OctoMed/NEJM-Image-Challenge · Datasets at Hugging Face

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201	dec-17-2009	This patient had a history of breast-cancer surgery. Which one of the following rib abnormalities is present on her follow-up imaging?	yes	14%	15%	25%	20%	26%	127289	0.138	d9b714407091e0849e240498a6dee14e	[ "A: Absent rib", "B: Inferior rib notching", "C: Rib metastases", "D: Sternocostal anomaly", "E: Supernumerary rib" ]	E: Supernumerary rib
202	dec-17-2015	What is the most likely diagnosis associated with these findings and symptoms of eye and ear pain?	yes	53%	9%	17%	7%	15%	94376	0.057	b760dc338bab50018fab71b5e034a5f9	[ "A: Polychondritis", "B: Sjogren's syndrome", "C: Granulomatosis with polyangiitis", "D: Takayasu arteritis", "E: Sarcoidosis" ]	A: Polychondritis
203	dec-17-2020	A 60-year-old man presented to the hematology clinic with fatigue and dyspnea on exertion. He had a history of sickle cell disease with hemoglobin genotype SS. Laboratory studies showed a hemoglobin level of 4 g per deciliter. Light microscopy of a bone marrow biopsy specimen is as shown. What is the diagnosis?	yes	11%	15%	14%	50%	10%	45143	0.063	05d41a229d98331c08b07285ed3115d4	[ "A: Sideroblastic anemia", "B: B-cell acute lymphoblastic leukemia", "C: Aplastic anemia", "D: Hemophagocytosis of sickle cells", "E: Multiple myeloma" ]	D: Hemophagocytosis of sickle cells
204	dec-18-2008	What endocrine diagnosis is affecting the identical twin on the right side of the image?	yes	5%	7%	20%	57%	11%	139371	0.049	b1a9c05c2ddb4c188bba53da6d8ddc47	[ "A: Acromegaly", "B: Addison's disease", "C: Cushing's syndrome", "D: Hypogonadism", "E: Hypothyroidism" ]	D: Hypogonadism
205	dec-18-2014	What is the diagnosis?	no	17%	11%	25%	40%	7%	110123	0.094	c518e00cfb8dbf7cfdbbe112909f3306	[ "A: Aortic aneurysm", "B: Aortic coarctation", "C: Diaphragmatic hernia", "D: Esophageal diverticulum", "E: Pericardial effusion" ]	D: Esophageal diverticulum
206	dec-19-2013	What is the diagnosis?	no	15%	6%	17%	5%	57%	70409	0.048	0f126b52a3ebb8ddd07872960515c8ae	[ "A: Ehlers-Danlos syndrome", "B: Familial hypertriglyceridemia", "C: Hidradinitis suppurativa", "D: Marfan syndrome", "E: Pseudoxanthoma elasticum" ]	E: Pseudoxanthoma elasticum
207	dec-19-2019	A 74-year-old woman was hospitalized with sudden-onset weakness on the left side due to an acute infarct of the right middle cerebral artery. Examination of the oral mucosa and hands demonstrated the following lesions. What is the most likely diagnosis?	yes	25%	7%	41%	13%	14%	102762	0.09	d364056fce49b050be723a4669f39685	[ "A: Infective endocarditis", "B: Scleroderma", "C: Hereditary hemorrhagic telangiectasia", "D: Levamisole-induced vasculitis", "E: Amyloid angiopathy" ]	C: Hereditary hemorrhagic telangiectasia
208	dec-20-2007	Which cardiac valves have been replaced?	yes	50%	12%	16%	12%	9%	132314	0.062	b7fc90fea704cac5bc44d306814610f2	[ "A: Aortic and mitral valves", "B: Aortic and tricuspid valves", "C: Mitral and tricuspid valves", "D: Pulmonary and mitral valves", "E: Pulmonary and tricuspid valves" ]	A: Aortic and mitral valves
209	dec-20-2012	What is the diagnosis?	no	37%	24%	5%	10%	23%	84598	0.104	f00f2f888bcaaf307cf5605373306b77	[ "A: Albright's hereditary osteodystrophy", "B: Hypertrophic osteoarthropathy", "C: Median nerve palsy", "D: Osteoarthritis", "E: Rheumatoid arthritis" ]	A: Albright's hereditary osteodystrophy
210	dec-20-2018	An 84-year-old man presented with fever, malaise, and discoloration and pain in his fingers and toes ongoing for 2 weeks. He had no history of smoking. On physical examination, he was afebrile with blue-black discoloration on several fingers of his left hand and purpuric lesions on both hands and feet. He had palpable ...	yes	15%	46%	10%	7%	21%	135323	0.075	8974634cc5c99c7e18e23936842868d1	[ "A: Infection with Vibrio vulnificus", "B: Polyarteritis nodosa", "C: Necrotizing fasciitis", "D: Herpetic whitlow", "E: Arterial embolism" ]	B: Polyarteritis nodosa
211	dec-21-2006	This 84-cm tall 40-year-old man underwent whole-body dual-energy x-ray absorptiometry. What is the diagnosis?	yes	5%	9%	54%	25%	8%	100228	0.058	1cbc516268801998dcef08ac0df1c1a3	[ "A: Pseudohypoparathyroidism", "B: X-linked hypophosphatemia", "C: Osteogenesis imperfecta", "D: Achondroplasia", "E: Ehlers Danlos syndrome" ]	C: Osteogenesis imperfecta
212	dec-21-2017	A 70-year-old woman presented to the neurology clinic with a 2-year history of gait disturbance, cognitive impairment, and urinary incontinence. What is the diagnosis?	yes	68%	7%	6%	9%	11%	61534	0.026	9b382c95e1758ebc09eda7aecbf591ca	[ "A: Normal-pressure hydrocephalus", "B: Alzheimer's disease", "C: Parkinson's disease", "D: Benign intracranial hypertension", "E: Multiple system atrophy" ]	A: Normal-pressure hydrocephalus
213	dec-21-2023	A 25-year-old woman with severe obesity presented to the emergency department with a 1-week history of blurred vision, headaches, and transient visual obscurations. Neurologic examination showed optic disk swelling and retinal hemorrhages in both eyes. An MRI and MRV of the head showed flattened posterior globes, an em...	yes	58%	7%	11%	14%	11%	12400	0.045	3654dfd1f2611c35abf0a3f8e2e9e350	[ "A: Elevated opening pressure", "B: Elevated white blood cell count", "C: Oligoclonal bands", "D: Positive anti-aquaporin 4 antibody", "E: Xanthochromia" ]	A: Elevated opening pressure
214	dec-22-2005	What endocrinopathy is most frequently associated with this sign?	yes	30%	46%	6%	11%	7%	72519	0.08	bc16cca9dd89eb5c9b93627b6a874dc1	[ "A: Addison's disease", "B: Insulin resistance", "C: Growth hormone excess", "D: Glucagonoma", "E: Diabetes insipidus" ]	B: Insulin resistance
215	dec-22-2011	What is the diagnosis?	no	5%	8%	47%	19%	22%	93972	0.075	310e7c1095a4a696aea14e9bc4023df7	[ "A: Cushing's syndrome", "B: Decompression sickness", "C: Electrocution", "D: Filariasis", "E: Lymphangitis" ]	C: Electrocution
216	dec-22-2016	A 23-year-old woman presented with a 1-month history of headache, syncope, weight gain. Physical examination revealed hypertrophic appearance of the thigh and calf muscles, and imaging of her thighs is shown. What is the diagnosis?	yes	4%	13%	21%	55%	8%	99845	0.054	6982d46f3b31558c1649fe0fbaa04c8d	[ "A: Septic emboli", "B: Echinococcus granulosus", "C: Myxoid sarcoma", "D: Cysticercosis", "E: Toxoplasma gondii" ]	D: Cysticercosis
