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stringclasses
75 values
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stringclasses
74 values
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stringclasses
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74
1
apr-01-2010
<image> This 4-year-old boy presented with a 5-day history of mild fever and malaise and a 3-day history of rash. What is the diagnosis?
yes
12%
62%
10%
11%
6%
96521
0.037
[ { "from": "human", "value": "<image>\nThis 4-year-old boy presented with a 5-day history of mild fever and malaise and a 3-day history of rash. What is the diagnosis?\nA: Erythema infectiosum\nB: Hand, foot, and mouth disease\nC: Kawasaki disease\nD: Measles\nE: Pityriasis rosea" }, { "from": "gpt", "value": "B: Hand, foot, and mouth disease" } ]
22a308b8983b3dcb60375bac04347a26
[ "A: Erythema infectiosum", "B: Hand, foot, and mouth disease", "C: Kawasaki disease", "D: Measles", "E: Pityriasis rosea" ]
B: Hand, foot, and mouth disease
2
apr-01-2021
<image> A 5-year-old girl presented with a 4-week history of painful swelling on both sides of her lower abdomen. Six weeks before presentation, her parents removed a tick they found buried in her umbilicus. Five days after this she developed fevers. What is the diagnosis?
yes
17%
16%
31%
21%
16%
130077
0.12
[ { "from": "human", "value": "<image>\nA 5-year-old girl presented with a 4-week history of painful swelling on both sides of her lower abdomen. Six weeks before presentation, her parents removed a tick they found buried in her umbilicus. Five days after this she developed fevers. What is the diagnosis?\nA: Ehrlichiosis\nB: Babesiosis\nC: Tularemia\nD: Lyme disease\nE: Rocky Mountain spotted fever" }, { "from": "gpt", "value": "C: Tularemia" } ]
710db3c4b917d478ee231f50416c16f5
[ "A: Ehrlichiosis", "B: Babesiosis", "C: Tularemia", "D: Lyme disease", "E: Rocky Mountain spotted fever" ]
C: Tularemia
3
apr-02-2009
<image> What is the diagnosis?
no
6%
39%
31%
10%
14%
129386
0.1
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Carcinoid syndrome\nB: Dermatomyositis\nC: Endocarditis\nD: Lichen planus\nE: Porphyria" }, { "from": "gpt", "value": "B: Dermatomyositis" } ]
0d08dbca65e634e1efcb54348c2e6f84
[ "A: Carcinoid syndrome", "B: Dermatomyositis", "C: Endocarditis", "D: Lichen planus", "E: Porphyria" ]
B: Dermatomyositis
4
apr-02-2015
<image> What is the most likely diagnosis in this 65-year-old woman with a 7-day history of throat pain and difficulty swallowing?
yes
40%
27%
6%
20%
7%
113962
0.096
[ { "from": "human", "value": "<image>\nWhat is the most likely diagnosis in this 65-year-old woman with a 7-day history of throat pain and difficulty swallowing?\nA: Epiglottitis\nB: Foreign body aspiration\nC: Peritonsillar abscess\nD: Retropharyngeal abscess\nE: Thyroid nodule" }, { "from": "gpt", "value": "A: Epiglottitis" } ]
76643769fc511d50976faed3b2c882a9
[ "A: Epiglottitis", "B: Foreign body aspiration", "C: Peritonsillar abscess", "D: Retropharyngeal abscess", "E: Thyroid nodule" ]
A: Epiglottitis
5
apr-02-2020
<image> A 2-year-old boy who was born at full term and had been delivered with the assistance of forceps presented to the otolaryngology clinic with an 18-month history of flushing on his right cheek that appeared when he ate. Flushing appeared when he ate strawberries in the clinic and was not associated with pain, pruritus, sweating, or respiratory symptoms. The findings from the remainder of the examination were normal. What is the underlying condition?
yes
61%
15%
10%
7%
7%
57038
0.039
[ { "from": "human", "value": "<image>\nA 2-year-old boy who was born at full term and had been delivered with the assistance of forceps presented to the otolaryngology clinic with an 18-month history of flushing on his right cheek that appeared when he ate. Flushing appeared when he ate strawberries in the clinic and was not associated with pain, pruritus, sweating, or respiratory symptoms. The findings from the remainder of the examination were normal. What is the underlying condition?\nA: Frey’s syndrome\nB: Food allergy\nC: Rosacea\nD: Autonomic epilepsy\nE: Carcinoid syndrome" }, { "from": "gpt", "value": "A: Frey’s syndrome" } ]
758ff9dd0c5c51b25b8751a4c40d5abd
[ "A: Frey’s syndrome", "B: Food allergy", "C: Rosacea", "D: Autonomic epilepsy", "E: Carcinoid syndrome" ]
A: Frey’s syndrome
6
apr-03-2008
<image> A patient with this tomogram would be most likely to present with which one of the following signs?
yes
23%
37%
12%
12%
15%
118628
0.1
[ { "from": "human", "value": "<image>\nA patient with this tomogram would be most likely to present with which one of the following signs?\nA: Uniocular blindness\nB: Hemiplegia\nC: Alexia without agraphia\nD: Hemiballismus\nE: Internuclear ophthalmoplegia" }, { "from": "gpt", "value": "B: Hemiplegia" } ]
a9fefa553b6b8c3a599e4763a12f8333
[ "A: Uniocular blindness", "B: Hemiplegia", "C: Alexia without agraphia", "D: Hemiballismus", "E: Internuclear ophthalmoplegia" ]
B: Hemiplegia
7
apr-03-2014
<image> What is the diagnosis?
no
11%
8%
61%
6%
14%
77860
0.039
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Empyema\nB: Lymphangioleiomyomatosis\nC: Paraesophageal hernia\nD: Pericardial effusion\nE: Plombage" }, { "from": "gpt", "value": "C: Paraesophageal hernia" } ]
82081ef87459ddf47974f34e98609389
[ "A: Empyema", "B: Lymphangioleiomyomatosis", "C: Paraesophageal hernia", "D: Pericardial effusion", "E: Plombage" ]
C: Paraesophageal hernia
8
apr-04-2013
<image> What is the diagnosis?
no
8%
23%
8%
48%
13%
75732
0.071
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Adrenal cancer\nB: Echinococcal infection\nC: Meckel's diverticulitis\nD: Pneumatosis intestinalis\nE: Trichobezoar" }, { "from": "gpt", "value": "D: Pneumatosis intestinalis" } ]
265de82ee3128df8baf91b1398bacb40
[ "A: Adrenal cancer", "B: Echinococcal infection", "C: Meckel's diverticulitis", "D: Pneumatosis intestinalis", "E: Trichobezoar" ]
D: Pneumatosis intestinalis
9
apr-04-2019
<image> A 48-year-old man presented to the ophthalmology clinic with a 1-week history of pain, double vision, and blurred vision in his left eye. What is the abnormality depicted here?
yes
75%
9%
8%
1%
6%
64348
0.016
[ { "from": "human", "value": "<image>\nA 48-year-old man presented to the ophthalmology clinic with a 1-week history of pain, double vision, and blurred vision in his left eye. What is the abnormality depicted here?\nA: Separation of the iris\nB: Separation of the pupil\nC: Separation of the lens\nD: Normal eye finding\nE: Separation of the sclerae" }, { "from": "gpt", "value": "A: Separation of the iris" } ]
ee7bbc90717eb551fba5f8be9abdc66a
[ "A: Separation of the iris", "B: Separation of the pupil", "C: Separation of the lens", "D: Normal eye finding", "E: Separation of the sclerae" ]
A: Separation of the iris
10
apr-05-2007
<image> This 9-kg liver was removed at the time of liver transplantation. What is the diagnosis?
yes
14%
7%
12%
63%
5%
114695
0.036
[ { "from": "human", "value": "<image>\nThis 9-kg liver was removed at the time of liver transplantation. What is the diagnosis?\nA: Macronodular cirrhosis\nB: Hepatocellular carcinoma\nC: Echinococcosis\nD: Polycystic liver disease\nE: Trophoblastic tumor" }, { "from": "gpt", "value": "D: Polycystic liver disease" } ]
5240a28586c31856b7714ea8c42a4171
[ "A: Macronodular cirrhosis", "B: Hepatocellular carcinoma", "C: Echinococcosis", "D: Polycystic liver disease", "E: Trophoblastic tumor" ]
D: Polycystic liver disease
11
apr-05-2012
<image> What is the diagnosis?
no
7%
58%
26%
4%
5%
95890
0.051
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Granulomatosis with polyangiitis (Wegener's)\nB: Lepromatous leprosy\nC: Neurofibromatosis type 1\nD: Sarcoidosis\nE: Tertiary syphilis" }, { "from": "gpt", "value": "B: Lepromatous leprosy" } ]
6a21a1d2ee88735c71dc42801b5bdab8
[ "A: Granulomatosis with polyangiitis (Wegener's)", "B: Lepromatous leprosy", "C: Neurofibromatosis type 1", "D: Sarcoidosis", "E: Tertiary syphilis" ]
B: Lepromatous leprosy
12
apr-05-2018
<image> A 21-year-old woman presented to the emergency department with an 8-month history of swelling and pain in the right thigh. MRI of the right leg revealed a large periosteal femoral mass and thrombus in the right femoral vein, for which she received anticoagulation therapy. The patient subsequently experienced dyspnea and pleuritic chest pain, and a chest x-ray was done. What is the likely diagnosis?
yes
9%
14%
16%
43%
18%
186500
0.082
[ { "from": "human", "value": "<image>\nA 21-year-old woman presented to the emergency department with an 8-month history of swelling and pain in the right thigh. MRI of the right leg revealed a large periosteal femoral mass and thrombus in the right femoral vein, for which she received anticoagulation therapy. The patient subsequently experienced dyspnea and pleuritic chest pain, and a chest x-ray was done. What is the likely diagnosis?\nA: Pulmonary embolism\nB: Pulmonary sarcoidosis\nC: Eosinophilic granulomatosis with polyangiitis\nD: Chondroblastic osteosarcoma\nE: Miliary tuberculosis" }, { "from": "gpt", "value": "D: Chondroblastic osteosarcoma" } ]
f57669f6e808686fe7d8a5836a535c3e
[ "A: Pulmonary embolism", "B: Pulmonary sarcoidosis", "C: Eosinophilic granulomatosis with polyangiitis", "D: Chondroblastic osteosarcoma", "E: Miliary tuberculosis" ]
D: Chondroblastic osteosarcoma
13
apr-06-2006
<image> This 36-year-old man has undergone renal transplantation and parathyroidectomy. What is the most likely cause of the changes in his hands?
yes
44%
14%
37%
3%
2%
88222
0.094
[ { "from": "human", "value": "<image>\nThis 36-year-old man has undergone renal transplantation and parathyroidectomy. What is the most likely cause of the changes in his hands?\nA: Pseudoclubbing\nB: Albright's hereditary osteodystrophy\nC: Hypertrophic osteoarthropathy\nD: Yellow nail syndrome\nE: Psoriasis" }, { "from": "gpt", "value": "A: Pseudoclubbing" } ]
54c6d230737ded9ff7dc98eafda961ec
[ "A: Pseudoclubbing", "B: Albright's hereditary osteodystrophy", "C: Hypertrophic osteoarthropathy", "D: Yellow nail syndrome", "E: Psoriasis" ]
A: Pseudoclubbing
14
apr-06-2017
<image> A 3-year-old boy presented with a 6-month history of gross hematuria, and was found to have kidney, bladder, and ureteral stones. Which of the following factors predisposed this boy to genitourinary stone formation?
