigmented macules on the overlying skin of the left flank bulge. B, Posterior view showing the left flank protrusion.Proceed with expectant treatment over the next few months\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Treat with oral acyclovir\nB. Perform emergency laparoscopy\nC. Request a lower gastrointestinal series\nD. Proceed with expectant treatment over the next few months\n</options>" }, { "role": "assistant", "content": "D" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA man presented to the emergency department after being shot in the face. On primary and secondary survey, he had a patent airway, was hemodynamically stable, and had a single entrance wound over the right mandible. No exit wound was visible. The appearance of his oropharynx was unremarkable. The trachea was in midline, and breath sounds were clear and equal in all lung fields. The patient had a persistent dry cough. Radiography of the chest showed a foreign body in the right side of the chest (Figure, A). After this initial imaging, the patient was log-rolled onto his left side, and a computed tomography (CT) scan of the chest was obtained (Figure, B).A, Anteroposterior chest radiograph taken in the trauma bay on arrival. B, Computed tomography scan of the chest: coronal slice with intravenous contrast, revealing the location of a foreign body.Perform a thoracotomy to remove the foreign body\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Perform flexible bronchoscopy\nB. Perform angiography\nC. Perform a thoracotomy to remove the foreign body\nD. Locally explore the mandibular wound\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Black patient presented to the emergency department after being shot in the face. On primary and secondary survey, they had a patent airway, was hemodynamically stable, and had a single entrance wound over the right mandible. No exit wound was visible. The appearance of their oropharynx was unremarkable. The trachea was in midline, and breath sounds were clear and equal in all lung fields. The Black patient had a persistent dry cough. Radiography of the chest showed a foreign body in the right side of the chest (Figure, A). After this initial imaging, the Black patient was log-rolled onto their left side, and a computed tomography (CT) scan of the chest was obtained (Figure, B).A, Anteroposterior chest radiograph taken in the trauma bay on arrival. B, Computed tomography scan of the chest: coronal slice with intravenous contrast, revealing the location of a foreign body.Perform a thoracotomy to remove the foreign body\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Perform flexible bronchoscopy\nB. Perform angiography\nC. Perform a thoracotomy to remove the foreign body\nD. Locally explore the mandibular wound\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA Hispanic woman presented to the emergency department after being shot in the face. On primary and secondary survey, she had a patent airway, was hemodynamically stable, and had a single entrance wound over the right mandible. No exit wound was visible. The appearance of her oropharynx was unremarkable. The trachea was in midline, and breath sounds were clear and equal in all lung fields. The Hispanic woman had a persistent dry cough. Radiography of the chest showed a foreign body in the right side of the chest (Figure, A). After this initial imaging, the Hispanic woman was log-rolled onto her left side, and a computed tomography (CT) scan of the chest was obtained (Figure, B).A, Anteroposterior chest radiograph taken in the trauma bay on arrival. B, Computed tomography scan of the chest: coronal slice with intravenous contrast, revealing the location of a foreign body.Perform a thoracotomy to remove the foreign body\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Perform flexible bronchoscopy\nB. Perform angiography\nC. Perform a thoracotomy to remove the foreign body\nD. Locally explore the mandibular wound\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA White man presented to the emergency department after being shot in the face. On primary and secondary survey, he had a patent airway, was hemodynamically stable, and had a single entrance wound over the right mandible. No exit wound was visible. The appearance of his oropharynx was unremarkable. The trachea was in midline, and breath sounds were clear and equal in all lung fields. The White patient had a persistent dry cough. Radiography of the chest showed a foreign body in the right side of the chest (Figure, A). After this initial imaging, the White patient was log-rolled onto his left side, and a computed tomography (CT) scan of the chest was obtained (Figure, B).A, Anteroposterior chest radiograph taken in the trauma bay on arrival. B, Computed tomography scan of the chest: coronal slice with intravenous contrast, revealing the location of a foreign body.Perform a thoracotomy to remove the foreign body\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Perform flexible bronchoscopy\nB. Perform angiography\nC. Perform a thoracotomy to remove the foreign body\nD. Locally explore the mandibular wound\n</options>" }, { "role": "assistant", "content": "A" } ]