217	dec-22-2022	An 18-year-old man presented with a 2-day history of fever, vomiting, and diarrhea. Three weeks before presentation, he had fallen into a canal. Physical exam was notable for the findings shown in the image. Laboratory studies showed acute kidney injury and elevations in aminotransferase and total bilirubin levels. Wha...	yes	14%	8%	13%	57%	8%	51894	0.047	bb98c3ca1bbaf76bb3076287de35132b	[ "A: Acute hemorrhagic conjunctivitis", "B: Ebola hemorrhagic fever", "C: Giardiasis", "D: Leptospirosis", "E: Subarachnoid hemorrhage" ]	D: Leptospirosis
218	dec-23-2010	This patient had diabetes. What is the diagnosis?	yes	1%	57%	23%	4%	15%	95942	0.052	568e7d100cdc1f61bcf71ab1db327399	[ "A: Ichthyosis", "B: Ischemic gangrene", "C: Necrobiosis lipoidica diabeticorum", "D: Phlegmasia cerulea dolens", "E: Pyoderma gangrenosum" ]	B: Ischemic gangrene
219	dec-23-2021	A 65-year-old man presented to the dermatology clinic with a 7-month history of painless skin thickening over the left side of his chest and on his left arm. Physical examination showed sclerotic skin over his left chest and nipple, multiple erythematous nodules over the left arm, axilla, and posterior trunk, left axil...	yes	40%	18%	18%	10%	16%	59405	0.092	162659276897d4970283ccc3152bb752	[ "A: Carcinoma en cuirasse", "B: Carcinoma erysipeloides", "C: Inflammatory breast cancer", "D: Morphea", "E: Paget's disease" ]	A: Carcinoma en cuirasse
220	dec-24-2009	What is the diagnosis?	no	7%	18%	6%	59%	10%	97341	0.044	c513244452c3495077964bc64b5ea61a	[ "A: Eczema", "B: Herpetic whitlow", "C: Impetigo", "D: Scabies", "E: Tinea pedis" ]	D: Scabies
221	dec-24-2015	What radiographic finding is observed here?	yes	8%	4%	8%	5%	75%	61007	0.016	d89931f1f94638fa24286323e52bae04	[ "A: Air in the subcutaneous space", "B: Diffuse osteopenia", "C: Ground-glass opacity", "D: Kerley’s B lines", "E: Air bronchogram" ]	E: Air bronchogram
222	dec-24-2020	A 35-year-old man presented with a 6-month history of increased swelling in his right leg. Physical exam revealed firmness in the right lower leg without tenderness to palpation. Magnetic resonance imaging of the area revealed multiple cystic lesions. What is the diagnosis?	yes	13%	56%	9%	10%	12%	90448	0.049	62cc3702e361549b4d7e2e39fcd21645	[ "A: Lipomas", "B: Echinococcal cysts", "C: Sebaceous cysts", "D: Metastatic sarcoma", "E: Ganglion cysts" ]	B: Echinococcal cysts
223	dec-25-2008	What is the diagnosis?	no	5%	11%	6%	72%	6%	105083	0.02	f17ec3e5553e46d2943fcf97b14ebdbe	[ "A: Neuropathic arthropathy", "B: Rheumatoid arthritis", "C: Hemophilia", "D: Chondrocalcinosis", "E: Rickets" ]	D: Chondrocalcinosis
224	dec-25-2014	What is the diagnosis in this patient with chest pain?	yes	9%	16%	13%	12%	51%	87372	0.061	c52f3d5ecbbfd098b457580890d42c5c	[ "A: Anxiety", "B: Myocarditis", "C: Pericardial effusion", "D: Pulmonary embolism", "E: Stenosis of the left anterior descending artery" ]	E: Stenosis of the left anterior descending artery
225	dec-26-2013	What is the diagnosis?	no	5%	3%	12%	10%	69%	69850	0.025	0a4e68413f1e515d536debee2eac0100	[ "A: African trypanosomiasis", "B: Frostbite", "C: Keratosis follicularis", "D: Leprosy", "E: Papillomatosis cutis lymphostatica" ]	E: Papillomatosis cutis lymphostatica
226	dec-26-2019	A 19-year-old woman presented to the emergency department with severe abdominal pain that had started 9 hours earlier. Rebound tenderness was present in the suprapubic and left iliac fossa regions on physical examination. A urine test for beta human chorionic gonadotropin was negative. A diagnostic laparoscopy was perf...	yes	20%	19%	38%	11%	12%	85650	0.097	424c9b08bd864afe78ad4048eadca3e4	[ "A: Ovarian torsion", "B: Paraovarian cyst torsion", "C: Fallopian tube torsion", "D: Broad ligament torsion", "E: Uterine torsion" ]	C: Fallopian tube torsion
227	dec-27-2007	What is the diagnosis?	no	59%	7%	6%	12%	17%	134988	0.044	a4e4111f904a1406976c32668d25168f	[ "A: Rhinophyma", "B: Leishmaniasis", "C: Lupus pernio", "D: Wegener's granulomatosis", "E: Basal cell carcinoma" ]	A: Rhinophyma
228	dec-27-2012	This ocular nodule had several black hairs. What is the diagnosis?	yes	8%	55%	6%	12%	19%	79783	0.053	d6c67aeea40e6e9a97aec066f4ae56bb	[ "A: Chalazion", "B: Dermoid", "C: Melanoma", "D: Phlyctenule", "E: Pinguecula" ]	B: Dermoid
229	dec-27-2018	A 29-year-old man presented to the dermatology clinic with a pruritic, erythematous, and scaly rash that had first appeared 2 years earlier. He had sought no medical treatment until this presentation. His medical history included eczema during childhood and seasonal allergies. Physical examination showed erythematous, ...	yes	7%	25%	11%	50%	7%	87738	0.067	a224827cb27ab04851351c001185138a	[ "A: Seborrheic dermatitis", "B: Pityriasis rubra pilaris", "C: Erythema multiforme", "D: Erythrodermic psoriasis", "E: Toxic epidermal necrolysis" ]	D: Erythrodermic psoriasis
230	dec-28-2006	What is the diagnosis?	no	49%	19%	12%	9%	11%	87744	0.066	90a1170c485629cb18ca379ce463832b	[ "A: Prolapse of orbital fat", "B: Pinguecula", "C: Graves' disease", "D: Neurofibromatosis", "E: Wilson's disease" ]	A: Prolapse of orbital fat
231	dec-28-2017	An 86-year-old man presented with an absent right pectoralis major muscle and brachydactyly of the right hand since birth. What is the diagnosis?	yes	1%	66%	17%	5%	11%	85942	0.032	d6eb258e9d5d214e3054b3507c9bf10f	[ "A: Down syndrome", "B: Poland syndrome", "C: Prenatal thalidomide exposure", "D: Fanconi anemia", "E: Ehlers-Danlos syndrome" ]	B: Poland syndrome
232	dec-29-2005	What is the diagnosis?	no	7%	4%	12%	8%	70%	76906	0.023	83ce9c3b2e70e43987a65d10942685fd	[ "A: Aspergillosis", "B: Adrenal insufficiency", "C: Oral leukoplakia", "D: Pellagra", "E: Lingua villosa nigra" ]	E: Lingua villosa nigra
233	dec-29-2011	What structure has ruptured in this image?	yes	13%	9%	60%	5%	14%	84044	0.041	7651490be880d39d4b3bc7bcf595461b	[ "A: Diaphragm", "B: Esophagus", "C: Intercostal muscle", "D: Interventricular septum", "E: Pericardium" ]	C: Intercostal muscle
234	dec-29-2016	A 90-year-old man presented with a 1-month history of progressive edema in both of his legs, malaise, and dizziness associated with hypoglycemia. His chest radiograph demonstrated abnormal findings. What is the diagnosis?	yes	28%	10%	7%	53%	2%	103282	0.063	0497f3ba7ef97f351ad99ff472dfcea4	[ "A: Gastric bezoar", "B: Gastric polyp", "C: Pyloric stenosis", "D: Gastric cancer", "E: Peptic ulcer disease" ]	D: Gastric cancer
235	dec-29-2022	A 34-year-old man was admitted to the hospital with diabetic ketoacidosis. He reported having had blurry vision, increasing shoe size, and a change in his facial features over the past several years. On exam, he was found to have bitemporal hemianopsia. Which of the following is the most likely cause of his presentatio...	yes	5%	5%	5%	4%	80%	28784	0.01	dc4d5a953d3557e4ddde71102b5ed19c	[ "A: Anabolic steroid use", "B: Beckwith–Wiedemann syndrome", "C: Nelson’s syndrome", "D: Pachydermoperiostosis", "E: Somatotropic pituitary adenoma" ]	E: Somatotropic pituitary adenoma