yes
10%
10%
63%
9%
8%
69416
0.034
[ { "from": "human", "value": "<image>\nA 3-year-old boy presented with a 6-month history of gross hematuria, and was found to have kidney, bladder, and ureteral stones. Which of the following factors predisposed this boy to genitourinary stone formation?\nA: Phenylketonuria\nB: Ornithine transcarbamylase deficiency\nC: Primary hyperoxaluria\nD: Acid maltase deficiency (Pompe disease)\nE: Pyruvate kinase deficiency" }, { "from": "gpt", "value": "C: Primary hyperoxaluria" } ]
1ca599712907e3340bf93e17f5c36ead
[ "A: Phenylketonuria", "B: Ornithine transcarbamylase deficiency", "C: Primary hyperoxaluria", "D: Acid maltase deficiency (Pompe disease)", "E: Pyruvate kinase deficiency" ]
C: Primary hyperoxaluria
15
apr-06-2023
<image> An 87-year-old man with chronic kidney disease, hypertension, and atrial fibrillation presented to the emergency department with a 3-day history of constipation and lower abdominal pain. Physical examination was notable for abdominal distention and tenderness to palpation of the right lower quadrant without rebound or guarding. A plain radiograph of the abdomen is shown. What is the most likely diagnosis?
yes
57%
6%
5%
23%
10%
30921
0.051
[ { "from": "human", "value": "<image>\nAn 87-year-old man with chronic kidney disease, hypertension, and atrial fibrillation presented to the emergency department with a 3-day history of constipation and lower abdominal pain. Physical examination was notable for abdominal distention and tenderness to palpation of the right lower quadrant without rebound or guarding. A plain radiograph of the abdomen is shown. What is the most likely diagnosis?\nA: Cecal volvulus\nB: Constipation\nC: Hiatal hernia\nD: Ogilvie’s Syndrome (acute colonic pseudo-obstruction)\nE: Small bowel obstruction" }, { "from": "gpt", "value": "A: Cecal volvulus" } ]
54f083d5b14a455dfbb4744b94ea466b
[ "A: Cecal volvulus", "B: Constipation", "C: Hiatal hernia", "D: Ogilvie’s Syndrome (acute colonic pseudo-obstruction)", "E: Small bowel obstruction" ]
A: Cecal volvulus
16
apr-07-2011
<image> What is the diagnosis?
no
16%
7%
8%
11%
58%
99378
0.045
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Dermatitis herpetiformis\nB: Impetigo\nC: Measles\nD: Secondary syphilis\nE: Varicella" }, { "from": "gpt", "value": "E: Varicella" } ]
4c746a45fa8ec7bb530dd9367c63a806
[ "A: Dermatitis herpetiformis", "B: Impetigo", "C: Measles", "D: Secondary syphilis", "E: Varicella" ]
E: Varicella
17
apr-07-2016
<image> What is the most likely diagnosis in a patient with dysarthria and gait instability and this finding?
yes
14%
18%
10%
12%
45%
93055
0.076
[ { "from": "human", "value": "<image>\nWhat is the most likely diagnosis in a patient with dysarthria and gait instability and this finding?\nA: Huntington's disease\nB: Wilson's disease\nC: Middle cerebral artery stroke\nD: NMDA receptor encephalitis\nE: Metronidazole-associated encephalopathy" }, { "from": "gpt", "value": "E: Metronidazole-associated encephalopathy" } ]
57e364ea780e466be3ba61d7bc63afbf
[ "A: Huntington's disease", "B: Wilson's disease", "C: Middle cerebral artery stroke", "D: NMDA receptor encephalitis", "E: Metronidazole-associated encephalopathy" ]
E: Metronidazole-associated encephalopathy
18
apr-07-2022
<image> A 30-year-old man with Crohn's disease presented to the dermatology clinic with multiple painful ulcers in his groin and perineal area, as well as an ongoing Crohn's disease flare with fatigue, abdominal pain, and bloody diarrhea. Physical examination of the skin showed deep, linear erosions across the perineum and inguinal folds, on the scrotum and penile shaft, and in the intergluteal cleft. Which of the following is the most likely etiology underlying the genital ulcers?
yes
15%
64%
6%
6%
8%
31111
0.033
[ { "from": "human", "value": "<image>\nA 30-year-old man with Crohn's disease presented to the dermatology clinic with multiple painful ulcers in his groin and perineal area, as well as an ongoing Crohn's disease flare with fatigue, abdominal pain, and bloody diarrhea. Physical examination of the skin showed deep, linear erosions across the perineum and inguinal folds, on the scrotum and penile shaft, and in the intergluteal cleft. Which of the following is the most likely etiology underlying the genital ulcers?\nA: Ecthyma gangrenosum\nB: Knife-cut ulcers from Crohn’s disease\nC: Lichen sclerosus\nD: Linear IgA disease\nE: Pemphigus foliaceus" }, { "from": "gpt", "value": "B: Knife-cut ulcers from Crohn’s disease" } ]
0da80e1e80aba8308f4aee22f58152f7
[ "A: Ecthyma gangrenosum", "B: Knife-cut ulcers from Crohn’s disease", "C: Lichen sclerosus", "D: Linear IgA disease", "E: Pemphigus foliaceus" ]
B: Knife-cut ulcers from Crohn’s disease
19
apr-08-2010
<image> This patient was trying to look right when the image was taken. What is the diagnosis?
yes
9%
10%
21%
13%
47%
103941
0.072
[ { "from": "human", "value": "<image>\nThis patient was trying to look right when the image was taken. What is the diagnosis?\nA: Internuclear ophthalmoplegia\nB: Left fourth cranial nerve palsy\nC: Left sixth cranial nerve palsy\nD: Right fourth cranial nerve palsy\nE: Right sixth cranial nerve palsy" }, { "from": "gpt", "value": "E: Right sixth cranial nerve palsy" } ]
3cbdda08793d8e9ee94fcc609a43319b
[ "A: Internuclear ophthalmoplegia", "B: Left fourth cranial nerve palsy", "C: Left sixth cranial nerve palsy", "D: Right fourth cranial nerve palsy", "E: Right sixth cranial nerve palsy" ]
E: Right sixth cranial nerve palsy
20
apr-08-2021
<image> A 68-year-old woman presented to clinic with a 40-year history of worsening hyperkeratotic non-painful, non-pruritic papules and plaques on her hands and feet. Her mother, son, and granddaughter had similar lesions. What is the diagnosis?
yes
4%
72%
5%
11%
7%
71861
0.02
[ { "from": "human", "value": "<image>\nA 68-year-old woman presented to clinic with a 40-year history of worsening hyperkeratotic non-painful, non-pruritic papules and plaques on her hands and feet. Her mother, son, and granddaughter had similar lesions. What is the diagnosis?\nA: Erythema multiforme\nB: Punctate palmoplantar keratoderma\nC: Incontinentia pigmenti\nD: Tuberous sclerosis\nE: Syphilis" }, { "from": "gpt", "value": "B: Punctate palmoplantar keratoderma" } ]
b298e5a9c5c45b56c98c53003ea7cd6d
[ "A: Erythema multiforme", "B: Punctate palmoplantar keratoderma", "C: Incontinentia pigmenti", "D: Tuberous sclerosis", "E: Syphilis" ]
B: Punctate palmoplantar keratoderma
21
apr-09-2009
<image> What term is used to describe this finding?
no
9%
8%
9%
62%
12%
113468
0.036
[ { "from": "human", "value": "<image>\nWhat term is used to describe this finding?\nA: Arc eye\nB: Asthenopia\nC: Choroideremia\nD: Coloboma\nE: Corectopia" }, { "from": "gpt", "value": "D: Coloboma" } ]
256b9edd63cdd052280124700bfa2dd4
[ "A: Arc eye", "B: Asthenopia", "C: Choroideremia", "D: Coloboma", "E: Corectopia" ]
D: Coloboma
22
apr-09-2015
<image> What is the most likely cause of this physical exam finding in a 65-year-old woman undergoing treatment for breast cancer?
yes
9%
48%
24%
11%
8%
90516
0.071
[ { "from": "human", "value": "<image>\nWhat is the most likely cause of this physical exam finding in a 65-year-old woman undergoing treatment for breast cancer?\nA: Vitamin E deficiency\nB: Chemotherapy\nC: Scleroderma\nD: Chronic inflammatory demyelinating polyneuropathy\nE: Mercury toxicity" }, { "from": "gpt", "value": "B: Chemotherapy" } ]
d6d7552e25e6dde7b89e578c6e9301c2
[ "A: Vitamin E deficiency", "B: Chemotherapy", "C: Scleroderma", "D: Chronic inflammatory demyelinating polyneuropathy", "E: Mercury toxicity" ]
B: Chemotherapy
23
apr-09-2020
<image> A 45-year-old woman was referred to the outpatient clinic after multiple hepatic lesions were incidentally noted on imaging. She had no related symptoms. The physical examination and laboratory tests were all normal. Enhanced computed tomography of the abdomen had shown multiple small, hypodense, nonenhancing nodules throughout the liver. Magnetic resonance imaging with cholangiopancreatography revealed multiple small, T2-weighted, hyperintense cystic nodules in the liver, without biliary duct communication, creating a "starry sky" appearance. What is the diagnosis?
yes
4%
48%
15%
10%
23%
64551
0.071
[ { "from": "human", "value": "<image>\nA 45-year-old woman was referred to the outpatient clinic after multiple hepatic lesions were incidentally noted on imaging. She had no related symptoms. The physical examination and laboratory tests were all normal. Enhanced computed tomography of the abdomen had shown multiple small, hypodense, nonenhancing nodules throughout the liver. Magnetic resonance imaging with cholangiopancreatography revealed multiple small, T2-weighted, hyperintense cystic nodules in the liver, without biliary duct communication, creating a \"starry sky\" appearance. What is the diagnosis?\nA: Acute hepatitis\nB: Multiple biliary hamartomas\nC: Malignant hydatidosis\nD: Multiple liver metastases\nE: Caroli syndrome" }, { "from": "gpt", "value": "B: Multiple biliary hamartomas" } ]
9749b77fb59101c21714b7476446d40d
[ "A: Acute hepatitis", "B: Multiple biliary hamartomas", "C: Malignant hydatidosis", "D: Multiple liver metastases", "E: Caroli syndrome" ]
B: Multiple biliary hamartomas
24
apr-10-2008
<image> This rash appeared following treatment for leukemia. What is the diagnosis?
yes
18%
17%
4%
41%
21%
127715
0.091
[ { "from": "human", "value": "<image>\nThis rash appeared following treatment for leukemia. What is the diagnosis?\nA: Cryoglobulinemia\nB: Leukemia cutis\nC: Herpes zoster\nD: Graft-versus-host disease\nE: Urticaria pigmentosa" }, { "from": "gpt", "value": "D: Graft-versus-host disease" } ]
7c48805e409ecfaf6137fc38e9b103cc
[ "A: Cryoglobulinemia", "B: Leukemia cutis", "C: Herpes zoster", "D: Graft-versus-host disease", "E: Urticaria pigmentosa" ]
D: Graft-versus-host disease
25
apr-10-2014
<image> What is the diagnosis?
no
30%
20%
8%
30%
11%
116652
0.168
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Blastomycosis\nB: Celiac disease\nC: Down's syndrome\nD: Hyperparathyroidism\nE: IgA nephropathy" }, { "from": "gpt", "value": "B: Celiac disease" } ]
16c5f7db46777c341e3fd102bcc5c09f
[ "A: Blastomycosis", "B: Celiac disease", "C: Down's syndrome", "D: Hyperparathyroidism", "E: IgA nephropathy" ]
B: Celiac disease
26
apr-11-2013
<image> What is the diagnosis?