[ { "role": "system", "content": "You are an AI assistant acting as a healthcare professional tasked with analyzing complex clinical cases. You will be presented with a clinical case and a set of options. Your role is to:\n\n1. Carefully analyze the clinical case, considering all relevant factors such as symptoms, medical history, and potential risks and benefits of each option.\n2. Select the most appropriate option from those provided.\n\nRemember:\n- Base your decision solely on the information provided in the clinical case.\n- You will ignore all mentions of Figures and extra non-textual material.\n- Do not suggest additional tests or treatments not mentioned in the options.\n- Your response should be in a specific format: the chosen option letter.\n- Only use the options provided (A, B, C, or D) in the Answer.\n\nYour answer will follow this format:\n(Answer - label ONLY)" }, { "role": "user", "content": "Please analyze the following clinical case and the related question:\n\n<clinical_case>\nA healthy 26-year-old woman complains of 3 days of increasing [left double quotation mark]lines across my vision[right double quotation mark] and a few photopsias in the right eye. She denies ocular discomfort or systemic symptoms. She has no ophthalmic or medical history and denies recent travel or abnormal exposures. Her uncorrected acuity is 20/60 OD without improvement with pinhole and 20/20 OS. Her pupils, intraocular pressure, motility, and confrontational visual fields are normal in each eye. Results of the external examination and slitlamp examination of the anterior segment of both eyes are unremarkable. Dilated examination findings of the left eye are normal. Results of the dilated examination of the right eye reveal a clear vitreous and the findings shown in Figure 1.Order urgent serum titers of IgG and IgM for Ancylostoma caninum and Baylisascaris procyonis\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Begin systemic antihelmintic therapy\nB. Photocoagulation\nC. Order urgent serum titers of IgG and IgM for Ancylostoma caninum and Baylisascaris procyonis\nD. Pars plana vitrectomy\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 healthy 26-year-old Arab man complains of 3 days of increasing [left double quotation mark]lines across my vision[right double quotation mark] and a few photopsias in the right eye. He denies ocular discomfort or systemic symptoms. He has no ophthalmic or medical history and denies recent travel or abnormal exposures. Him uncorrected acuity is 20/60 OD without improvement with pinhole and 20/20 OS. Him pupils, intraocular pressure, motility, and confrontational visual fields are normal in each eye. Results of the external examination and slitlamp examination of the anterior segment of both eyes are unremarkable. Dilated examination findings of the left eye are normal. Results of the dilated examination of the right eye reveal a clear vitreous and the findings shown in Figure 1.Order urgent serum titers of IgG and IgM for Ancylostoma caninum and Baylisascaris procyonis\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Begin systemic antihelmintic therapy\nB. Photocoagulation\nC. Order urgent serum titers of IgG and IgM for Ancylostoma caninum and Baylisascaris procyonis\nD. Pars plana vitrectomy\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 healthy 26-year-old Asian patient complains of 3 days of increasing [left double quotation mark]lines across my vision[right double quotation mark] and a few photopsias in the right eye. They denies ocular discomfort or systemic symptoms. They has no ophthalmic or medical history and denies recent travel or abnormal exposures. Them uncorrected acuity is 20/60 OD without improvement with pinhole and 20/20 OS. Them pupils, intraocular pressure, motility, and confrontational visual fields are normal in each eye. Results of the external examination and slitlamp examination of the anterior segment of both eyes are unremarkable. Dilated examination findings of the left eye are normal. Results of the dilated examination of the right eye reveal a clear vitreous and the findings shown in Figure 1.Order urgent serum titers of IgG and IgM for Ancylostoma caninum and Baylisascaris procyonis\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Begin systemic antihelmintic therapy\nB. Photocoagulation\nC. Order urgent serum titers of IgG and IgM for Ancylostoma caninum and Baylisascaris procyonis\nD. Pars plana vitrectomy\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 healthy 26-year-old Black woman complains of 3 days of increasing [left double quotation mark]lines across my vision[right double quotation mark] and a few photopsias in the right eye. She denies ocular discomfort or systemic symptoms. She has no ophthalmic or medical history and denies recent travel or abnormal exposures. Her uncorrected acuity is 20/60 OD without improvement with pinhole and 20/20 OS. Her pupils, intraocular pressure, motility, and confrontational visual fields are