236	dec-30-2010	This rash had been present for 2 weeks. What is the diagnosis?	yes	14%	9%	5%	8%	64%	88392	0.033	ea82875c0456156849f1b95cfb2b63dd	[ "A: Coxsackie A", "B: Gonococcus", "C: Measles", "D: Parvovirus B19", "E: Treponema pallidum" ]	E: Treponema pallidum
237	dec-30-2021	A 48-year-old woman presented to the emergency department with a 1-week history of fatigue and painful, swollen gums. On examination, she was febrile and tachycardic with a well-demarcated region of gingival infiltration and whitening and submandibular lymphadenopathy. A white-cell count was 225,000 per cubic millimete...	yes	12%	57%	8%	14%	9%	98966	0.047	68f4cb085cab293e22312d0eed218474	[ "A: Gingival candidiasis", "B: Leukemic infiltration of the gingiva", "C: Oral lichen planus", "D: Proliferative verrucous leukoplakia", "E: White sponge nevus" ]	B: Leukemic infiltration of the gingiva
238	dec-31-2009	This patient had a 4-year history of diabetes. What is the diagnosis?	yes	12%	42%	31%	5%	10%	113453	0.136	5c93e6524b20191ec515cf4519042b93	[ "A: Bullous disease of diabetes", "B: Necrobiosis lipoidica diabeticorum", "C: Necrolytic migratory erythema", "D: Pigmented purpuric dermatosis", "E: Scleredema of diabetes" ]	C: Necrolytic migratory erythema
239	dec-31-2015	What is the most likely diagnosis in a 60-year-old man with blurry vision for 2 months and the findings seen here?	yes	6%	8%	9%	23%	53%	70457	0.058	6307cb79396e7f94d6a07a0b0921364b	[ "A: HIV", "B: Syphilis", "C: Closed-angle glaucoma", "D: Hypertensive crisis", "E: Waldenström’s macroglobulinemia" ]	E: Waldenström’s macroglobulinemia
240	dec-31-2020	A 45-year-old man presented to the emergency department after a motorcycle accident. Physical examination was notable for a bruise in the pubic area and severe pain in the anterior and posterior pelvic areas with manual compression. What is the diagnosis?	yes	68%	20%	3%	4%	4%	46415	0.029	21e3228ebc6c5bea097fd6512270a4cc	[ "A: Open-book fracture", "B: Straddle pelvic fracture", "C: Avascular necrosis of the hip", "D: Femoral head fracture", "E: Hip dysplasia" ]	A: Open-book fracture
241	feb-01-2007	What is the diagnosis?	no	46%	21%	6%	10%	17%	100449	0.076	b7e672a63c76927c41487c98ca946aee	[ "A: Tinea barbae", "B: Herpes simplex infection", "C: Eczema", "D: Mycosis fungoides", "E: Impetigo" ]	A: Tinea barbae
242	feb-01-2018	A previously healthy 1-year-old girl was admitted to the hospital with a 4-day history of high fever accompanied by erythema and swelling of the left third finger, gingival inflammation, and tongue ulcerations. What is the likely diagnosis?	yes	15%	20%	13%	41%	10%	136996	0.088	d36d097e3274e777f9012bac35a4f6ce	[ "A: Bacterial cellulitis", "B: Hand, foot, and mouth disease", "C: Paronychia", "D: Herpetic whitlow", "E: Sporotrichosis" ]	D: Herpetic whitlow
243	feb-02-2006	This patient underwent computed tomography of the pelvis having presented with lower extremity edema. What diagnosis is suggested?	yes	21%	11%	48%	10%	10%	71275	0.069	ab0b8b1773029521569d4b08352e871a	[ "A: Uterine fibroid", "B: Ovarian cyst", "C: Urinary retention", "D: Teratoma", "E: Aortic aneurysm" ]	C: Urinary retention
244	feb-02-2012	This 23-year-old man was involved in a motor vehicle accident. What is the diagnosis?	yes	12%	5%	25%	55%	4%	89149	0.057	ccc0298ea33b84f5e18118db25c563ff	[ "A: Aortic dissection", "B: Cardiac rupture", "C: Diaphragmatic rupture", "D: Pneumothorax", "E: Vertebral fractures" ]	D: Pneumothorax
245	feb-02-2017	A 15-year-old boy presented with decreased vision in both eyes, and a slit lamp examination revealed this finding. What is the diagnosis?	yes	12%	10%	10%	8%	60%	92107	0.04	0cd29c498c2a9a7b5e7567009e7d7586	[ "A: Juvenile xanthogranuloma", "B: Persistent hyperplastic primary vitreous", "C: Protruding iris collarette", "D: Iris duplication", "E: Persistent pupillary membranes" ]	E: Persistent pupillary membranes
246	feb-02-2023	A previously healthy 42-year-old woman presented to the dental clinic with a 6-month history of swelling and pain on the right side of her chin (left). She reported no history of chin trauma, tooth pain, or fevers, but did recall injuring her right lateral incisor 10 years prior. Palpation of the lesion caused pain and...	yes	83%	6%	4%	3%	4%	31485	0.007	27215623165fc49bc8ca53c49af5091c	[ "A: Odontogenic cutaneous fistula", "B: Osteosarcoma", "C: Pilar cyst", "D: Sebaceous cyst", "E: Squamous cell carcinoma" ]	A: Odontogenic cutaneous fistula
247	feb-03-2011	What is the diagnosis?	no	10%	10%	8%	11%	60%	88537	0.04	bf791fb000703f24dd75c1b94952794b	[ "A: Bancroftian filariasis", "B: Deep-vein thrombosis", "C: Erythema ab igne", "D: Lipodermatosclerosis", "E: Superficial thrombophlebitis" ]	E: Superficial thrombophlebitis
248	feb-03-2022	A 60-year-old man with HIV presented to the ophthalmology clinic with eyelid and facial lesions. His CD4 cell count was 20 per cubic millimeter and his HIV viral load was 120,000 copies/ml. Physical exam showed numerous dome-shaped papules with central umbilication. What is the most likely diagnosis?	yes	4%	10%	8%	69%	8%	40046	0.024	c905b6e02329bb34795f1f7f82633c62	[ "A: Basal-cell carcinoma", "B: Cryptococcosis", "C: Histoplasmosis", "D: Molluscum contagiosum", "E: Verruca vulgaris" ]	D: Molluscum contagiosum
249	feb-04-2010	What is the diagnosis?	no	55%	9%	12%	10%	14%	118427	0.051	1a537b0b7da9249f232276177f427b20	[ "A: Cutaneous leishmaniasis", "B: Leprosy", "C: Leukemia cutis", "D: Syphilis", "E: Yaws" ]	A: Cutaneous leishmaniasis
250	feb-04-2016	Which of the following choices is the most likely diagnosis in a patient presenting with 3 months of headache, jaw claudication, and these scalp findings?	yes	8%	9%	15%	7%	61%	77244	0.039	e498454a63978b74589e4640770afdcc	[ "A: Behcet's syndrome", "B: Polyarteritis nodosa", "C: Granulomatosis with polyangiitis", "D: Takayasu arteritis", "E: Giant-cell arteritis" ]	E: Giant-cell arteritis
251	feb-04-2021	A 37-year-old man presented with a 14-month history of painful, thickened, and cracked skin on the fingertips of both hands. He also had low-grade fevers and muscle weakness. Laboratory testing showed that the creatine kinase level was above 20,000 U per liter (reference range, 51 to 298). What is the diagnosis?	yes	13%	61%	7%	9%	9%	85429	0.038	8b6be3a6030e3e357ede357164b11782	[ "A: Psoriasis", "B: Antisynthetase syndrome", "C: Rheumatoid arthritis", "D: Overuse from manual labor", "E: Eczema" ]	B: Antisynthetase syndrome