no
49%
13%
8%
26%
4%
75898
0.071
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Amelanotic melanoma\nB: Angioma\nC: Dermal nevus\nD: Pyogenic granuloma\nE: Wart" }, { "from": "gpt", "value": "A: Amelanotic melanoma" } ]
fd164aacec343bdd070cebdfdc793fa0
[ "A: Amelanotic melanoma", "B: Angioma", "C: Dermal nevus", "D: Pyogenic granuloma", "E: Wart" ]
A: Amelanotic melanoma
27
apr-11-2019
<image> A 35-year-old man presented to the emergency department with a 2-day history of abdominal pain, headache, and brown urine. He was alert and oriented to time, place, and self. He had no purpura or petechiae. Laboratory evaluation revealed a hemoglobin level of 8.6 g per deciliter (normal range, 13.7 to 17.5) and a platelet count of 6000 per cubic millimeter (normal range, 140,000 to 370,000). Levels of indirect bilirubin and lactate dehydrogenase were elevated, haptoglobin was undetectable, and the serum creatinine level was 1 mg per deciliter (88 umol per liter; normal range, 0.6 to 1.3 mg per deciliter [57 to 115 umol per liter]). Test results for infection with the human immunodeficiency virus were negative. A peripheral-blood smear showed numerous schistocytes. What is the diagnosis?
yes
13%
43%
8%
24%
12%
86397
0.084
[ { "from": "human", "value": "<image>\nA 35-year-old man presented to the emergency department with a 2-day history of abdominal pain, headache, and brown urine. He was alert and oriented to time, place, and self. He had no purpura or petechiae. Laboratory evaluation revealed a hemoglobin level of 8.6 g per deciliter (normal range, 13.7 to 17.5) and a platelet count of 6000 per cubic millimeter (normal range, 140,000 to 370,000). Levels of indirect bilirubin and lactate dehydrogenase were elevated, haptoglobin was undetectable, and the serum creatinine level was 1 mg per deciliter (88 umol per liter; normal range, 0.6 to 1.3 mg per deciliter [57 to 115 umol per liter]). Test results for infection with the human immunodeficiency virus were negative. A peripheral-blood smear showed numerous schistocytes. What is the diagnosis?\nA: Idiopathic thrombocytopenic purpura\nB: Thrombotic thrombocytopenic purpura\nC: Pseudotrombocytopenia\nD: Hemolytic-uremic syndrome\nE: Excessive splenic platelet sequestration" }, { "from": "gpt", "value": "B: Thrombotic thrombocytopenic purpura" } ]
825aefb4c6e86911a1a9ff4f6dc90798
[ "A: Idiopathic thrombocytopenic purpura", "B: Thrombotic thrombocytopenic purpura", "C: Pseudotrombocytopenia", "D: Hemolytic-uremic syndrome", "E: Excessive splenic platelet sequestration" ]
B: Thrombotic thrombocytopenic purpura
28
apr-12-2007
<image> What is the diagnosis?
no
6%
36%
8%
12%
38%
115281
0.108
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Intracranial hemorrhage\nB: Osteoma\nC: Neurocysticercosis\nD: Arachnoid cyst\nE: Meningioma" }, { "from": "gpt", "value": "E: Meningioma" } ]
f3ba23e4129701bd68c7127ef14937d0
[ "A: Intracranial hemorrhage", "B: Osteoma", "C: Neurocysticercosis", "D: Arachnoid cyst", "E: Meningioma" ]
E: Meningioma
29
apr-12-2012
<image> What is the diagnosis?
no
6%
13%
11%
17%
53%
87068
0.056
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Cryptorchidism\nB: Femoral-artery pseudoaneurysm\nC: Iliopectineal bursitis\nD: Inguinal hernia\nE: Metastatic inguinal lymphadenopathy" }, { "from": "gpt", "value": "E: Metastatic inguinal lymphadenopathy" } ]
5b26f982458eed01a6ae19dc169b6018
[ "A: Cryptorchidism", "B: Femoral-artery pseudoaneurysm", "C: Iliopectineal bursitis", "D: Inguinal hernia", "E: Metastatic inguinal lymphadenopathy" ]
E: Metastatic inguinal lymphadenopathy
30
apr-12-2018
<image> A 70-year-old man presented to the ophthalmology clinic with a 1-year history of progressive bluish discoloration of the sclerae of both eyes. He reported no ocular discomfort or blurry vision. He had previously received a diagnosis of an inflammatory arthritis for which he had been taking minocycline for more than 15 years. Examination was notable for bluish discoloration of the sclera of both eyes and pinnae of both ears. Ophthalmologic examination was otherwise normal. What is the diagnosis?
yes
13%
65%
8%
8%
6%
68753
0.031
[ { "from": "human", "value": "<image>\nA 70-year-old man presented to the ophthalmology clinic with a 1-year history of progressive bluish discoloration of the sclerae of both eyes. He reported no ocular discomfort or blurry vision. He had previously received a diagnosis of an inflammatory arthritis for which he had been taking minocycline for more than 15 years. Examination was notable for bluish discoloration of the sclera of both eyes and pinnae of both ears. Ophthalmologic examination was otherwise normal. What is the diagnosis?\nA: Osteogenesis imperfecta\nB: Minocycline-induced pigmentation\nC: Ehlers-Danlos syndrome\nD: Primary acquired melanosis\nE: Conjunctival melanoma" }, { "from": "gpt", "value": "B: Minocycline-induced pigmentation" } ]
e2aa978d299aeeab7c99907e8fccf89f
[ "A: Osteogenesis imperfecta", "B: Minocycline-induced pigmentation", "C: Ehlers-Danlos syndrome", "D: Primary acquired melanosis", "E: Conjunctival melanoma" ]
B: Minocycline-induced pigmentation
31
apr-13-2006
<image> This 46-year-old woman developed pruritus and similar papular lesions over her axillae, groin, and buttocks. What is the most likely diagnosis?
yes
3%
4%
5%
8%
80%
66795
0.01
[ { "from": "human", "value": "<image>\nThis 46-year-old woman developed pruritus and similar papular lesions over her axillae, groin, and buttocks. What is the most likely diagnosis?\nA: Pilonidal sinus\nB: Psoriasis\nC: Impetigo\nD: Dermatomyositis\nE: Scabies" }, { "from": "gpt", "value": "E: Scabies" } ]
fab61e3d1fc500942aa0dc8eb57befd7
[ "A: Pilonidal sinus", "B: Psoriasis", "C: Impetigo", "D: Dermatomyositis", "E: Scabies" ]
E: Scabies
32
apr-13-2017
<image> A 6-year-old girl presented with short stature, impaired hearing, and vision loss at 2 years of age. A radiograph of her wrists show the following features. What is the diagnosis?
yes
13%
46%
18%
14%
9%
96827
0.074
[ { "from": "human", "value": "<image>\nA 6-year-old girl presented with short stature, impaired hearing, and vision loss at 2 years of age. A radiograph of her wrists show the following features. What is the diagnosis?\nA: Lead poisoning\nB: Osteopetrosis\nC: Fibrous dysplasia\nD: Hypoparathyroidism\nE: Hypervitaminosis D" }, { "from": "gpt", "value": "B: Osteopetrosis" } ]
8468a24b04b771116b00ca8854f7af17
[ "A: Lead poisoning", "B: Osteopetrosis", "C: Fibrous dysplasia", "D: Hypoparathyroidism", "E: Hypervitaminosis D" ]
B: Osteopetrosis
33
apr-13-2023
<image> A 34-year-old woman with tobacco use disorder was referred to the pulmonary clinic for worsening dyspnea and dry cough. She had chronic hypoxemic respiratory failure of unknown cause, requiring supplemental oxygen. Computed tomography of the chest showed diffuse ground-glass opacities and areas of peripheral consolidation but no basilar reticulations or honeycombing. Bronchoalveolar lavage was not diagnostic, so surgical lung biopsy was performed. Histopathological analysis showed extensive alveolar filling with pigment-laden macrophages. What is the most likely diagnosis?
yes
39%
12%
10%
15%
23%
38273
0.094
[ { "from": "human", "value": "<image>\nA 34-year-old woman with tobacco use disorder was referred to the pulmonary clinic for worsening dyspnea and dry cough. She had chronic hypoxemic respiratory failure of unknown cause, requiring supplemental oxygen. Computed tomography of the chest showed diffuse ground-glass opacities and areas of peripheral consolidation but no basilar reticulations or honeycombing. Bronchoalveolar lavage was not diagnostic, so surgical lung biopsy was performed. Histopathological analysis showed extensive alveolar filling with pigment-laden macrophages. What is the most likely diagnosis?\nA: Desquamative interstitial pneumonia\nB: Diffuse alveolar hemorrhage\nC: Idiopathic pulmonary fibrosis\nD: Lipoid pneumonia\nE: Pulmonary alveolar proteinosis" }, { "from": "gpt", "value": "A: Desquamative interstitial pneumonia" } ]
d48f7b5997ceccd9ba035c99e13d6f91
[ "A: Desquamative interstitial pneumonia", "B: Diffuse alveolar hemorrhage", "C: Idiopathic pulmonary fibrosis", "D: Lipoid pneumonia", "E: Pulmonary alveolar proteinosis" ]
A: Desquamative interstitial pneumonia
34
apr-14-2011
<image> What is the most likely diagnosis?
no
17%
6%
9%
29%
39%
127332
0.099
[ { "from": "human", "value": "<image>\nWhat is the most likely diagnosis?\nA: Calciphylaxis\nB: Factor V Leiden\nC: Protein C deficiency\nD: Scleroderma\nE: Waldenstrom's macroglobulinemia" }, { "from": "gpt", "value": "E: Waldenstrom's macroglobulinemia" } ]
b7f21b63216b4cf6bedd1d950acdc183
[ "A: Calciphylaxis", "B: Factor V Leiden", "C: Protein C deficiency", "D: Scleroderma", "E: Waldenstrom's macroglobulinemia" ]
E: Waldenstrom's macroglobulinemia
35
apr-14-2016
<image> What is the most likely cause of this physical finding?
no
8%
59%
12%
11%
9%
107013
0.042
[ { "from": "human", "value": "<image>\nWhat is the most likely cause of this physical finding?\nA: Ascariasis\nB: Esophagogastric bypass\nC: Hirschsprung's disease\nD: Acute intestinal pseudo-obstruction\nE: Cutaneous leishmaniasis" }, { "from": "gpt", "value": "B: Esophagogastric bypass" } ]
a93c1db4f0e8d736eb04d0f2c6d941a1
[ "A: Ascariasis", "B: Esophagogastric bypass", "C: Hirschsprung's disease", "D: Acute intestinal pseudo-obstruction", "E: Cutaneous leishmaniasis" ]
B: Esophagogastric bypass
36
apr-14-2022
<image> A 64-year-old man with metastatic lung adenocarcinoma who had recently started high-dose steroids for malignant spinal cord compression developed an itchy rash and diarrhea. He had a 3-year history of intermittent peripheral eosinophilia of unknown cause. What is the most likely diagnosis?
yes
21%
14%
40%
16%
10%
81969
0.092
[ { "from": "human", "value": "<image>\nA 64-year-old man with metastatic lung adenocarcinoma who had recently started high-dose steroids for malignant spinal cord compression developed an itchy rash and diarrhea. He had a 3-year history of intermittent peripheral eosinophilia of unknown cause. What is the most likely diagnosis?\nA: Cutaneous larva migrans\nB: Cutaneous schistosomiasis\nC: Larva currens from Strongyloides\nD: Lichen striatus\nE: Scabies" }, { "from": "gpt", "value": "C: Larva currens from Strongyloides" } ]
ec548f83dbd871577fc45ad94b286ce3
[ "A: Cutaneous larva migrans", "B: Cutaneous schistosomiasis", "C: Larva currens from Strongyloides", "D: Lichen striatus", "E: Scabies" ]
C: Larva currens from Strongyloides
37
apr-15-2010
<image> What is the diagnosis?