normal in each eye. Results of the external examination and slitlamp examination of the anterior segment of both eyes are unremarkable. Dilated examination findings of the left eye are normal. Results of the dilated examination of the right eye reveal a clear vitreous and the findings shown in Figure 1.Order urgent serum titers of IgG and IgM for Ancylostoma caninum and Baylisascaris procyonis\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Begin systemic antihelmintic therapy\nB. Photocoagulation\nC. Order urgent serum titers of IgG and IgM for Ancylostoma caninum and Baylisascaris procyonis\nD. Pars plana vitrectomy\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 23-year-old woman had a progressively enlarging mass associated with abdominal distention and a dragging type of discomfort for 1 week. She denied any history of hematemesis or hematochezia. On abdominal examination, an irregular mass measuring 20[thin space][multiplication sign][thin space]10 cm without tenderness was found, and no bruit was heard on auscultation. No other vascular anomalies were detected on systemic examination. All laboratory test results were within normal limits. Upper gastrointestinal endoscopy showed normal gastric mucosa. Nonenhanced computed tomography of the abdomen showed a partially well-circumscribed, mixed cystic and solitary mass that partially enveloped the stomach and compressed adjacent organs, likely arising from the stomach (Figure 1).Axial nonenhanced computed tomographic image showing a mixed cystic and solitary mass that partially enveloped the stomach.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Complicated cyst\nB. Gastrointestinal stromal tumor\nC. Exophytic solitary giant cavernous hemangioma of stomach\nD. Neurilemmoma\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 23-year-old Hispanic woman had a progressively enlarging mass associated with abdominal distention and a dragging type of discomfort for 1 week. She denied any history of hematemesis or hematochezia. On abdominal examination, an irregular mass measuring 20[thin space][multiplication sign][thin space]10 cm without tenderness was found, and no bruit was heard on auscultation. No other vascular anomalies were detected on systemic examination. All laboratory test results were within normal limits. Upper gastrointestinal endoscopy showed normal gastric mucosa. Nonenhanced computed tomography of the abdomen showed a partially well-circumscribed, mixed cystic and solitary mass that partially enveloped the stomach and compressed adjacent organs, likely arising from the stomach (Figure 1).Axial nonenhanced computed tomographic image showing a mixed cystic and solitary mass that partially enveloped the stomach.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Complicated cyst\nB. Gastrointestinal stromal tumor\nC. Exophytic solitary giant cavernous hemangioma of stomach\nD. Neurilemmoma\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 23-year-old White patient had a progressively enlarging mass associated with abdominal distention and a dragging type of discomfort for 1 week. They denied any history of hematemesis or hematochezia. On abdominal examination, an irregular mass measuring 20[thin space][multiplication sign][thin space]10 cm without tenderness was found, and no bruit was heard on auscultation. No other vascular anomalies were detected on systemic examination. All laboratory test results were within normal limits. Upper gastrointestinal endoscopy showed normal gastric mucosa. Nonenhanced computed tomography of the abdomen showed a partially well-circumscribed, mixed cystic and solitary mass that partially enveloped the stomach and compressed adjacent organs, likely arising from the stomach (Figure 1).Axial nonenhanced computed tomographic image showing a mixed cystic and solitary mass that partially enveloped the stomach.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Complicated cyst\nB. Gastrointestinal stromal tumor\nC. Exophytic solitary giant cavernous hemangioma of stomach\nD. Neurilemmoma\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 23-year-old Arab man had a progressively enlarging mass associated with abdominal distention and a dragging type of discomfort for 1 week. He denied any history of hematemesis or hematochezia. On abdominal examination, an irregular mass measuring 20[thin space][multiplication sign][thin space]10 cm without tenderness was found, and no bruit was heard on auscultation. No other vascular anomalies were detected on systemic examination. All laboratory test results were within normal limits. Upper gastrointestinal endoscopy showed normal gastric mucosa. Nonenhanced computed tomography of the abdomen showed a partially well-circumscribed, mixed cystic and solitary mass that partially enveloped the stomach and compressed adjacent organs, likely arising from the stomach (Figure 1).Axial nonenhanced computed tomographic image showing a mixed cystic and solitary mass that partially enveloped the stomach.