252	feb-05-2009	What is the diagnosis?	no	10%	21%	12%	51%	6%	122136	0.062	db356d6cdeb36ed91940b119dcfba60d	[ "A: Contact dermatitis", "B: Discoid lupus erythematosus", "C: Melanoma", "D: Nummular eczema", "E: Tinea corporis" ]	D: Nummular eczema
253	feb-05-2015	What is the diagnosis?	no	57%	5%	5%	2%	32%	90419	0.059	c89969a65cd63e2862c3e40ab095e856	[ "A: Acute lymphangitis", "B: Cellulitis", "C: Deep vein thrombosis", "D: Myositis", "E: Superficial thrombophlebitis" ]	A: Acute lymphangitis
254	feb-06-2014	What is the most likely underlying cause of this problem?	no	15%	9%	36%	21%	20%	82188	0.105	3fbce8a70255cdaf79f82410ebb0c34d	[ "A: Cavernous sinus thrombosis", "B: Graves' disease", "C: Rheumatoid arthritis", "D: Syphilis", "E: Vitamin E deficiency" ]	C: Rheumatoid arthritis
255	feb-06-2020	A 73-year-old woman presented to the emergency department with difficulty in speaking, which had progressively worsened over a period of 4 days. Physical examination showed a large, fluctuant, painless swelling of the anterior floor of the mouth. Contrast-enhanced computed tomography of the neck is shown. What is the d...	yes	48%	13%	15%	10%	14%	72135	0.068	2ca134f30f714070b31dbc2dcfd53abb	[ "A: Sublingual epidermoid cyst", "B: Carcinoma of the tongue", "C: Beckwith-Wiedemann syndrome", "D: Diphtheria", "E: Tuberculosis of the tongue" ]	A: Sublingual epidermoid cyst
256	feb-07-2008	This 43-year-old patient presented with bilateral pain, swelling, and stiffness in the hands and feet. Her chest radiograph was abnormal. What is the most likely diagnosis?	yes	19%	10%	10%	14%	47%	127033	0.071	988b65ebde46909a780b5400efc3ed4d	[ "A: Miliary tuberculosis", "B: Psoriasis", "C: Syphilis", "D: Reiter syndrome", "E: Sarcoidosis" ]	E: Sarcoidosis
257	feb-07-2013	These oral ulcers were painless. What is the most likely diagnosis?	yes	17%	13%	8%	9%	53%	94370	0.056	da3ce5fdb772834db7e5f6669a74bba4	[ "A: Chancroid", "B: Herpes simplex", "C: Iron deficiency", "D: Squamous cell cancer", "E: Syphilis" ]	E: Syphilis
258	feb-07-2019	A 3-year-old girl presented to the emergency department after she had ingested a metal pendant. She had not vomited and had no pain in her chest. A physical examination was unremarkable. A radiograph of the chest confirmed a heart-shaped foreign body in the proximal thoracic esophagus. Ingestions of foreign bodies are ...	yes	47%	18%	10%	11%	15%	93463	0.072	9ef990e1cfcfd72fe9081d80d367515c	[ "A: Foreign bodies that have been present for longer than 24 hours", "B: Small coins (e.g., a penny)", "C: Chewing gum", "D: Smooth plastic button", "E: Pencil-top eraser" ]	A: Foreign bodies that have been present for longer than 24 hours
259	feb-08-2007	What is the diagnosis?	no	18%	11%	21%	19%	30%	212268	0.123	0529d11a14a70f451f4744df8fc37511	[ "A: Digitalis intoxication", "B: Dextrocardia", "C: Pacemaker malfunction", "D: Electrical alternans", "E: Cardiac allograft" ]	E: Cardiac allograft
260	feb-08-2018	An 81-year-old man with hypertension presented with pain and swelling of the left thigh and lower leg that had developed during the previous several hours. He had no history of recent surgery or trauma and no known personal or family history of clotting disorders. The left lower leg was tender, cold, and swollen, and t...	yes	14%	9%	64%	7%	6%	110734	0.033	72bcd34d904aa110c7f37eed1a447c17	[ "A: Polycythemia vera", "B: Generalized essential telangiectasia", "C: Phlegmasia cerulea dolens", "D: Rhabdomyolysis", "E: Cellulitis" ]	C: Phlegmasia cerulea dolens
261	feb-09-2006	This 16-year-old boy presented with malaise and fever. What is the diagnosis?	yes	10%	17%	48%	9%	16%	75429	0.069	d930255751b12e6da289706513f631ae	[ "A: Scarlet fever", "B: Infectious mononucleosis", "C: Measles", "D: Mumps", "E: Coxsackie viral infection" ]	C: Measles
262	feb-09-2012	What is the diagnosis?	no	13%	27%	15%	15%	30%	212769	0.125	27b2bfce3e889dcd9e18397efdbf9055	[ "A: Arcus juvenilus", "B: Calcific band keratopathy", "C: Herpetic keratitis", "D: Kayser-Fleischer ring", "E: Vernal conjunctivitis" ]	E: Vernal conjunctivitis
263	feb-09-2017	A 60-year-old man with atrial fibrillation presented with chest pain and numbness in both arms, then collapsed. This image from his CT scan shows air in which anatomical space?	yes	62%	15%	5%	6%	12%	72274	0.037	4790538f4d55325b25e7551236a7d104	[ "A: Left ventricle", "B: Right ventricle", "C: Right atrium", "D: Left atrium", "E: Pericardial space" ]	A: Left ventricle
264	feb-09-2023	A 77-year-old man with metastatic lung adenocarcinoma presented to the emergency department with a 2-week history of dyspnea. Imaging studies showed a pleural effusion on the right side, previously known liver metastases and perihepatic fluid, and new intrahepatic dilatation of the biliary ducts. A chest tube was place...	yes	10%	60%	13%	9%	8%	32267.	0.04	d408ddee154ab1c4a882db4a3f4ee9af	[ "A: Bacterial gram stain and culture", "B: Bilirubin", "C: Cytology", "D: Fungal stain and culture", "E: Triglycerides" ]	B: Bilirubin
265	feb-10-2011	What is the most likely diagnosis?	no	18%	14%	41%	23%	4%	114832	0.091	939024fd440f1793fd12c493c2144ae0	[ "A: Acromegaly", "B: Cystic fibrosis", "C: Eisenmenger's syndrome", "D: Squamous-cell lung cancer", "E: Ulcerative colitis" ]	C: Eisenmenger's syndrome
266	feb-10-2022	A 21-year-old woman with a history of surgically corrected Hirschsprung’s disease presented with 6-week history of abdominal pain and constipation. Her blood pressure was 162/108 mm Hg. She had an elevated creatinine and CT showed large subcapsular urinomas and hydronephrosis caused by distal ureteral obstruction from ...	yes	9%	16%	21%	45%	9%	51432	0.078	426fcc9f2f9d432d739d8945a42dc47b	[ "A: Atherosclerotic renal artery stenosis", "B: Fibromuscular dysplasia", "C: Medullary sponge kidney", "D: Page kidney", "E: Polycystic kidney disease" ]	D: Page kidney
267	feb-11-2010	What is the diagnosis?	no	23%	30%	23%	18%	7%	152548	0.175	79fafb15ba0132854d58e3c4a050bad4	[ "A: Gastric outlet obstruction", "B: Hirschsprung disease", "C: Ileal intussusception", "D: Ulcerative colitis", "E: Zollinger-Ellison syndrome" ]	D: Ulcerative colitis
268	feb-11-2016	What is the most likely diagnosis in a man with a 3-month history of migratory lesions on the tongue?	yes	54%	15%	10%	13%	7%	95386	0.053	b00a2783d9eaece3703545057f49d21d	[ "A: Geographic tongue", "B: Oral candidiasis", "C: Lichen planus", "D: Oral hairy leukoplakia", "E: Pemphigus vulgaris" ]	A: Geographic tongue