no
46%
26%
14%
8%
6%
88766
0.078
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Duodenal perforation\nB: Emphysematous pyelonephritis\nC: Perinephric cyst\nD: Situs inversus\nE: Ureterocele" }, { "from": "gpt", "value": "A: Duodenal perforation" } ]
e4782a5eca3fe76a3d4caaab223c76fc
[ "A: Duodenal perforation", "B: Emphysematous pyelonephritis", "C: Perinephric cyst", "D: Situs inversus", "E: Ureterocele" ]
A: Duodenal perforation
38
apr-15-2021
<image> A 27-year-old primigravid woman was admitted with new-onset diabetes and hypertension at 32 weeks of gestation. She had worsening proximal muscle weakness, striae, and facial plethora for several months. Physical examination showed striae over the abdomen, breasts, and dorsal and supraclavicular fat pads. Laboratory studies were notable for a potassium of 2.9 mmol per liter (reference range, 3.5 to 5.5) and a urine protein:creatinine ratio of 24 (reference value, <30). What is the most likely diagnosis?
yes
13%
9%
24%
50%
5%
104566
0.067
[ { "from": "human", "value": "<image>\nA 27-year-old primigravid woman was admitted with new-onset diabetes and hypertension at 32 weeks of gestation. She had worsening proximal muscle weakness, striae, and facial plethora for several months. Physical examination showed striae over the abdomen, breasts, and dorsal and supraclavicular fat pads. Laboratory studies were notable for a potassium of 2.9 mmol per liter (reference range, 3.5 to 5.5) and a urine protein:creatinine ratio of 24 (reference value, <30). What is the most likely diagnosis?\nA: Eclampsia\nB: Hyperthyroidism\nC: Addison’s disease\nD: Adrenal mass\nE: Parathyroid mass" }, { "from": "gpt", "value": "D: Adrenal mass" } ]
0189828491c96333a75abc9ecf1ced51
[ "A: Eclampsia", "B: Hyperthyroidism", "C: Addison’s disease", "D: Adrenal mass", "E: Parathyroid mass" ]
D: Adrenal mass
39
apr-16-2009
<image> What is the diagnosis?
no
11%
53%
7%
19%
10%
116464
0.057
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Epidermolysis bullosa\nB: Hereditary hemorrhagic telangiectasia\nC: Neurofibromatosis\nD: Peutz-Jeghers syndrome\nE: Scleroderma" }, { "from": "gpt", "value": "B: Hereditary hemorrhagic telangiectasia" } ]
b2afd7dcdf273204c5a638dcf8a668a5
[ "A: Epidermolysis bullosa", "B: Hereditary hemorrhagic telangiectasia", "C: Neurofibromatosis", "D: Peutz-Jeghers syndrome", "E: Scleroderma" ]
B: Hereditary hemorrhagic telangiectasia
40
apr-16-2015
<image> What is the most likely diagnosis in this 50-year-old woman with atrial fibrillation who sees halos around lights?
yes
5%
19%
14%
6%
56%
84438
0.051
[ { "from": "human", "value": "<image>\nWhat is the most likely diagnosis in this 50-year-old woman with atrial fibrillation who sees halos around lights?\nA: Early cataract\nB: Herpes simplex virus keratitis\nC: Digoxin-associated visual disturbance\nD: Amaurosis fugax\nE: Amiodarone-induced vortex keratopathy" }, { "from": "gpt", "value": "E: Amiodarone-induced vortex keratopathy" } ]
68d4d486fc43cf86a2a1d13e4953f709
[ "A: Early cataract", "B: Herpes simplex virus keratitis", "C: Digoxin-associated visual disturbance", "D: Amaurosis fugax", "E: Amiodarone-induced vortex keratopathy" ]
E: Amiodarone-induced vortex keratopathy
41
apr-16-2020
<image> A 71-year-old man was hospitalized with altered mental status progressing over the preceding 3 weeks. The patient had a recent diagnosis of adenocarcinoma of the colon with known metastatic lesions in the lung and bones. A gadolinium-enhanced magnetic resonance image of the brain was performed and is shown. What is the most likely diagnosis?
yes
12%
24%
47%
9%
7%
96161
0.073
[ { "from": "human", "value": "<image>\nA 71-year-old man was hospitalized with altered mental status progressing over the preceding 3 weeks. The patient had a recent diagnosis of adenocarcinoma of the colon with known metastatic lesions in the lung and bones. A gadolinium-enhanced magnetic resonance image of the brain was performed and is shown. What is the most likely diagnosis?\nA: Group D streptococcus abscesses\nB: Neurocysticercosis\nC: Metastatic adenocarcinoma\nD: Tuberculosis\nE: Primary central nervous system lymphoma" }, { "from": "gpt", "value": "C: Metastatic adenocarcinoma" } ]
93f05a8fde182f73c47aaeff6fa08234
[ "A: Group D streptococcus abscesses", "B: Neurocysticercosis", "C: Metastatic adenocarcinoma", "D: Tuberculosis", "E: Primary central nervous system lymphoma" ]
C: Metastatic adenocarcinoma
42
apr-17-2008
<image> What is the diagnosis?
no
36%
3%
10%
39%
12%
128105
0.117
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Babesiosis\nB: Iron deficiency anemia\nC: Hereditary spherocytosis\nD: Malaria\nE: Sideroblastic anemia" }, { "from": "gpt", "value": "A: Babesiosis" } ]
e4f8c2d40e7c1a7b28257eacfcc06aa7
[ "A: Babesiosis", "B: Iron deficiency anemia", "C: Hereditary spherocytosis", "D: Malaria", "E: Sideroblastic anemia" ]
A: Babesiosis
43
apr-17-2014
<image> What is the diagnosis?
no
6%
6%
24%
13%
52%
75184
0.062
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Blepharitis\nB: Entropion\nC: Eyelid wart\nD: Keratoconjunctivitis sicca\nE: Vernal keratoconjunctivitis" }, { "from": "gpt", "value": "E: Vernal keratoconjunctivitis" } ]
dc6ccc761d00369cf1bf69d8ac1e542f
[ "A: Blepharitis", "B: Entropion", "C: Eyelid wart", "D: Keratoconjunctivitis sicca", "E: Vernal keratoconjunctivitis" ]
E: Vernal keratoconjunctivitis
44
apr-18-2013
<image> What diagnosis explains these lesions that developed after acupuncture to the area?
yes
20%
27%
25%
7%
20%
106232
0.144
[ { "from": "human", "value": "<image>\nWhat diagnosis explains these lesions that developed after acupuncture to the area?\nA: Herpetic whitlow\nB: Nummular eczema\nC: Psoriasis\nD: Ringworm\nE: Scabies" }, { "from": "gpt", "value": "C: Psoriasis" } ]
4547d8c5c2e94ff85d8c80e5df15e423
[ "A: Herpetic whitlow", "B: Nummular eczema", "C: Psoriasis", "D: Ringworm", "E: Scabies" ]
C: Psoriasis
45
apr-18-2019
<image> A 60-year-old woman presented to the ophthalmology clinic after noticing central blind spots in the visual fields of both eyes. She had a history of rheumatoid arthritis, which had been treated with hydroxychloroquine for 14 years. The retinal examination showed the pattern below. What is the most likely underlying cause of this abnormality?
yes
5%
68%
13%
5%
8%
42782
0.026
[ { "from": "human", "value": "<image>\nA 60-year-old woman presented to the ophthalmology clinic after noticing central blind spots in the visual fields of both eyes. She had a history of rheumatoid arthritis, which had been treated with hydroxychloroquine for 14 years. The retinal examination showed the pattern below. What is the most likely underlying cause of this abnormality?\nA: Rheumatoid arthritis\nB: Hydroxychloroquine toxicity\nC: Age-related macular degeneration\nD: Type 2 diabetes\nE: Bardet-Biedl syndrome" }, { "from": "gpt", "value": "B: Hydroxychloroquine toxicity" } ]
ce60c65aa040c398cdcff55a4d15564f
[ "A: Rheumatoid arthritis", "B: Hydroxychloroquine toxicity", "C: Age-related macular degeneration", "D: Type 2 diabetes", "E: Bardet-Biedl syndrome" ]
B: Hydroxychloroquine toxicity
46
apr-19-2007
<image> What is the diagnosis?
no
9%
13%
5%
56%
17%
111961
0.05
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Syphilis\nB: Phenytoin exposure\nC: Marfan syndrome\nD: Torus palatinus\nE: Kaposi sarcoma" }, { "from": "gpt", "value": "D: Torus palatinus" } ]
16a7e101f49142f45a3afd960c51caff
[ "A: Syphilis", "B: Phenytoin exposure", "C: Marfan syndrome", "D: Torus palatinus", "E: Kaposi sarcoma" ]
D: Torus palatinus
47
apr-19-2012
<image> Which of these medications, used to treat this patient's glioblastoma multiforme, is most likely to have contributed to this complication?
yes
11%
43%
10%
17%
18%
96463
0.082
[ { "from": "human", "value": "<image>\nWhich of these medications, used to treat this patient's glioblastoma multiforme, is most likely to have contributed to this complication?\nA: Acetazolamide\nB: Dexamethasone\nC: Levetiracetam\nD: Temozolomide\nE: Topotecan" }, { "from": "gpt", "value": "B: Dexamethasone" } ]
16eaac00ee2aaa67a75f31858e95c9bc
[ "A: Acetazolamide", "B: Dexamethasone", "C: Levetiracetam", "D: Temozolomide", "E: Topotecan" ]
B: Dexamethasone
48
apr-19-2018
<image> A 74-year-old woman presented to the emergency department with a 3-day history of lower abdominal pain, nausea, and vomiting. A plain-film radiograph of the abdomen showed marked dilatation of bowel loops and abrupt termination of gas within the descending colon, referred to as a colon cutoff sign.
yes
13%
35%
14%
14%
24%
128944
0.107
[ { "from": "human", "value": "<image>\nA 74-year-old woman presented to the emergency department with a 3-day history of lower abdominal pain, nausea, and vomiting. A plain-film radiograph of the abdomen showed marked dilatation of bowel loops and abrupt termination of gas within the descending colon, referred to as a colon cutoff sign.\nA: Diaphragmatic hernia\nB: Acute pancreatitis\nC: Toxic shock syndrome\nD: Lead poisoning\nE: Crohn’s disease" }, { "from": "gpt", "value": "B: Acute pancreatitis" } ]
028d27a9c5ac00a54b366263382f9bc0
[ "A: Diaphragmatic hernia", "B: Acute pancreatitis", "C: Toxic shock syndrome", "D: Lead poisoning", "E: Crohn’s disease" ]
B: Acute pancreatitis
49
apr-20-2006
<image> This 63-year-old man with a 10-year history of progressive neck enlargement noted a sudden increase in the size of the swelling on the left side. What is the most likely diagnosis?
yes
16%
8%
37%
17%
22%
92009
0.101
[ { "from": "human", "value": "<image>\nThis 63-year-old man with a 10-year history of progressive neck enlargement noted a sudden increase in the size of the swelling on the left side. What is the most likely diagnosis?\nA: Superior vena cava syndrome\nB: Scrofula\nC: Bleeding into a thyroid nodule\nD: Non-hodgkins lymphoma\nE: Follicular thyroid carcinoma" }, { "from": "gpt", "value": "C: Bleeding into a thyroid nodule" } ]
d830b4550dad00fbdba162d661c8c2dd
[ "A: Superior vena cava syndrome", "B: Scrofula", "C: Bleeding into a thyroid nodule", "D: Non-hodgkins lymphoma", "E: Follicular thyroid carcinoma" ]
C: Bleeding into a thyroid nodule
50
apr-20-2017
<image> A 30-year-old man presented with this lesion on his right lower eyelid that had grown over 3 days. Two weeks before his presentation, a cyst had ruptured on the same eyelid. What is the diagnosis?