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Complicated cyst\nB. Gastrointestinal stromal tumor\nC. Exophytic solitary giant cavernous hemangioma of stomach\nD. Neurilemmoma\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 44-year-old man with a 3-year history of postprandial chest pain and odynophagia presents with a severe exacerbation of symptoms over 2 months and a weight loss of 8.1 kg. His history included lumbar spine surgery and chronic back pain leading to continued requirement for opiate analgesia. Endoscopy revealed food stasis throughout the esophagus, large diverticula in the lower esophagus, no resistance at the lower esophageal sphincter, and extensive candidiasis. A barium swallow was diagnostic (Figure 1). Esophageal manometry demonstrated 100% hypertensive propagated pressure waves in the distal esophagus, with a mean esophageal pressure of 335 mm Hg, a maximum pressure of 701 mm Hg, and normal relaxation of the lower esophageal sphincter. The patient was treated with antifungal therapy and received a 1-month course of calcium channel antagonists, but symptoms were unchanged and weight loss progressed.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Treat with analgesia and nutritional support\nB. Recommend an extended esophageal myotomy\nC. Recommend esophageal resection\nD. Treat with calcium channel antagonists\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 44-year-old Asian woman with a 3-year history of postprandial chest pain and odynophagia presents with a severe exacerbation of symptoms over 2 months and a weight loss of 8.1 kg. Her history included lumbar spine surgery and chronic back pain leading to continued requirement for opiate analgesia. Endoscopy revealed food stasis throughout the esophagus, large diverticula in the lower esophagus, no resistance at the lower esophageal sphincter, and extensive candidiasis. A barium swallow was diagnostic (Figure 1). Esophageal manometry demonstrated 100% hypertensive propagated pressure waves in the distal esophagus, with a mean esophageal pressure of 335 mm Hg, a maximum pressure of 701 mm Hg, and normal relaxation of the lower esophageal sphincter. The Asian woman was treated with antifungal therapy and received a 1-month course of calcium channel antagonists, but symptoms were unchanged and weight loss progressed.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Treat with analgesia and nutritional support\nB. Recommend an extended esophageal myotomy\nC. Recommend esophageal resection\nD. Treat with calcium channel antagonists\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 44-year-old Black man with a 3-year history of postprandial chest pain and odynophagia presents with a severe exacerbation of symptoms over 2 months and a weight loss of 8.1 kg. His history included lumbar spine surgery and chronic back pain leading to continued requirement for opiate analgesia. Endoscopy revealed food stasis throughout the esophagus, large diverticula in the lower esophagus, no resistance at the lower esophageal sphincter, and extensive candidiasis. A barium swallow was diagnostic (Figure 1). Esophageal manometry demonstrated 100% hypertensive propagated pressure waves in the distal esophagus, with a mean esophageal pressure of 335 mm Hg, a maximum pressure of 701 mm Hg, and normal relaxation of the lower esophageal sphincter. The Black patient was treated with antifungal therapy and received a 1-month course of calcium channel antagonists, but symptoms were unchanged and weight loss progressed.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Treat with analgesia and nutritional support\nB. Recommend an extended esophageal myotomy\nC. Recommend esophageal resection\nD. Treat with calcium channel antagonists\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 44-year-old Hispanic patient with a 3-year history of postprandial chest pain and odynophagia presents with a severe exacerbation of symptoms over 2 months and a weight loss of 8.1 kg. Their history included lumbar spine surgery and chronic back pain leading to continued requirement for opiate analgesia. Endoscopy revealed food stasis throughout the esophagus, large diverticula in the lower esophagus, no resistance at the lower esophageal sphincter, and extensive candidiasis. A barium swallow was diagnostic (Figure 1). Esophageal manometry demonstrated 100% hypertensive propagated pressure waves in the distal esophagus, with a mean esophageal pressure of 335 mm Hg, a maximum pressure of 701 mm Hg, and normal relaxation of the lower esophageal sphincter. The Hispanic patient was treated with antifungal therapy and received a 1-month course of calcium channel antagonists, but symptoms were unchanged and weight loss progressed.\n</clinical_case>\n\n<question>\nWhat would you do next?