269	feb-11-2021	A 56-year-old man with a new diagnosis of acute monoblastic leukemia received induction chemotherapy and subsequently developed disseminated intravascular coagulation and tumor lysis syndrome. While his condition improved, he began having persistent lower back pain. A pelvic bone marrow specimen is as shown. What is th...	yes	50%	10%	20%	11%	8%	40460	0.064	0835d404efde2e9fd78d640e727c2199	[ "A: Bone marrow necrosis", "B: Megaloblastic anemia", "C: Myelofibrosis", "D: Multiple Myeloma", "E: Essential thrombocythemia" ]	A: Bone marrow necrosis
270	feb-12-2009	This 22-year-old man presented with a 1-month history of severe pubic itch that was worst at night. What is the most appropriate topical treatment?	yes	4%	4%	6%	73%	13%	111813	0.019	7acc8fab165c1e619c4d570cdced879a	[ "A: Hydrocortisone", "B: Hydroxyzine", "C: Mupirocin", "D: Permethrin", "E: Selenium sulfide" ]	D: Permethrin
271	feb-12-2015	What is the most likely diagnosis in this patient with hypothermia and bradycardia?	yes	12%	3%	77%	4%	4%	94070	0.014	eb739d66781b0492d41abfcff66bf52d	[ "A: Cushing's syndrome", "B: Generalized lipodystrophy", "C: Hypothyroidism", "D: Primary systemic amyloidosis", "E: Superior vena cava syndrome" ]	C: Hypothyroidism
272	feb-13-2014	What diagnosis explains the loss of visual acuity in this woman who is at 36 weeks of gestation?	yes	17%	16%	4%	3%	60%	57502	0.043	7c9268bcca7d47661f956ebcedb83abb	[ "A: Central serous chorioretinitis", "B: Diabetes mellitus", "C: Glaucoma", "D: Graves' disease", "E: Preeclampsia" ]	E: Preeclampsia
273	feb-13-2020	A 74-year-old woman presented to the gastroenterology clinic with a long history of bloating and abdominal distention. On physical examination, the abdomen was found to be distended but was nontender on palpation, with normal bowel sounds. This image shows findings on computed tomography of the abdomen and pelvis. What...	yes	19%	12%	24%	37%	9%	95906	0.103	79054313345e6504b884f74f232b8e5b	[ "A: Diffuse mesenteric hydatid cyst disease", "B: Senile ileus", "C: Pneumatosis cystoides intestinalis", "D: Intestinal lipomatosis", "E: Food bolus obstruction" ]	D: Intestinal lipomatosis
274	feb-14-2008	This patient presented with transient, painless visual obscuration in the left eye. What is the diagnosis?	yes	7%	11%	61%	7%	14%	96057	0.039	a036a2c45452560ec3de06f1c8a0af90	[ "A: Papilledema", "B: Hypertensive retinopathy", "C: Cholesterol emboli", "D: Temporal arteritis", "E: Diabetic retinopathy" ]	C: Cholesterol emboli
275	feb-14-2013	What is the diagnosis?	no	9%	5%	3%	77%	6%	76706	0.014	4c78feacad33c4db55bbbd24acaa68a2	[ "A: Aphthous stomatitis", "B: Bullous pemphigoid", "C: Chickenpox", "D: Herpes zoster", "E: Paraneoplastic pemphigus" ]	D: Herpes zoster
276	feb-14-2019	A 65-year-old man who was otherwise healthy presented to the dermatology clinic with a 5-month history of a progressively enlarging annular rash over his right hand and forearm. He worked as a farmer in southern China and noted that the erythema had developed after trauma to his hand from agricultural work. What is the...	yes	16%	3%	60%	8%	13%	75552	0.042	2103e2f1229bb34d4b5d9eefe163ed0b	[ "A: Cutaneous leishmaniasis", "B: Sarcoidosis", "C: Sporotrichosis", "D: Tinea versicolor", "E: Scrofuladerma" ]	C: Sporotrichosis
277	feb-15-2007	This patient presented with loss of vision. What is the diagnosis?	yes	48%	12%	16%	15%	9%	80792	0.068	cc885a3bf2bf801fb094443a3592abc7	[ "A: Central retinal artery occlusion", "B: Diabetic retinopathy", "C: Tay-Sach's disease", "D: Hypertensive retinopathy", "E: Papilledema" ]	A: Central retinal artery occlusion
278	feb-15-2018	A 19-year-old woman presented to the emergency department with a 7-year history of periodic lower abdominal and pelvic pain without fever, chills, or dysuria. She had not had menses nor vaginal intercourse. Physical exam revealed lower abdominal distention and a firm and tender suprapubic mass extending from the pelvis...	yes	7%	12%	11%	15%	56%	116641	0.049	aae77ba86c2512484391752796d88a5b	[ "A: Molar pregnancy", "B: Choriocarcinoma", "C: Endometrial cancer", "D: Uterine fibroids", "E: Hematometrocolpos" ]	E: Hematometrocolpos
279	feb-16-2006	This 75-year-old man presented with cough and hoarseness. What is the most likely cause of his appearance?	yes	55%	11%	14%	7%	13%	69790	0.051	775580444baf877a8efad0d0d9eefd24	[ "A: Superior vena cava syndrome", "B: Mitral stenosis", "C: Chronic obstructive airways disease", "D: Angioedema", "E: Systemic lupus erythematosus" ]	A: Superior vena cava syndrome
280	feb-16-2012	What is the most likely underlying diagnosis?	no	79%	4%	2%	8%	7%	84640	0.011	60141e51ee5dc9ff5cdc8125b2d3afd4	[ "A: Cirrhosis", "B: Chronic renal failure", "C: Hypothyroidism", "D: Myeloma", "E: Sickle cell disease" ]	A: Cirrhosis
281	feb-16-2017	A previously healthy 5-year-old boy presented with a 4-day history of nausea, vomiting, and intermittent abdominal pain. On examination he had mild periorbital edema. A computed tomography scan with contrast demonstrated these findings. What is the diagnosis?	yes	8%	4%	16%	58%	14%	73493	0.046	260989f322f2ed5ad09112754ea0a7be	[ "A: Hyperplastic polyps", "B: Reflux gastropathy", "C: Zollinger-Ellison syndrome", "D: Ménétrier’s disease", "E: Cronkite-Canada syndrome" ]	D: Ménétrier’s disease
282	feb-16-2023	An 80-year-old woman was admitted to the intensive care unit with severe second- and third-degree burns. On laboratory studies, she was noted to have a platelet count of 930,000 per cubic millimeter. Manual analysis of a subsequent peripheral-blood smear identified a platelet count of 115,000 per cubic millimeter. What...	yes	11%	11%	12%	7%	59%	25569	0.042	be33ee5fe2b83923f695827a0dda08da	[ "A: Pseudothrombocytopenia due to giant platelets", "B: Pseudothrombocytopenia due to plate clumping associated with EDTA", "C: Pseudothrombocytosis due to cryoglobulin-related interference by cryoprecipitates", "D: Pseudothrombocytosis due to presence of microorganisms", "E: Pseudothrombocytosis due to red...	E: Pseudothrombocytosis due to red cell fragments
283	feb-17-2011	What is the diagnosis?	no	12%	31%	5%	20%	32%	109410	0.127	b5218ec9ac1dd179a48061fbc062ed15	[ "A: Anterior uveitis", "B: Carotid cavernous sinus fistula", "C: Graves' disease", "D: Orbital lymphoma", "E: Scleral rupture" ]	B: Carotid cavernous sinus fistula