yes
17%
4%
5%
62%
12%
84701
0.038
[ { "from": "human", "value": "<image>\nA 30-year-old man presented with this lesion on his right lower eyelid that had grown over 3 days. Two weeks before his presentation, a cyst had ruptured on the same eyelid. What is the diagnosis?\nA: Squamous papilloma\nB: Amelanotic melanoma\nC: Squamous-cell carcinoma\nD: Pyogenic granuloma\nE: Suture granuloma" }, { "from": "gpt", "value": "D: Pyogenic granuloma" } ]
525b57975503d190a322a94367a3b5f3
[ "A: Squamous papilloma", "B: Amelanotic melanoma", "C: Squamous-cell carcinoma", "D: Pyogenic granuloma", "E: Suture granuloma" ]
D: Pyogenic granuloma
51
apr-20-2023
<image> A 60-year-old left-handed woman presented to the emergency department with pain in her left forearm. The arm was swollen and tender, especially with passive pronation and supination. The overlying skin was intact, and the results of neurovascular examination were normal. Radiographs of the left forearm were performed (upper image, anteroposterior view; lower image, lateral view). The findings should raise concern for which contributory factor?
yes
42%
15%
12%
19%
12%
41942
0.085
[ { "from": "human", "value": "<image>\nA 60-year-old left-handed woman presented to the emergency department with pain in her left forearm. The arm was swollen and tender, especially with passive pronation and supination. The overlying skin was intact, and the results of neurovascular examination were normal. Radiographs of the left forearm were performed (upper image, anteroposterior view; lower image, lateral view). The findings should raise concern for which contributory factor?\nA: Assault\nB: Fall\nC: Malignancy\nD: Osteoporosis\nE: Repetitive strain" }, { "from": "gpt", "value": "A: Assault" } ]
d6ca50da3aede1ecf8fd6047370ff76f
[ "A: Assault", "B: Fall", "C: Malignancy", "D: Osteoporosis", "E: Repetitive strain" ]
A: Assault
52
apr-21-2011
<image> What is the diagnosis?
no
24%
29%
11%
16%
20%
153754
0.164
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Erythema marginatum\nB: Erythema multiforme\nC: Pityriasis rosea\nD: Tinea versicolor\nE: Tuberculoid leprosy" }, { "from": "gpt", "value": "E: Tuberculoid leprosy" } ]
998146f48ca9e7e68b23749f4231b76b
[ "A: Erythema marginatum", "B: Erythema multiforme", "C: Pityriasis rosea", "D: Tinea versicolor", "E: Tuberculoid leprosy" ]
E: Tuberculoid leprosy
53
apr-21-2016
<image> What is the most likely diagnosis in an elderly woman with dyspnea and these findings?
yes
9%
64%
8%
8%
10%
69714
0.032
[ { "from": "human", "value": "<image>\nWhat is the most likely diagnosis in an elderly woman with dyspnea and these findings?\nA: Esophageal tumor\nB: Vein-graft aneurysms\nC: Thymoma\nD: Liposarcoma\nE: Hemangioma" }, { "from": "gpt", "value": "B: Vein-graft aneurysms" } ]
ae6d814adb970970bd69e848e76e59ef
[ "A: Esophageal tumor", "B: Vein-graft aneurysms", "C: Thymoma", "D: Liposarcoma", "E: Hemangioma" ]
B: Vein-graft aneurysms
54
apr-21-2022
<image> A 56-year-old man with sickle hemoglobin C disease and proliferative sickle cell retinopathy presented for a routine eye examination. He was asymptomatic. What is seen on this examination of the anterior segment of the eye?
yes
24%
15%
33%
16%
12%
53751
0.114
[ { "from": "human", "value": "<image>\nA 56-year-old man with sickle hemoglobin C disease and proliferative sickle cell retinopathy presented for a routine eye examination. He was asymptomatic. What is seen on this examination of the anterior segment of the eye?\nA: Bilateral acute depigmentation of the iris (BADI)\nB: Cornea verticillata\nC: Iris atrophy\nD: Mutton-fat keratic precipitates\nE: Sunflower cataract" }, { "from": "gpt", "value": "C: Iris atrophy" } ]
2f46989159d4af54c5a73fc6a5550fbf
[ "A: Bilateral acute depigmentation of the iris (BADI)", "B: Cornea verticillata", "C: Iris atrophy", "D: Mutton-fat keratic precipitates", "E: Sunflower cataract" ]
C: Iris atrophy
55
apr-22-2010
<image> What is the most likely diagnosis?
no
16%
7%
56%
11%
10%
103467
0.049
[ { "from": "human", "value": "<image>\nWhat is the most likely diagnosis?\nA: End-stage renal disease\nB: Graves' disease\nC: Iron deficiency\nD: Pseudohypoparathyroidism\nE: Sarcoidosis" }, { "from": "gpt", "value": "C: Iron deficiency" } ]
bdb4e140be3fb7dd37f1f8f1c6e5d6b1
[ "A: End-stage renal disease", "B: Graves' disease", "C: Iron deficiency", "D: Pseudohypoparathyroidism", "E: Sarcoidosis" ]
C: Iron deficiency
56
apr-22-2021
<image> A 48-year-old man presented with a 2-week history of fever, shortness of breath, and painful skin lesions with blistering. His temperature was 39.2°C. What is the diagnosis?
yes
20%
23%
18%
26%
13%
180013
0.138
[ { "from": "human", "value": "<image>\nA 48-year-old man presented with a 2-week history of fever, shortness of breath, and painful skin lesions with blistering. His temperature was 39.2°C. What is the diagnosis?\nA: Weil’s disease\nB: Staphylococcal scalded skin syndrome\nC: Legionnaires' disease\nD: Leprosy\nE: Lyme disease" }, { "from": "gpt", "value": "D: Leprosy" } ]
45424b397ee407c218c4b2396e917fcc
[ "A: Weil’s disease", "B: Staphylococcal scalded skin syndrome", "C: Legionnaires' disease", "D: Leprosy", "E: Lyme disease" ]
D: Leprosy
57
apr-23-2009
<image> What is the diagnosis?
no
24%
8%
33%
15%
20%
205366
0.151
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Hypercholesterolemia\nB: Leukemia\nC: Lichen planus\nD: Pompe's disease\nE: Psoriasis" }, { "from": "gpt", "value": "A: Hypercholesterolemia" } ]
fdccd3d3100a46d2bca139711e1d269b
[ "A: Hypercholesterolemia", "B: Leukemia", "C: Lichen planus", "D: Pompe's disease", "E: Psoriasis" ]
A: Hypercholesterolemia
58
apr-23-2015
<image> The following physical exam finding is most commonly associated with which one of the following?
no
49%
18%
16%
12%
6%
97279
0.067
[ { "from": "human", "value": "<image>\nThe following physical exam finding is most commonly associated with which one of the following?\nA: Chronic kidney disease\nB: Thyroid dysfunction\nC: End-stage liver disease\nD: Pulmonary disease\nE: Systemic infection" }, { "from": "gpt", "value": "A: Chronic kidney disease" } ]
d090fe75d278f5015c71bc3652d68aef
[ "A: Chronic kidney disease", "B: Thyroid dysfunction", "C: End-stage liver disease", "D: Pulmonary disease", "E: Systemic infection" ]
A: Chronic kidney disease
59
apr-23-2020
<image> An 83-year-old woman presented to the gastroenterology clinic with dysphagia and regurgitation that occurred with every meal associated with postprandial chest pain. For several years she had difficulty swallowing both solids and liquids. Barium esophagram is shown. What is the diagnosis?
yes
17%
17%
13%
9%
43%
100982
0.082
[ { "from": "human", "value": "<image>\nAn 83-year-old woman presented to the gastroenterology clinic with dysphagia and regurgitation that occurred with every meal associated with postprandial chest pain. For several years she had difficulty swallowing both solids and liquids. Barium esophagram is shown. What is the diagnosis?\nA: Scleroderma\nB: Esophageal stricture\nC: Esophageal web\nD: Esophageal carcinoma\nE: Achalasia" }, { "from": "gpt", "value": "E: Achalasia" } ]
3f67e08c03b8af5579802bcd92cc14b4
[ "A: Scleroderma", "B: Esophageal stricture", "C: Esophageal web", "D: Esophageal carcinoma", "E: Achalasia" ]
E: Achalasia
60
apr-24-2008
<image> What is the diagnosis?
no
9%
26%
16%
7%
42%
105778
0.089
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Central retinal artery occlusion\nB: Diabetic papillopathy\nC: Ocular toxoplasmosis\nD: Optic neuritis\nE: Malignant hypertension" }, { "from": "gpt", "value": "E: Malignant hypertension" } ]
a814ba86cc8362c62a5fdb6df1507310
[ "A: Central retinal artery occlusion", "B: Diabetic papillopathy", "C: Ocular toxoplasmosis", "D: Optic neuritis", "E: Malignant hypertension" ]
E: Malignant hypertension
61
apr-24-2014
<image> What is the cause of this new skin lesion in this patient whose blood CD4+ cell count was 20 per cubic millimeter (1%) following treatment for chronic lymphocytic leukemia?
yes
17%
6%
31%
23%
22%
201064
0.122
[ { "from": "human", "value": "<image>\nWhat is the cause of this new skin lesion in this patient whose blood CD4+ cell count was 20 per cubic millimeter (1%) following treatment for chronic lymphocytic leukemia?\nA: Bacillary angiomatosis\nB: Bullous impetigo\nC: Cryptococcosis\nD: Kaposi's sarcoma\nE: Verruca vulgaris" }, { "from": "gpt", "value": "C: Cryptococcosis" } ]
ba04fd43f42eefe641a9d1a70ef0fea6
[ "A: Bacillary angiomatosis", "B: Bullous impetigo", "C: Cryptococcosis", "D: Kaposi's sarcoma", "E: Verruca vulgaris" ]
C: Cryptococcosis
62
apr-25-2013
<image> In addition to neurofibromatosis, what other examination finding would you expect for this patient?
yes
13%
12%
56%
9%
10%
71010
0.049
[ { "from": "human", "value": "<image>\nIn addition to neurofibromatosis, what other examination finding would you expect for this patient?\nA: Aortic regurgitation\nB: Chvostek sign\nC: Lisch nodules\nD: Thyroid bruit\nE: Web neck" }, { "from": "gpt", "value": "C: Lisch nodules" } ]
96b1bd987cc53d56b3d1fc50735b65a8
[ "A: Aortic regurgitation", "B: Chvostek sign", "C: Lisch nodules", "D: Thyroid bruit", "E: Web neck" ]
C: Lisch nodules
63
apr-25-2019
<image> A 37-year-old man presented with a 4-year history of excessive sweating, headaches, and joint pain. His wife had also noticed increasing skin folds on his scalp. What is the most likely diagnosis?
yes
38%
19%
17%
11%
16%
171218
0.097
[ { "from": "human", "value": "<image>\nA 37-year-old man presented with a 4-year history of excessive sweating, headaches, and joint pain. His wife had also noticed increasing skin folds on his scalp. What is the most likely diagnosis?\nA: Acromegaly\nB: Amyloidosis\nC: Systemic sclerosis\nD: Hypogonadism\nE: Sarcoidosis" }, { "from": "gpt", "value": "A: Acromegaly" } ]
397f0a7a40a0bcbc2d3c052b266a4cbc
[ "A: Acromegaly", "B: Amyloidosis", "C: Systemic sclerosis", "D: Hypogonadism", "E: Sarcoidosis" ]
A: Acromegaly
64
apr-26-2007
<image> In what vessel is this patient's dialysis catheter?
yes
11%
32%
33%
18%
6%
107164
0.12
[ { "from": "human", "value": "<image>\nIn what vessel is this patient's dialysis catheter?\nA: Left axillary vein\nB: Left internal mammary vein\nC: Left-sided superior vena cava\nD: Azygous vein\nE: Highest intercostal vein" }, { "from": "gpt", "value": "C: Left-sided superior vena cava" } ]
eb240cc05f3d774a184cc77bddfc3297
[ "A: Left axillary vein", "B: Left internal mammary vein", "C: Left-sided superior vena cava", "D: Azygous vein", "E: Highest intercostal vein" ]
C: Left-sided superior vena cava
65
apr-26-2012
<image> What is the most likely infecting organism in this patient with prostatitis?