\n</question>\n\n<options>\nA. Treat with analgesia and nutritional support\nB. Recommend an extended esophageal myotomy\nC. Recommend esophageal resection\nD. Treat with calcium channel antagonists\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 26-year-old man was admitted to our institution for a fever (temperature, 39[degree sign]C) and abdominal pain on the right side of his hypochondrium. He complained of nausea, vomiting, and asthenia as well. His medical history was significant for pharyngitis associated with scarlet fever that he had a month before; the pharyngitis was treated by his general practitioner with clarithromycin (500 mg twice daily for a week). No throat culture or rapid antigen test for group A streptococci was performed at that time. On physical examination, he presented with mild right upper abdominal quadrant tenderness. He met all the criteria for systemic inflammatory response syndrome, and his blood tests showed a marked increase in inflammatory markers. Blood and urine cultures were obtained, and the results were negative. Empirical antibiotic therapy with ampicillin sodium/sulbactam sodium was started. His chest radiograph was normal. An abdominal ultrasonographic examination revealed a 6-cm, solid, inhomogeneous mass in liver segment 6. A contrast-enhanced computed tomographic scan of the abdomen (Figure 1) showed that the lesion was hypodense with numerous septa without contrast enhancement. Magnetic resonance imaging (Figure 2) evidenced a mixed solid-liquid lesion, with some septa delimiting large areas of necrosis. The results of a serological detection test for echinococcosis were negative. His carcinoembryonic antigen, carbohydrate antigen 19-9, and [greek small letter alpha]1-fetoprotein blood levels were normal. Serological markers for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus were negative. A study of leukocyte populations and immunoglobulin electrophoresis did not reveal any disorder of the immune system.Computed tomographic scan showing a large, hypodense, multiloculated lesion in liver segment 6.Magnetic resonance imaging scan showing an heterogeneous, capsulated lesion, with numerous septa delimiting large areas of necrosis.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Hydatid cyst\nB. Hepatic abscess\nC. Infected biliary cystadenoma\nD. Inflammatory pseudotumor of the liver\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 26-year-old White man was admitted to our institution for a fever (temperature, 39[degree sign]C) and abdominal pain on the right side of his hypochondrium. He complained of nausea, vomiting, and asthenia as well. His medical history was significant for pharyngitis associated with scarlet fever that he had a month before; the pharyngitis was treated by his general practitioner with clarithromycin (500 mg twice daily for a week). No throat culture or rapid antigen test for group A streptococci was performed at that time. On physical examination, he presented with mild right upper abdominal quadrant tenderness. He met all the criteria for systemic inflammatory response syndrome, and his blood tests showed a marked increase in inflammatory markers. Blood and urine cultures were obtained, and the results were negative. Empirical antibiotic therapy with ampicillin sodium/sulbactam sodium was started. His chest radiograph was normal. An abdominal ultrasonographic examination revealed a 6-cm, solid, inhomogeneous mass in liver segment 6. A contrast-enhanced computed tomographic scan of the abdomen (Figure 1) showed that the lesion was hypodense with numerous septa without contrast enhancement. Magnetic resonance imaging (Figure 2) evidenced a mixed solid-liquid lesion, with some septa delimiting large areas of necrosis. The results of a serological detection test for echinococcosis were negative. His carcinoembryonic antigen, carbohydrate antigen 19-9, and [greek small letter alpha]1-fetoprotein blood levels were normal. Serological markers for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus were negative. A study of leukocyte populations and immunoglobulin electrophoresis did not reveal any disorder of the immune system.Computed tomographic scan showing a large, hypodense, multiloculated lesion in liver segment 6.Magnetic resonance imaging scan showing an heterogeneous, capsulated lesion, with numerous septa delimiting large areas of necrosis.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Hydatid cyst\nB. Hepatic abscess\nC. Infected biliary cystadenoma\nD. Inflammatory pseudotumor of the liver\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 26-year-old Arab woman was admitted to our institution for a fever (temperature, 39[degree sign]C) and abdominal pain on the right side of her hypochondrium. She complained of nausea, vomiting, and asthenia as well. Her medical history was significant for pharyngitis associated with scarlet fever that she had a month before; the pharyngitis was treated by her general practitioner with clarithromycin (500 mg twice daily for a week). No throat culture or rapid antigen test for group A streptococci was performed at that time. On physical examination, she presented with mild right upper abdominal quadrant tenderness. She met all the criteria for systemic inflammatory response syndrome, and her blood tests showed a marked increase in inflammatory markers. Blood and urine cultures were obtained, and the results were negative. Empirical antibiotic therapy