284	feb-17-2022	A 50-year-old man with a history of several months of productive cough presented to the emergency department with stupor and hypercarbic respiratory failure. He was intubated. Chest radiograph several days later revealed complete collapse of the left lung. On bronchoscopy, several casts, as shown, were retrieved. Follo...	yes	4%	18%	14%	57%	7%	42400	0.049	585a0ddcb1f00b23061864dc6be2b834	[ "A: Asthma", "B: Bronchiectasis", "C: Cystic fibrosis", "D: Plastic bronchitis", "E: Tuberculosis" ]	D: Plastic bronchitis
285	feb-18-2010	This 12-year-old presented with decreased appetite and vomiting. What is the most likely diagnosis?	yes	7%	29%	5%	28%	31%	235472	0.141	221d5a60b62d8eedb1bc8a1604ba874e	[ "A: Endometrioma", "B: Hernia", "C: Keloid", "D: Intraabdominal cancer", "E: Urachal duct cyst" ]	D: Intraabdominal cancer
286	feb-18-2016	What is the most likely diagnosis in a man with recurrent facial flushing, foreign-body sensation, and blurry vision?	yes	45%	8%	19%	23%	6%	106297	0.08	b1247c5d6ee0f47aa8a053ed6889bee7	[ "A: Rosacea", "B: Blepharitis", "C: Sjogren’s syndrome", "D: Anterior uveitis", "E: Conjunctival hemorrhage" ]	A: Rosacea
287	feb-18-2021	An 80-year-old man presented to the emergency department with abdominal bloating and constipation. He had lost 5 kg during the previous 8 months. Examination of the abdomen was notable for a mass that extended from the epigastrium to the pelvis and was nontender and dull on percussion. What is the diagnosis?	yes	7%	10%	62%	7%	14%	75527	0.037	40b3c2b7967156b5e2261811f4b42400	[ "A: Abdominal aortic aneurysm", "B: Castleman disease", "C: Urachal mucinous cystic tumor", "D: Cysticercosis", "E: Wilms’s tumor" ]	C: Urachal mucinous cystic tumor
288	feb-19-2009	What clinical presentation would be expected in this patient?	no	9%	20%	10%	43%	17%	120280	0.082	c4d7c53446dbdc417a74cf88540a483f	[ "A: Asymmetrical mydriasis", "B: Ataxic hemiparesis", "C: Hypothermia", "D: Quadriplegia", "E: Upward gaze palsy" ]	D: Quadriplegia
289	feb-19-2015	What is the diagnosis in this 31-year-old woman with gradual bilateral vision loss?	yes	13%	30%	28%	18%	11%	116345	0.134	931e51c408328ad1f2f5b3ff94c0ea46	[ "A: Glaucoma", "B: Graves’ ophthalmopathy", "C: Marfan’s syndrome", "D: Retinitis pigmentosa", "E: Temporal arteritis" ]	C: Marfan’s syndrome
290	feb-20-2014	What is the most likely diagnosis in this patient who underwent fine-needle aspiration after reporting several weeks of submandibular pain?	yes	9%	17%	28%	41%	4%	86175	0.093	c6dbdf7f66ddc87dbe759572b2419ed5	[ "A: Adenoid cystic carcinoma", "B: Cat scratch disease", "C: Infectious mononucleosis", "D: Sclerosing sialadenitis", "E: Systemic lupus erythematosus" ]	D: Sclerosing sialadenitis
291	feb-20-2020	A 66-year-old man presented to the emergency department with a 4-day history of shortness of breath and swelling in the legs along with recent fatigue and a 15-kg weight loss. Over the course of hospitalization, the patient developed hemodynamic instability and, despite receiving maximal supportive therapy, died in the...	yes	13%	36%	21%	13%	17%	143005	0.103	ffb218ba6cdccc8adcab66cd4e3b9ae8	[ "A: Staphylococcus aureus septic emboli", "B: Angiosarcoma", "C: Pericardial mesothelioma", "D: Chronic Chagas' heart disease", "E: Cardiac amyloidosis" ]	B: Angiosarcoma
292	feb-21-2008	What is the most likely diagnosis?	no	37%	8%	8%	24%	23%	127667	0.104	9cd3fc2cb389926339372abf764f91bb	[ "A: Chronic venous insufficiency", "B: Reiter syndrome", "C: Gunshot wound", "D: Chronic renal failure", "E: Pseudohypoparathyroidism" ]	A: Chronic venous insufficiency
293	feb-21-2013	What is the diagnosis?	no	8%	9%	19%	12%	52%	75861	0.059	4931992172643cf0efb87c1fb95a3da9	[ "A: Parulis", "B: Pyogenic granuloma", "C: Peripheral ossifying fibroma", "D: Retrocuspid papillae", "E: Torus mandibularis" ]	E: Torus mandibularis
294	feb-21-2019	A 54-year-old man presented to the oral and maxillofacial clinic with a 2-month history of difficulty chewing his food. He reported a painless brown lesion had grown on his tongue in the center of a white patch that had been present for years. Examination of the oral cavity revealed a well-circumscribed hard mass, meas...	yes	17%	5%	9%	52%	16%	112843	0.059	6a0d57c0388f940e6085b85a7241ce58	[ "A: Dermoid cyst", "B: Oral candidiasis", "C: Lipoma", "D: Spindle-cell sarcoma", "E: Tongue mucocele" ]	D: Spindle-cell sarcoma
295	feb-22-2007	Which one of the following organs is enlarged?	yes	11%	6%	48%	29%	6%	110857	0.075	ca51f73bbd713e1804f19ca5500eedf8	[ "A: Colon", "B: Ovary", "C: Stomach", "D: Spleen", "E: Gall bladder" ]	C: Stomach
296	feb-22-2018	A 24-year-old woman with a 10-year history of intermittent episodes of redness and photophobia in both eyes presented to the ophthalmology clinic. On examination, the visual acuity was 20/30 in the right eye and 20/25 in the left eye. Slit-lamp examination revealed conjunctival hyperemia and peripheral corneal pacifica...	yes	13%	13%	17%	53%	4%	89908	0.057	a236290455cd728dee2d2f2c1166ba74	[ "A: Syphilis", "B: Systemic lupus erythematosus", "C: High lead exposure", "D: Cogan’s syndrome", "E: Lymphoma" ]	D: Cogan’s syndrome
297	feb-23-2006	What nebulized medication is most likely to have caused this patient's anisocoria?	yes	21%	44%	7%	13%	15%	77563	0.08	9bf3456189aaf8ca6aa66a0a444ff758	[ "A: Racemic epinephrine", "B: Ipratropium", "C: Ribavirin", "D: Salbutamol", "E: Theophylline" ]	B: Ipratropium
298	feb-23-2012	This patient had diabetes. What is the diagnosis?	yes	11%	38%	8%	17%	26%	101947	0.1	cdab8b72eed25e1cb2e560a7d9da0c7f	[ "A: Diabetic bullae", "B: Eruptive xanthomas", "C: Lichen amyloidosis", "D: Necrobiosis lipoidica", "E: Pustular psoriasis" ]	B: Eruptive xanthomas
299	feb-23-2017	A 67-year-old man with a substantial cardiac history and renal disease presented to the emergency department with neck swelling, dysphagia, and hoarseness. Computed tomographic scans of his neck showed these findings. What is the diagnosis?	yes	13%	12%	44%	13%	18%	90233	0.079	35ac9783299c2b2bb6226008dad4bb44	[ "A: Acute bacterial sialadenitis", "B: Mumps", "C: Iodide-associated sialadenitis", "D: Sialolithiasis", "E: Mikulicz syndrome" ]	C: Iodide-associated sialadenitis
300	feb-23-2023	A 52-year-old woman with end-stage kidney disease that was being managed with peritoneal dialysis presented with a 1-month history of bloody dialysate. She had had 3 episodes of bacterial peritonitis in the past 12 years. Physical examination and laboratory studies were unremarkable. Computed tomography of the abdomen ...	yes	23%	55%	6%	8%	9%	27772	0.055	d0acc26097c8eba6f2a3aa8995d843a1	[ "A: Calciphylaxis", "B: Encapsulating peritoneal sclerosis", "C: Fungal peritonitis", "D: Peritoneal carcinomatosis", "E: Tuberculous peritonitis" ]	B: Encapsulating peritoneal sclerosis