yes
28%
12%
12%
15%
33%
93945
0.136
[ { "from": "human", "value": "<image>\nWhat is the most likely infecting organism in this patient with prostatitis?\nA: Blastomyces dermatitidis\nB: Escherichia coli\nC: Histoplasma capsulatum\nD: Pseudomonas aeruginosa\nE: Staphylococcus aureus" }, { "from": "gpt", "value": "A: Blastomyces dermatitidis" } ]
db1159ded67405646b4ec8ea1ed8e5f7
[ "A: Blastomyces dermatitidis", "B: Escherichia coli", "C: Histoplasma capsulatum", "D: Pseudomonas aeruginosa", "E: Staphylococcus aureus" ]
A: Blastomyces dermatitidis
66
apr-26-2018
<image> A 31-year-old man presented to the emergency department with a 2-week history of left ear swelling. He had similar episodes over the past 2 years, and a 6-month history of weight loss, fatigue, and generalized aches. Physical exam revealed a swollen and tender ear, costochondral joints, and left knee. Lab tests showed an elevated erythrocyte sedimentation rate. What is the likely diagnosis?
yes
13%
8%
13%
13%
53%
111748
0.056
[ { "from": "human", "value": "<image>\nA 31-year-old man presented to the emergency department with a 2-week history of left ear swelling. He had similar episodes over the past 2 years, and a 6-month history of weight loss, fatigue, and generalized aches. Physical exam revealed a swollen and tender ear, costochondral joints, and left knee. Lab tests showed an elevated erythrocyte sedimentation rate. What is the likely diagnosis?\nA: Infectious perichondritis\nB: Rheumatoid arthritis\nC: Granulomatosis with polyangiitis\nD: Polyarteritis nodosa\nE: Relapsing polychondritis" }, { "from": "gpt", "value": "E: Relapsing polychondritis" } ]
4c7587859b88d97a6161fe82436876e9
[ "A: Infectious perichondritis", "B: Rheumatoid arthritis", "C: Granulomatosis with polyangiitis", "D: Polyarteritis nodosa", "E: Relapsing polychondritis" ]
E: Relapsing polychondritis
67
apr-27-2006
<image> A 39-year-old Zambian man who has tested positive for the human immunodeficiency virus presented with a three-week history of a draining neck mass. What is the most likely diagnosis?
yes
16%
41%
21%
12%
10%
85230.
0.088
[ { "from": "human", "value": "<image>\nA 39-year-old Zambian man who has tested positive for the human immunodeficiency virus presented with a three-week history of a draining neck mass. What is the most likely diagnosis?\nA: Actinomycosis\nB: Scrofula\nC: Kaposi sarcoma\nD: Burkitt lymphoma\nE: Nocardiosis" }, { "from": "gpt", "value": "B: Scrofula" } ]
c95060794df4aaea2f4877fb9164bd0a
[ "A: Actinomycosis", "B: Scrofula", "C: Kaposi sarcoma", "D: Burkitt lymphoma", "E: Nocardiosis" ]
B: Scrofula
68
apr-27-2017
<image> A 25-year-old man presented to the emergency department with severe neck pain after a high-speed motor vehicle collision resulted in neck hyperextension. Axial CT scan of the C2 vertebrae is shown here. What is the diagnosis?
yes
48%
8%
12%
6%
25%
79770
0.071
[ { "from": "human", "value": "<image>\nA 25-year-old man presented to the emergency department with severe neck pain after a high-speed motor vehicle collision resulted in neck hyperextension. Axial CT scan of the C2 vertebrae is shown here. What is the diagnosis?\nA: Traumatic spondylolisthesis of the axis (hangman’s fracture)\nB: Odontoid fracture (dens fracture)\nC: Cervical spinous process fracture (Clay-shoveler fracture)\nD: Flexion tear drop fracture\nE: Cervical burst fracture (Jefferson fracture)" }, { "from": "gpt", "value": "A: Traumatic spondylolisthesis of the axis (hangman’s fracture)" } ]
03742f094dc0d7087d0045a6dab0fcf0
[ "A: Traumatic spondylolisthesis of the axis (hangman’s fracture)", "B: Odontoid fracture (dens fracture)", "C: Cervical spinous process fracture (Clay-shoveler fracture)", "D: Flexion tear drop fracture", "E: Cervical burst fracture (Jefferson fracture)" ]
A: Traumatic spondylolisthesis of the axis (hangman’s fracture)
69
apr-27-2023
<image> A 75-year-old woman presented to the infectious diseases clinic with a 10-day history of painful lesions on the right hand and forearm. An aspiration of the hand lesion was performed. Bacterial culture of the aspirate grew filamentous, gram-positive, acid-fast branching rods. Which of the following activities likely preceded development of the lesions?
yes
21%
45%
10%
13%
11%
62473
0.077
[ { "from": "human", "value": "<image>\nA 75-year-old woman presented to the infectious diseases clinic with a 10-day history of painful lesions on the right hand and forearm. An aspiration of the hand lesion was performed. Bacterial culture of the aspirate grew filamentous, gram-positive, acid-fast branching rods. Which of the following activities likely preceded development of the lesions?\nA: Cleaning a fish tank\nB: Gardening\nC: Getting bitten by a sandfly\nD: Handling feline waste\nE: Petting an armadillo" }, { "from": "gpt", "value": "B: Gardening" } ]
e0250197ce2ec979f8e3237f2d11b526
[ "A: Cleaning a fish tank", "B: Gardening", "C: Getting bitten by a sandfly", "D: Handling feline waste", "E: Petting an armadillo" ]
B: Gardening
70
apr-28-2011
<image> What is the diagnosis?
no
2%
7%
11%
73%
7%
92860
0.019
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Addison's disease\nB: Alkaptonuria\nC: Hematoma\nD: Melanoma\nE: Zidovudine exposure" }, { "from": "gpt", "value": "D: Melanoma" } ]
0579fd32596b4bfadefcc199a4b810bb
[ "A: Addison's disease", "B: Alkaptonuria", "C: Hematoma", "D: Melanoma", "E: Zidovudine exposure" ]
D: Melanoma
71
apr-28-2016
<image> What is the most likely diagnosis in this man with left knee swelling and these findings for the past 2 years?
yes
14%
7%
14%
15%
51%
89991
0.061
[ { "from": "human", "value": "<image>\nWhat is the most likely diagnosis in this man with left knee swelling and these findings for the past 2 years?\nA: Nonpulmonary tuberculosis\nB: Tularemia\nC: Cutaneous anthrax\nD: Sporotrichosis\nE: Actinomycosis" }, { "from": "gpt", "value": "E: Actinomycosis" } ]
98979040596bbb4669210d6bc01ad3c8
[ "A: Nonpulmonary tuberculosis", "B: Tularemia", "C: Cutaneous anthrax", "D: Sporotrichosis", "E: Actinomycosis" ]
E: Actinomycosis
72
apr-28-2022
<image> A 53-year-old landscaper presented to the dermatology clinic with a 4-month history of red, raised, itchy skin lesions on his left lower back and buttock. Physical examination showed numerous verrucous nodules and plaques with overlying crusting and surrounding erythema on the left lower back and buttock. Grocott-Gomori methenamine silver staining showed broad-based budding organisms. Chest imaging showed no abnormalities. Which of the following is the best treatment?
yes
10%
57%
6%
15%
12%
48300
0.047
[ { "from": "human", "value": "<image>\nA 53-year-old landscaper presented to the dermatology clinic with a 4-month history of red, raised, itchy skin lesions on his left lower back and buttock. Physical examination showed numerous verrucous nodules and plaques with overlying crusting and surrounding erythema on the left lower back and buttock. Grocott-Gomori methenamine silver staining showed broad-based budding organisms. Chest imaging showed no abnormalities. Which of the following is the best treatment?\nA: Clarithromycin and amikacin\nB: Itraconazole\nC: Penicillin\nD: Rifampicin, isoniazid, pyrazinamide, and ethambutol\nE: Trimethoprim-sulfamethoxazole" }, { "from": "gpt", "value": "B: Itraconazole" } ]
73b6c0908dac03ec8d3be2a6a420eef0
[ "A: Clarithromycin and amikacin", "B: Itraconazole", "C: Penicillin", "D: Rifampicin, isoniazid, pyrazinamide, and ethambutol", "E: Trimethoprim-sulfamethoxazole" ]
B: Itraconazole
73
apr-29-2010
<image> What is the diagnosis?
no
5%
42%
5%
9%
39%
98161
0.1
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Cerebral aneurysm\nB: Chiari I malformation\nC: Neurofibromatosis\nD: Paget disease\nE: Subdural hematoma" }, { "from": "gpt", "value": "B: Chiari I malformation" } ]
0910c518725f9c555bcca2bddfe6f347
[ "A: Cerebral aneurysm", "B: Chiari I malformation", "C: Neurofibromatosis", "D: Paget disease", "E: Subdural hematoma" ]
B: Chiari I malformation
74
apr-29-2021
<image> A 54-year-old man presented to the emergency department with confusion and vomiting. He also reported an unintentional 10 kg weight loss and progressive darkening of his skin over the past 6 months. Laboratory studies showed a serum glucose of 40 mg per deciliter (reference range, 70 to 110 mg per deciliter), sodium of 108 mmol per liter (reference range, 136 to 145), and a potassium of 6.4 mmol per liter (reference range, 3.5 to 5.1). What is the diagnosis?
yes
85%
4%
6%
3%
2%
34900
0.006
[ { "from": "human", "value": "<image>\nA 54-year-old man presented to the emergency department with confusion and vomiting. He also reported an unintentional 10 kg weight loss and progressive darkening of his skin over the past 6 months. Laboratory studies showed a serum glucose of 40 mg per deciliter (reference range, 70 to 110 mg per deciliter), sodium of 108 mmol per liter (reference range, 136 to 145), and a potassium of 6.4 mmol per liter (reference range, 3.5 to 5.1). What is the diagnosis?\nA: Primary adrenal insufficiency (Addison’s disease)\nB: Acanthosis nigricans\nC: Cushing’s disease\nD: Smoker’s melanosis\nE: Solar lentigines" }, { "from": "gpt", "value": "A: Primary adrenal insufficiency (Addison’s disease)" } ]
1f97d4f64141f6dc84f04f8ebd612687
[ "A: Primary adrenal insufficiency (Addison’s disease)", "B: Acanthosis nigricans", "C: Cushing’s disease", "D: Smoker’s melanosis", "E: Solar lentigines" ]
A: Primary adrenal insufficiency (Addison’s disease)
75
apr-30-2009
<image> What is the diagnosis?
no
7%
8%
61%
10%
14%
103331
0.039
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Coxsackievirus infection\nB: Gorlin's syndrome\nC: Herpes zoster\nD: Orbital cellulitis\nE: Superficial pyoderma" }, { "from": "gpt", "value": "C: Herpes zoster" } ]
dce920232c50772aff2df98d1750a5ef
[ "A: Coxsackievirus infection", "B: Gorlin's syndrome", "C: Herpes zoster", "D: Orbital cellulitis", "E: Superficial pyoderma" ]
C: Herpes zoster
76
apr-30-2015
<image> What is the most likely diagnosis?
no
7%
10%
14%
60%
10%
112843
0.041
[ { "from": "human", "value": "<image>\nWhat is the most likely diagnosis?\nA: Staphyloma\nB: Pigmentary glaucoma\nC: Conjunctival hemorrhage\nD: Melanoma\nE: Squamous-cell carcinoma" }, { "from": "gpt", "value": "D: Melanoma" } ]
fd9ada662d2af3067a360cbd6a5fc90e
[ "A: Staphyloma", "B: Pigmentary glaucoma", "C: Conjunctival hemorrhage", "D: Melanoma", "E: Squamous-cell carcinoma" ]
D: Melanoma
77
apr-30-2020
<image> A 34-year-old man with a history of intravenous drug use and hepatitis C infection presented to the ophthalmology clinic with a 1-week history of pain and decreased vision in his right eye. The visual acuity was 20/400 in the right eye and 20/20 in the left eye. Slit-lamp examination of the right eye showed conjunctival injection and inflammation in the anterior chamber. Indirect ophthalmoscopy showed vitreous haze with yellow-white lesions on the retina and optic nerve. Following workup, surgery was performed and a white mass measuring 4 mm by 3 mm by 1 mm was seen adherent to the optic nerve. What is the most likely diagnosis/etiology?