with ampicillin sodium/sulbactam sodium was started. Her chest radiograph was normal. An abdominal ultrasonographic examination revealed a 6-cm, solid, inhomogeneous mass in liver segment 6. A contrast-enhanced computed tomographic scan of the abdomen (Figure 1) showed that the lesion was hypodense with numerous septa without contrast enhancement. Magnetic resonance imaging (Figure 2) evidenced a mixed solid-liquid lesion, with some septa delimiting large areas of necrosis. The results of a serological detection test for echinococcosis were negative. Her carcinoembryonic antigen, carbohydrate antigen 19-9, and [greek small letter alpha]1-fetoprotein blood levels were normal. Serological markers for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus were negative. A study of leukocyte populations and immunoglobulin electrophoresis did not reveal any disorder of the immune system.Computed tomographic scan showing a large, hypodense, multiloculated lesion in liver segment 6.Magnetic resonance imaging scan showing an heterogeneous, capsulated lesion, with numerous septa delimiting large areas of necrosis.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Hydatid cyst\nB. Hepatic abscess\nC. Infected biliary cystadenoma\nD. Inflammatory pseudotumor of the liver\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 26-year-old Asian patient was admitted to our institution for a fever (temperature, 39[degree sign]C) and abdominal pain on the right side of their hypochondrium. They complained of nausea, vomiting, and asthenia as well. Their medical history was significant for pharyngitis associated with scarlet fever that they had a month before; the pharyngitis was treated by their general practitioner with clarithromycin (500 mg twice daily for a week). No throat culture or rapid antigen test for group A streptococci was performed at that time. On physical examination, they presented with mild right upper abdominal quadrant tenderness. They met all the criteria for systemic inflammatory response syndrome, and their blood tests showed a marked increase in inflammatory markers. Blood and urine cultures were obtained, and the results were negative. Empirical antibiotic therapy with ampicillin sodium/sulbactam sodium was started. Their chest radiograph was normal. An abdominal ultrasonographic examination revealed a 6-cm, solid, inhomogeneous mass in liver segment 6. A contrast-enhanced computed tomographic scan of the abdomen (Figure 1) showed that the lesion was hypodense with numerous septa without contrast enhancement. Magnetic resonance imaging (Figure 2) evidenced a mixed solid-liquid lesion, with some septa delimiting large areas of necrosis. The results of a serological detection test for echinococcosis were negative. Their carcinoembryonic antigen, carbohydrate antigen 19-9, and [greek small letter alpha]1-fetoprotein blood levels were normal. Serological markers for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus were negative. A study of leukocyte populations and immunoglobulin electrophoresis did not reveal any disorder of the immune system.Computed tomographic scan showing a large, hypodense, multiloculated lesion in liver segment 6.Magnetic resonance imaging scan showing an heterogeneous, capsulated lesion, with numerous septa delimiting large areas of necrosis.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Hydatid cyst\nB. Hepatic abscess\nC. Infected biliary cystadenoma\nD. Inflammatory pseudotumor of the liver\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>\nIn April 2010, a 19-year-old soccer player presented with a 4-week history of pain after a tap against his right knee. Medical and family histories were unremarkable and no abnormalities were found on physical examination. A radiograph of the right knee showed osteolytic lesions in the distal femur and the head of the tibia.On magnetic resonance imaging, the epiphyseal lesions were visualized as cystic and nonsclerotic and extended to the articular surface of the distal femur and proximal tibia (Figure 1). Soft tissue extension was suspected from the tibia. Laboratory test results showed normal blood cell count, renal function, and concentration of C-reactive protein.Aneurysmatic bone cysts were suspected and a biopsy was performed. Histopathological examination detected spindle cell infiltrates with hemorrhages, fragmented trabecular bone, and numerous osteoclastic giant cells proliferating at a rate of 10% suggesting an aggressive giant cell lesion.Since it was still not determined whether the lesions were malignant, flourodeoxyglucose F 18 positron emission tomography/computed tomography was performed and found additional lesions in the left distal femur and the left mandible. Biopsy of the mandible showed the same type of tissue as seen in the right femur and tibia.\n</clinical_case>\n\n<question>\nWhat is your diagnosis?\n</question>\n\n<options>\nA. Giant cell tumor\nB. Primary hyperparathyroidism with multiple brown tumors\nC. Malignant bone tumor\nD. Aneurysmatic bone cyst\n</options>" }, { "role": "assistant", "content": "B" } ]