201

dec-17-2009

This patient had a history of breast-cancer surgery. Which one of the following rib abnormalities is present on her follow-up imaging?

yes

14%

15%

25%

20%

26%

127289

0.138

d9b714407091e0849e240498a6dee14e

[ "A: Absent rib", "B: Inferior rib notching", "C: Rib metastases", "D: Sternocostal anomaly", "E: Supernumerary rib" ]

E: Supernumerary rib

202

dec-17-2015

What is the most likely diagnosis associated with these findings and symptoms of eye and ear pain?

yes

53%

9%

17%

7%

15%

94376

0.057

b760dc338bab50018fab71b5e034a5f9

[ "A: Polychondritis", "B: Sjogren's syndrome", "C: Granulomatosis with polyangiitis", "D: Takayasu arteritis", "E: Sarcoidosis" ]

A: Polychondritis

203

dec-17-2020

A 60-year-old man presented to the hematology clinic with fatigue and dyspnea on exertion. He had a history of sickle cell disease with hemoglobin genotype SS. Laboratory studies showed a hemoglobin level of 4 g per deciliter. Light microscopy of a bone marrow biopsy specimen is as shown. What is the diagnosis?

yes

11%

15%

14%

50%

10%

45143

0.063

05d41a229d98331c08b07285ed3115d4

[ "A: Sideroblastic anemia", "B: B-cell acute lymphoblastic leukemia", "C: Aplastic anemia", "D: Hemophagocytosis of sickle cells", "E: Multiple myeloma" ]

D: Hemophagocytosis of sickle cells

204

dec-18-2008

What endocrine diagnosis is affecting the identical twin on the right side of the image?

yes

5%

7%

20%

57%

11%

139371

0.049

b1a9c05c2ddb4c188bba53da6d8ddc47

[ "A: Acromegaly", "B: Addison's disease", "C: Cushing's syndrome", "D: Hypogonadism", "E: Hypothyroidism" ]

D: Hypogonadism

205

dec-18-2014

What is the diagnosis?

no

17%

11%

25%

40%

7%

110123

0.094

c518e00cfb8dbf7cfdbbe112909f3306

[ "A: Aortic aneurysm", "B: Aortic coarctation", "C: Diaphragmatic hernia", "D: Esophageal diverticulum", "E: Pericardial effusion" ]

D: Esophageal diverticulum

206

dec-19-2013

What is the diagnosis?

no

15%

6%

17%

5%

57%

70409

0.048

0f126b52a3ebb8ddd07872960515c8ae

[ "A: Ehlers-Danlos syndrome", "B: Familial hypertriglyceridemia", "C: Hidradinitis suppurativa", "D: Marfan syndrome", "E: Pseudoxanthoma elasticum" ]

E: Pseudoxanthoma elasticum

207

dec-19-2019

A 74-year-old woman was hospitalized with sudden-onset weakness on the left side due to an acute infarct of the right middle cerebral artery. Examination of the oral mucosa and hands demonstrated the following lesions. What is the most likely diagnosis?

yes

25%

7%

41%

13%

14%

102762

0.09

d364056fce49b050be723a4669f39685

[ "A: Infective endocarditis", "B: Scleroderma", "C: Hereditary hemorrhagic telangiectasia", "D: Levamisole-induced vasculitis", "E: Amyloid angiopathy" ]

C: Hereditary hemorrhagic telangiectasia

208

dec-20-2007

Which cardiac valves have been replaced?

yes

50%

12%

16%

12%

9%

132314

0.062

b7fc90fea704cac5bc44d306814610f2

[ "A: Aortic and mitral valves", "B: Aortic and tricuspid valves", "C: Mitral and tricuspid valves", "D: Pulmonary and mitral valves", "E: Pulmonary and tricuspid valves" ]

A: Aortic and mitral valves

209

dec-20-2012

What is the diagnosis?

no

37%

24%

5%

10%

23%

84598

0.104

f00f2f888bcaaf307cf5605373306b77

[ "A: Albright's hereditary osteodystrophy", "B: Hypertrophic osteoarthropathy", "C: Median nerve palsy", "D: Osteoarthritis", "E: Rheumatoid arthritis" ]

A: Albright's hereditary osteodystrophy

210

dec-20-2018

An 84-year-old man presented with fever, malaise, and discoloration and pain in his fingers and toes ongoing for 2 weeks. He had no history of smoking. On physical examination, he was afebrile with blue-black discoloration on several fingers of his left hand and purpuric lesions on both hands and feet. He had palpable ...

yes

15%

46%

10%

7%

21%

135323

0.075

8974634cc5c99c7e18e23936842868d1

[ "A: Infection with Vibrio vulnificus", "B: Polyarteritis nodosa", "C: Necrotizing fasciitis", "D: Herpetic whitlow", "E: Arterial embolism" ]

B: Polyarteritis nodosa

211

dec-21-2006

This 84-cm tall 40-year-old man underwent whole-body dual-energy x-ray absorptiometry. What is the diagnosis?

yes

5%

9%

54%

25%

8%

100228

0.058

1cbc516268801998dcef08ac0df1c1a3

[ "A: Pseudohypoparathyroidism", "B: X-linked hypophosphatemia", "C: Osteogenesis imperfecta", "D: Achondroplasia", "E: Ehlers Danlos syndrome" ]

C: Osteogenesis imperfecta

212

dec-21-2017

A 70-year-old woman presented to the neurology clinic with a 2-year history of gait disturbance, cognitive impairment, and urinary incontinence. What is the diagnosis?

yes

68%

7%

6%

9%

11%

61534

0.026

9b382c95e1758ebc09eda7aecbf591ca

[ "A: Normal-pressure hydrocephalus", "B: Alzheimer's disease", "C: Parkinson's disease", "D: Benign intracranial hypertension", "E: Multiple system atrophy" ]

A: Normal-pressure hydrocephalus

213

dec-21-2023

A 25-year-old woman with severe obesity presented to the emergency department with a 1-week history of blurred vision, headaches, and transient visual obscurations. Neurologic examination showed optic disk swelling and retinal hemorrhages in both eyes. An MRI and MRV of the head showed flattened posterior globes, an em...

yes

58%

7%

11%

14%

11%

12400

0.045

3654dfd1f2611c35abf0a3f8e2e9e350

[ "A: Elevated opening pressure", "B: Elevated white blood cell count", "C: Oligoclonal bands", "D: Positive anti-aquaporin 4 antibody", "E: Xanthochromia" ]

A: Elevated opening pressure

214

dec-22-2005

What endocrinopathy is most frequently associated with this sign?

yes

30%

46%

6%

11%

7%

72519

0.08

bc16cca9dd89eb5c9b93627b6a874dc1

[ "A: Addison's disease", "B: Insulin resistance", "C: Growth hormone excess", "D: Glucagonoma", "E: Diabetes insipidus" ]

B: Insulin resistance

215

dec-22-2011

What is the diagnosis?

no

5%

8%

47%

19%

22%

93972

0.075

310e7c1095a4a696aea14e9bc4023df7

[ "A: Cushing's syndrome", "B: Decompression sickness", "C: Electrocution", "D: Filariasis", "E: Lymphangitis" ]

C: Electrocution

216

dec-22-2016

A 23-year-old woman presented with a 1-month history of headache, syncope, weight gain. Physical examination revealed hypertrophic appearance of the thigh and calf muscles, and imaging of her thighs is shown. What is the diagnosis?

yes

4%

13%

21%

55%

8%

99845

0.054

6982d46f3b31558c1649fe0fbaa04c8d

[ "A: Septic emboli", "B: Echinococcus granulosus", "C: Myxoid sarcoma", "D: Cysticercosis", "E: Toxoplasma gondii" ]

D: Cysticercosis

217

dec-22-2022

An 18-year-old man presented with a 2-day history of fever, vomiting, and diarrhea. Three weeks before presentation, he had fallen into a canal. Physical exam was notable for the findings shown in the image. Laboratory studies showed acute kidney injury and elevations in aminotransferase and total bilirubin levels. Wha...

yes

14%

8%

13%

57%

8%

51894

0.047

bb98c3ca1bbaf76bb3076287de35132b

[ "A: Acute hemorrhagic conjunctivitis", "B: Ebola hemorrhagic fever", "C: Giardiasis", "D: Leptospirosis", "E: Subarachnoid hemorrhage" ]

D: Leptospirosis

218

dec-23-2010

This patient had diabetes. What is the diagnosis?