yes
9%
10%
9%
61%
10%
40913
0.038
[ { "from": "human", "value": "<image>\nA 34-year-old man with a history of intravenous drug use and hepatitis C infection presented to the ophthalmology clinic with a 1-week history of pain and decreased vision in his right eye. The visual acuity was 20/400 in the right eye and 20/20 in the left eye. Slit-lamp examination of the right eye showed conjunctival injection and inflammation in the anterior chamber. Indirect ophthalmoscopy showed vitreous haze with yellow-white lesions on the retina and optic nerve. Following workup, surgery was performed and a white mass measuring 4 mm by 3 mm by 1 mm was seen adherent to the optic nerve. What is the most likely diagnosis/etiology?\nA: Retinoblastoma\nB: Amelanotic uveal melanoma\nC: Astrocytic hamartoma\nD: Fungal endophthalmitis\nE: Malignant optic nerve prolapse" }, { "from": "gpt", "value": "D: Fungal endophthalmitis" } ]
6ca6681c2cea5af4a548e47c267d8779
[ "A: Retinoblastoma", "B: Amelanotic uveal melanoma", "C: Astrocytic hamartoma", "D: Fungal endophthalmitis", "E: Malignant optic nerve prolapse" ]
D: Fungal endophthalmitis
78
aug-01-2013
<image> What is the most likely diagnosis?
no
21%
19%
7%
30%
24%
109644
0.151
[ { "from": "human", "value": "<image>\nWhat is the most likely diagnosis?\nA: Discoid lupus\nB: Erythema migrans\nC: Psoriasis\nD: Tinea corporis\nE: Urticaria" }, { "from": "gpt", "value": "E: Urticaria" } ]
9ba88908b3390da7aeecfb9b6215c84c
[ "A: Discoid lupus", "B: Erythema migrans", "C: Psoriasis", "D: Tinea corporis", "E: Urticaria" ]
E: Urticaria
79
aug-01-2019
<image> A 56-year-old woman presented to the emergency department with a 1-month history of abdominal pain in the left upper quadrant. Her medical history was notable for polysubstance use disorder, hepatitis C virus infection, and rheumatoid arthritis managed with naproxen. Computed tomography of the abdomen was performed. What is the most likely diagnosis?
yes
18%
9%
28%
35%
10%
85024
0.11
[ { "from": "human", "value": "<image>\nA 56-year-old woman presented to the emergency department with a 1-month history of abdominal pain in the left upper quadrant. Her medical history was notable for polysubstance use disorder, hepatitis C virus infection, and rheumatoid arthritis managed with naproxen. Computed tomography of the abdomen was performed. What is the most likely diagnosis?\nA: Avascular necrosis of the spleen\nB: Visceral leishmaniasis\nC: Emphysematous infection of the spleen\nD: Gastrospenic fistulization\nE: Bezoar" }, { "from": "gpt", "value": "D: Gastrospenic fistulization" } ]
b1cab883e9444eb6b9a2cc61c9f8d00e
[ "A: Avascular necrosis of the spleen", "B: Visceral leishmaniasis", "C: Emphysematous infection of the spleen", "D: Gastrospenic fistulization", "E: Bezoar" ]
D: Gastrospenic fistulization
80
aug-02-2012
<image> What is the diagnosis?
no
10%
19%
30%
25%
15%
165,436
0.144
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Congenital hypothyroidism\nB: Congenital syphilis\nC: Dentinogenesis imperfecta\nD: Neonatal hyperbilirubinemia\nE: Williams syndrome" }, { "from": "gpt", "value": "D: Neonatal hyperbilirubinemia" } ]
b1781d720be0a3a00a0e0c7b3119cb70
[ "A: Congenital hypothyroidism", "B: Congenital syphilis", "C: Dentinogenesis imperfecta", "D: Neonatal hyperbilirubinemia", "E: Williams syndrome" ]
D: Neonatal hyperbilirubinemia
81
aug-02-2018
<image> A 69-year-old man presented to the dermatology clinic with a 2-month history of a pruritic rash. The rash first appeared on his right wrist and within 2 weeks had spread to his arms, legs, and trunk. He had completed treatment for chronic hepatitis C virus (HCV) infection with a 12-week course of elbasvir and grazoprevir 3 months before the onset of the purple papular rash. Some lesions showed a fine reticulate pattern of dots and lines (Wickham's striae). What is the diagnosis?
yes
13%
16%
13%
47%
11%
96606
0.07
[ { "from": "human", "value": "<image>\nA 69-year-old man presented to the dermatology clinic with a 2-month history of a pruritic rash. The rash first appeared on his right wrist and within 2 weeks had spread to his arms, legs, and trunk. He had completed treatment for chronic hepatitis C virus (HCV) infection with a 12-week course of elbasvir and grazoprevir 3 months before the onset of the purple papular rash. Some lesions showed a fine reticulate pattern of dots and lines (Wickham's striae). What is the diagnosis?\nA: Drug eruption\nB: Reactivation of endogenous latent varicella-zoster virus\nC: Discoid lupus erythematosus\nD: Lichen planus\nE: Pemphigus" }, { "from": "gpt", "value": "D: Lichen planus" } ]
d5027dc84290c168a704d3583a5f4721
[ "A: Drug eruption", "B: Reactivation of endogenous latent varicella-zoster virus", "C: Discoid lupus erythematosus", "D: Lichen planus", "E: Pemphigus" ]
D: Lichen planus
82
aug-03-2006
<image> What is the diagnosis?
no
30%
19%
31%
16%
4%
128251
0.126
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Elephantiasis\nB: Hydrocele\nC: Inguinal hernia\nD: Non-seminomatous germ-cell tumor\nE: Testicular torsion" }, { "from": "gpt", "value": "C: Inguinal hernia" } ]
5d6e74aaeca36cdc05903f3e2b8822fb
[ "A: Elephantiasis", "B: Hydrocele", "C: Inguinal hernia", "D: Non-seminomatous germ-cell tumor", "E: Testicular torsion" ]
C: Inguinal hernia
83
aug-03-2017
<image> What is the most likely diagnosis for these two painless periumbilical masses in a 76-year-old man with type 2 diabetes mellitus?
yes
2%
9%
3%
80%
6%
67978
0.011
[ { "from": "human", "value": "<image>\nWhat is the most likely diagnosis for these two painless periumbilical masses in a 76-year-old man with type 2 diabetes mellitus?\nA: Abscess\nB: Dermatofibrosarcoma protuberans\nC: Hematoma\nD: Insulin-induced lipohypertrophy\nE: Nodular fasciitis" }, { "from": "gpt", "value": "D: Insulin-induced lipohypertrophy" } ]
06d64a1ff70ad51f47ae5e6187c7f89e
[ "A: Abscess", "B: Dermatofibrosarcoma protuberans", "C: Hematoma", "D: Insulin-induced lipohypertrophy", "E: Nodular fasciitis" ]
D: Insulin-induced lipohypertrophy
84
aug-03-2023
<image> A 95-year-old woman presented with a 4-week history of dyspnea and dry cough. She had not previously reported these symptoms to her doctor. For the past 6 months, she had been taking nitrofurantoin daily to prevent recurrent urinary tract infections. Her oxygen saturation was 83% on room air. Physical examination showed inspiratory crackles in the upper lung fields but no jugular venous distention or edema. Laboratory studies showed neutrophilic leukocytosis but no eosinophilia or elevations in aminotransferase levels. A sputum culture and viral respiratory panel were negative. Chest radiograph and computed tomography of the chest are shown. What is the most important element of the management of this condition?
yes
7%
69%
15%
4%
5%
23391
0.026
[ { "from": "human", "value": "<image>\nA 95-year-old woman presented with a 4-week history of dyspnea and dry cough. She had not previously reported these symptoms to her doctor. For the past 6 months, she had been taking nitrofurantoin daily to prevent recurrent urinary tract infections. Her oxygen saturation was 83% on room air. Physical examination showed inspiratory crackles in the upper lung fields but no jugular venous distention or edema. Laboratory studies showed neutrophilic leukocytosis but no eosinophilia or elevations in aminotransferase levels. A sputum culture and viral respiratory panel were negative. Chest radiograph and computed tomography of the chest are shown. What is the most important element of the management of this condition?\nA: Antibiotics\nB: Cessation of nitrofurantoin\nC: Glucocorticoids\nD: Intravenous loop diuretics\nE: Scheduled nebulized bronchodilators" }, { "from": "gpt", "value": "B: Cessation of nitrofurantoin" } ]
b7b9e26865a090a7c1ecb069e5c17ed8
[ "A: Antibiotics", "B: Cessation of nitrofurantoin", "C: Glucocorticoids", "D: Intravenous loop diuretics", "E: Scheduled nebulized bronchodilators" ]
B: Cessation of nitrofurantoin
85
aug-04-2011
<image> This lesion developed on the chest of a 35-year-old man during treatment for a respiratory tract infection. What is the diagnosis?
yes
4%
10%
43%
34%
9%
105858
0.128
[ { "from": "human", "value": "<image>\nThis lesion developed on the chest of a 35-year-old man during treatment for a respiratory tract infection. What is the diagnosis?\nA: Acute urticaria\nB: Drug-induced pemphigus\nC: Erythema annulare\nD: Fixed drug eruption\nE: Stevens-Johnson syndrome" }, { "from": "gpt", "value": "D: Fixed drug eruption" } ]
386a6c59e402c490027afc14a433b07c
[ "A: Acute urticaria", "B: Drug-induced pemphigus", "C: Erythema annulare", "D: Fixed drug eruption", "E: Stevens-Johnson syndrome" ]
D: Fixed drug eruption
86
aug-04-2016
<image> A man presented with new peripheral edema. What diagnosis does his chest X-ray suggest?
yes
6%
8%
2%
32%
51%
106508
0.071
[ { "from": "human", "value": "<image>\nA man presented with new peripheral edema. What diagnosis does his chest X-ray suggest?\nA: Superior vena cava syndrome\nB: Dilated thoracic aorta\nC: Right middle lobe pneumonia\nD: Cardiac tamponade\nE: Giant right atrium" }, { "from": "gpt", "value": "E: Giant right atrium" } ]
519991e9a255071495ba8ce81a9d7291
[ "A: Superior vena cava syndrome", "B: Dilated thoracic aorta", "C: Right middle lobe pneumonia", "D: Cardiac tamponade", "E: Giant right atrium" ]
E: Giant right atrium
87
aug-04-2022
<image> A 71-year-old man presented with an 8-year history of enlarging nodules on his nose. On physical examination, he had painless, violaceous, indurated nodules on his nose, ears, fingers, and toes. Computed tomography of the chest revealed hilar and mediastinal lymphadenopathy. Skin biopsy showed non-caseating granulomas. What is the most likely diagnosis?
yes
15%
17%
36%
12%
20%
69090
0.103
[ { "from": "human", "value": "<image>\nA 71-year-old man presented with an 8-year history of enlarging nodules on his nose. On physical examination, he had painless, violaceous, indurated nodules on his nose, ears, fingers, and toes. Computed tomography of the chest revealed hilar and mediastinal lymphadenopathy. Skin biopsy showed non-caseating granulomas. What is the most likely diagnosis?\nA: Entomophthoramyocosis\nB: Leprosy\nC: Lupus pernio\nD: Lupus vulgaris\nE: Rhinophyma" }, { "from": "gpt", "value": "C: Lupus pernio" } ]
ce2f2a1af407453448aee5c550096885
[ "A: Entomophthoramyocosis", "B: Leprosy", "C: Lupus pernio", "D: Lupus vulgaris", "E: Rhinophyma" ]
C: Lupus pernio
88
aug-05-2010
<image> An 18-year-old woman presented with visual loss in the right eye. What diagnosis is suggested by this finding on ophthalmoscopy?
yes
5%
13%
17%
20%
45%
74241
0.078
[ { "from": "human", "value": "<image>\nAn 18-year-old woman presented with visual loss in the right eye. What diagnosis is suggested by this finding on ophthalmoscopy?\nA: Cystic fibrosis\nB: Marfan syndrome\nC: Sickle cell disease\nD: Tay-Sachs disease\nE: Von Hippel-Lindau disease" }, { "from": "gpt", "value": "E: Von Hippel-Lindau disease" } ]
8dbecc629f6cde0f86a99a83adb85a81
[ "A: Cystic fibrosis", "B: Marfan syndrome", "C: Sickle cell disease", "D: Tay-Sachs disease", "E: Von Hippel-Lindau disease" ]
E: Von Hippel-Lindau disease
89
aug-05-2021
<image> A 62-year-old woman with recent travel to Colombia presented with pruritic, draining nodules with a central punctum on her back and buttocks. The lesions were unchanged after a trial of antibiotics. What is the most likely diagnosis?
yes
23%
10%
14%
36%
17%
110076
0.104
[ { "from": "human", "value": "<image>\nA 62-year-old woman with recent travel to Colombia presented with pruritic, draining nodules with a central punctum on her back and buttocks. The lesions were unchanged after a trial of antibiotics. What is the most likely diagnosis?\nA: Cutaneous leishmaniasis\nB: Epidermoid cyst\nC: Furunculosis\nD: Myiasis\nE: Tungiasis" }, { "from": "gpt", "value": "D: Myiasis" } ]
8251c1020681d077eefb61aadb0c070a
[ "A: Cutaneous leishmaniasis", "B: Epidermoid cyst", "C: Furunculosis", "D: Myiasis", "E: Tungiasis" ]
D: Myiasis
90
aug-06-2009
<image> This 6-week old presented with scrotal pain. What is the diagnosis?
yes
8%
17%
30%
4%
41%
123854
0.095
[ { "from": "human", "value": "<image>\nThis 6-week old presented with scrotal pain. What is the diagnosis?\nA: Bilateral cryptorchidism\nB: Bilateral inguinal hernias\nC: Isolated right hydrocele\nD: Left retractile testis\nE: Left testicular torsion" }, { "from": "gpt", "value": "E: Left testicular torsion" } ]
10d4872b0acd0d53709eb9ad210918b3
[ "A: Bilateral cryptorchidism", "B: Bilateral inguinal hernias", "C: Isolated right hydrocele", "D: Left retractile testis", "E: Left testicular torsion" ]
E: Left testicular torsion
91
aug-06-2015
<image> Which of the following is the least likely differential diagnosis associated with this image finding?
no
51%
13%
10%
14%
11%
89280
0.06
[ { "from": "human", "value": "<image>\nWhich of the following is the least likely differential diagnosis associated with this image finding?\nA: Pulmonary hypertension\nB: Neoplasm\nC: Vasculitis\nD: Septic emboli\nE: Infection" }, { "from": "gpt", "value": "A: Pulmonary hypertension" } ]
8cf8c3bfa9c1346b7bb9a42fb246f981
[ "A: Pulmonary hypertension", "B: Neoplasm", "C: Vasculitis", "D: Septic emboli", "E: Infection" ]
A: Pulmonary hypertension
92
aug-06-2020
<image> A 60-year-old woman presented to an oral surgery clinic with gum swelling. She had associated bleeding while brushing her teeth. She had a history of colorectal cancer treated with surgery and chemotherapy. On examination, a large, nontender, pedunculated mass was noted. What is the diagnosis?
yes
11%
42%
21%
16%
10%
88448
0.086
[ { "from": "human", "value": "<image>\nA 60-year-old woman presented to an oral surgery clinic with gum swelling. She had associated bleeding while brushing her teeth. She had a history of colorectal cancer treated with surgery and chemotherapy. On examination, a large, nontender, pedunculated mass was noted. What is the diagnosis?\nA: Zimmerman-Laband syndrome\nB: Metastasis of colorectal cancer\nC: Gingival hyperplasia secondary to chemotherapy\nD: Alveolar soft part sarcoma\nE: Irritation fibroma" }, { "from": "gpt", "value": "B: Metastasis of colorectal cancer" } ]
e29c45036b05a659416c13466f811b3d
[ "A: Zimmerman-Laband syndrome", "B: Metastasis of colorectal cancer", "C: Gingival hyperplasia secondary to chemotherapy", "D: Alveolar soft part sarcoma", "E: Irritation fibroma" ]
B: Metastasis of colorectal cancer
93
aug-07-2008
<image> This 35-year-old pet shop worker developed progressively spreading nodular lesions. He was afebrile. What is the most likely causative organism?
yes
7%
15%
39%
21%
17%
144757
0.094
[ { "from": "human", "value": "<image>\nThis 35-year-old pet shop worker developed progressively spreading nodular lesions. He was afebrile. What is the most likely causative organism?\nA: Acinetobacter baumannii\nB: Erysipelothrix rhusiopathiae\nC: Mycobacterium marinum\nD: Pasteurella multocida\nE: Staphylococcus epidermidis" }, { "from": "gpt", "value": "C: Mycobacterium marinum" } ]
c4763c4e290bf803f392a12c3a1ac5ce
[ "A: Acinetobacter baumannii", "B: Erysipelothrix rhusiopathiae", "C: Mycobacterium marinum", "D: Pasteurella multocida", "E: Staphylococcus epidermidis" ]
C: Mycobacterium marinum
94
aug-07-2014
<image> What is the most likely diagnosis?
no
7%
14%
12%
13%
55%
93309
0.052
[ { "from": "human", "value": "<image>\nWhat is the most likely diagnosis?\nA: Mucocele\nB: Necrotizing sialometaplasia\nC: Periapical abscess\nD: Periodontal abscess\nE: Syphilitic gumma" }, { "from": "gpt", "value": "E: Syphilitic gumma" } ]
eb8b5c72ce584582b95a2708b1e96574
[ "A: Mucocele", "B: Necrotizing sialometaplasia", "C: Periapical abscess", "D: Periodontal abscess", "E: Syphilitic gumma" ]
E: Syphilitic gumma
95
aug-08-2013
<image> What is the diagnosis in this 42-year-old man with bone pain?
yes
11%
28%
19%
34%
8%
84108
0.138
[ { "from": "human", "value": "<image>\nWhat is the diagnosis in this 42-year-old man with bone pain?\nA: Hypervitaminosis A\nB: Gaucher's disease\nC: Multiple myeloma\nD: Osteopetrosis\nE: Thalassemia minor" }, { "from": "gpt", "value": "B: Gaucher's disease" } ]
d26b5f419f68d0aee357d36945b33422
[ "A: Hypervitaminosis A", "B: Gaucher's disease", "C: Multiple myeloma", "D: Osteopetrosis", "E: Thalassemia minor" ]
B: Gaucher's disease
96
aug-08-2019
<image> A 79-year-old man with a history of ischemic cardiomyopathy and chronic kidney disease presented 1 month after a transcatheter aortic-valve replacement (TAVR) with a serum creatinine level of 4.0 mg per deciliter (350 umol per liter), up from a baseline of 1.6 mg per deciliter (140 umol per liter). Renal biopsy is shown. What is the most likely diagnosis?
yes
10%
17%
13%
49%
12%
55114
0.066
[ { "from": "human", "value": "<image>\nA 79-year-old man with a history of ischemic cardiomyopathy and chronic kidney disease presented 1 month after a transcatheter aortic-valve replacement (TAVR) with a serum creatinine level of 4.0 mg per deciliter (350 umol per liter), up from a baseline of 1.6 mg per deciliter (140 umol per liter). Renal biopsy is shown. What is the most likely diagnosis?\nA: Calcium oxalate deposition\nB: Ischemic acute tubular necrosis\nC: Renal artery infarction\nD: Cholesterol crystal embolization\nE: Cryoglobulinemic vasculitis" }, { "from": "gpt", "value": "D: Cholesterol crystal embolization" } ]
077347bc16e778f4ad03f232cf8a8957
[ "A: Calcium oxalate deposition", "B: Ischemic acute tubular necrosis", "C: Renal artery infarction", "D: Cholesterol crystal embolization", "E: Cryoglobulinemic vasculitis" ]
D: Cholesterol crystal embolization
97
aug-09-2007
<image> What is the diagnosis?
no
15%
55%
5%
10%
14%
137802
0.051
[ { "from": "human", "value": "<image>\nWhat is the diagnosis?\nA: Molluscum contagiosum\nB: Pearly penile papules\nC: Secondary syphilis\nD: Obstruction of smegma-producing gland\nE: Condyloma acuminatum" }, { "from": "gpt", "value": "B: Pearly penile papules" } ]
6e1b161166db53e9133c7d08c96cdeab
[ "A: Molluscum contagiosum", "B: Pearly penile papules", "C: Secondary syphilis", "D: Obstruction of smegma-producing gland", "E: Condyloma acuminatum" ]
B: Pearly penile papules
98
aug-09-2012
<image> What diagnosis is suggested by the results of this coronary angiogram?
yes
3%
15%
7%
48%
27%
82891
0.074
[ { "from": "human", "value": "<image>\nWhat diagnosis is suggested by the results of this coronary angiogram?\nA: Diabetes mellitus\nB: Fibromuscular dysplasia\nC: Marfan syndrome\nD: Polyarteritis nodosa\nE: Takayasu arteritis" }, { "from": "gpt", "value": "D: Polyarteritis nodosa" } ]
f40315d5f4367e76481a8f636ddd887f
[ "A: Diabetes mellitus", "B: Fibromuscular dysplasia", "C: Marfan syndrome", "D: Polyarteritis nodosa", "E: Takayasu arteritis" ]
D: Polyarteritis nodosa
99
aug-09-2018
<image> A 39-year-old man presented to the emergency department with anorexia, nausea, vomiting, oliguria, and diffuse deposits on his skin. The physical exam findings are associated with what underlying disease?
yes
59%
10%
14%
9%
8%
69493
0.042
[ { "from": "human", "value": "<image>\nA 39-year-old man presented to the emergency department with anorexia, nausea, vomiting, oliguria, and diffuse deposits on his skin. The physical exam findings are associated with what underlying disease?\nA: End-stage renal disease\nB: Acute myeloid leukemia\nC: Sarcoidosis\nD: End-stage liver disease\nE: Tuberculosis" }, { "from": "gpt", "value": "A: End-stage renal disease" } ]
021172e7aadf571a66f39d897e9e2444
[ "A: End-stage renal disease", "B: Acute myeloid leukemia", "C: Sarcoidosis", "D: End-stage liver disease", "E: Tuberculosis" ]
A: End-stage renal disease
100
aug-10-2006
<image> A 25-year-old bodybuilder presented with a tender, erythematous mass in the left upper arm. What is the most likely diagnosis?
yes
30%
40%
20%
5%
5%
90070
0.099
[ { "from": "human", "value": "<image>\nA 25-year-old bodybuilder presented with a tender, erythematous mass in the left upper arm. What is the most likely diagnosis?\nA: Ruptured biceps tendon\nB: Abscess\nC: Axillary vein thrombosis\nD: Glenohumeral joint dislocation\nE: Osteosarcoma" }, { "from": "gpt", "value": "B: Abscess" } ]
4e38bd8e44f0dcdde34efe8592d16dad
[ "A: Ruptured biceps tendon", "B: Abscess", "C: Axillary vein thrombosis", "D: Glenohumeral joint dislocation", "E: Osteosarcoma" ]
B: Abscess