yes

1%

57%

23%

4%

15%

95942

0.052

568e7d100cdc1f61bcf71ab1db327399

[ "A: Ichthyosis", "B: Ischemic gangrene", "C: Necrobiosis lipoidica diabeticorum", "D: Phlegmasia cerulea dolens", "E: Pyoderma gangrenosum" ]

B: Ischemic gangrene

219

dec-23-2021

A 65-year-old man presented to the dermatology clinic with a 7-month history of painless skin thickening over the left side of his chest and on his left arm. Physical examination showed sclerotic skin over his left chest and nipple, multiple erythematous nodules over the left arm, axilla, and posterior trunk, left axil...

yes

40%

18%

10%

16%

59405

0.092

162659276897d4970283ccc3152bb752

[ "A: Carcinoma en cuirasse", "B: Carcinoma erysipeloides", "C: Inflammatory breast cancer", "D: Morphea", "E: Paget's disease" ]

A: Carcinoma en cuirasse

220

dec-24-2009

What is the diagnosis?

no

7%

18%

6%

59%

10%

97341

0.044

c513244452c3495077964bc64b5ea61a

[ "A: Eczema", "B: Herpetic whitlow", "C: Impetigo", "D: Scabies", "E: Tinea pedis" ]

D: Scabies

221

dec-24-2015

What radiographic finding is observed here?

yes

8%

4%

8%

5%

75%

61007

0.016

d89931f1f94638fa24286323e52bae04

[ "A: Air in the subcutaneous space", "B: Diffuse osteopenia", "C: Ground-glass opacity", "D: Kerley’s B lines", "E: Air bronchogram" ]

E: Air bronchogram

222

dec-24-2020

A 35-year-old man presented with a 6-month history of increased swelling in his right leg. Physical exam revealed firmness in the right lower leg without tenderness to palpation. Magnetic resonance imaging of the area revealed multiple cystic lesions. What is the diagnosis?

yes

13%

56%

9%

10%

12%

90448

0.049

62cc3702e361549b4d7e2e39fcd21645

[ "A: Lipomas", "B: Echinococcal cysts", "C: Sebaceous cysts", "D: Metastatic sarcoma", "E: Ganglion cysts" ]

B: Echinococcal cysts

223

dec-25-2008

What is the diagnosis?

no

5%

11%

6%

72%

6%

105083

0.02

f17ec3e5553e46d2943fcf97b14ebdbe

[ "A: Neuropathic arthropathy", "B: Rheumatoid arthritis", "C: Hemophilia", "D: Chondrocalcinosis", "E: Rickets" ]

D: Chondrocalcinosis

224

dec-25-2014

What is the diagnosis in this patient with chest pain?

yes

9%

16%

13%

12%

51%

87372

0.061

c52f3d5ecbbfd098b457580890d42c5c

[ "A: Anxiety", "B: Myocarditis", "C: Pericardial effusion", "D: Pulmonary embolism", "E: Stenosis of the left anterior descending artery" ]

E: Stenosis of the left anterior descending artery

225

dec-26-2013

What is the diagnosis?

no

5%

3%

12%

10%

69%

69850

0.025

0a4e68413f1e515d536debee2eac0100

[ "A: African trypanosomiasis", "B: Frostbite", "C: Keratosis follicularis", "D: Leprosy", "E: Papillomatosis cutis lymphostatica" ]

E: Papillomatosis cutis lymphostatica

226

dec-26-2019

A 19-year-old woman presented to the emergency department with severe abdominal pain that had started 9 hours earlier. Rebound tenderness was present in the suprapubic and left iliac fossa regions on physical examination. A urine test for beta human chorionic gonadotropin was negative. A diagnostic laparoscopy was perf...

yes

20%

19%

38%

11%

12%

85650

0.097

424c9b08bd864afe78ad4048eadca3e4

[ "A: Ovarian torsion", "B: Paraovarian cyst torsion", "C: Fallopian tube torsion", "D: Broad ligament torsion", "E: Uterine torsion" ]

C: Fallopian tube torsion

227

dec-27-2007

What is the diagnosis?

no

59%

7%

6%

12%

17%

134988

0.044

a4e4111f904a1406976c32668d25168f

[ "A: Rhinophyma", "B: Leishmaniasis", "C: Lupus pernio", "D: Wegener's granulomatosis", "E: Basal cell carcinoma" ]

A: Rhinophyma

228

dec-27-2012

This ocular nodule had several black hairs. What is the diagnosis?

yes

8%

55%

6%

12%

19%

79783

0.053

d6c67aeea40e6e9a97aec066f4ae56bb

[ "A: Chalazion", "B: Dermoid", "C: Melanoma", "D: Phlyctenule", "E: Pinguecula" ]

B: Dermoid

229

dec-27-2018

A 29-year-old man presented to the dermatology clinic with a pruritic, erythematous, and scaly rash that had first appeared 2 years earlier. He had sought no medical treatment until this presentation. His medical history included eczema during childhood and seasonal allergies. Physical examination showed erythematous, ...

yes

7%

25%

11%

50%

7%

87738

0.067

a224827cb27ab04851351c001185138a

[ "A: Seborrheic dermatitis", "B: Pityriasis rubra pilaris", "C: Erythema multiforme", "D: Erythrodermic psoriasis", "E: Toxic epidermal necrolysis" ]

D: Erythrodermic psoriasis

230

dec-28-2006

What is the diagnosis?

no

49%

19%

12%

9%

11%

87744

0.066

90a1170c485629cb18ca379ce463832b

[ "A: Prolapse of orbital fat", "B: Pinguecula", "C: Graves' disease", "D: Neurofibromatosis", "E: Wilson's disease" ]

A: Prolapse of orbital fat

231

dec-28-2017

An 86-year-old man presented with an absent right pectoralis major muscle and brachydactyly of the right hand since birth. What is the diagnosis?

yes

1%

66%

17%

5%

11%

85942

0.032

d6eb258e9d5d214e3054b3507c9bf10f

[ "A: Down syndrome", "B: Poland syndrome", "C: Prenatal thalidomide exposure", "D: Fanconi anemia", "E: Ehlers-Danlos syndrome" ]

B: Poland syndrome

232

dec-29-2005

What is the diagnosis?

no

7%

4%

12%

8%

70%

76906

0.023

83ce9c3b2e70e43987a65d10942685fd

[ "A: Aspergillosis", "B: Adrenal insufficiency", "C: Oral leukoplakia", "D: Pellagra", "E: Lingua villosa nigra" ]

E: Lingua villosa nigra

233

dec-29-2011

What structure has ruptured in this image?

yes

13%

9%

60%

5%

14%

84044

0.041

7651490be880d39d4b3bc7bcf595461b

[ "A: Diaphragm", "B: Esophagus", "C: Intercostal muscle", "D: Interventricular septum", "E: Pericardium" ]

C: Intercostal muscle

234

dec-29-2016

A 90-year-old man presented with a 1-month history of progressive edema in both of his legs, malaise, and dizziness associated with hypoglycemia. His chest radiograph demonstrated abnormal findings. What is the diagnosis?

yes

28%

10%

7%

53%

2%

103282

0.063

0497f3ba7ef97f351ad99ff472dfcea4

[ "A: Gastric bezoar", "B: Gastric polyp", "C: Pyloric stenosis", "D: Gastric cancer", "E: Peptic ulcer disease" ]

D: Gastric cancer

235

dec-29-2022

A 34-year-old man was admitted to the hospital with diabetic ketoacidosis. He reported having had blurry vision, increasing shoe size, and a change in his facial features over the past several years. On exam, he was found to have bitemporal hemianopsia. Which of the following is the most likely cause of his presentatio...

yes

5%

4%

80%

28784

0.01

dc4d5a953d3557e4ddde71102b5ed19c

[ "A: Anabolic steroid use", "B: Beckwith–Wiedemann syndrome", "C: Nelson’s syndrome", "D: Pachydermoperiostosis", "E: Somatotropic pituitary adenoma" ]

E: Somatotropic pituitary adenoma

236

dec-30-2010

This rash had been present for 2 weeks. What is the diagnosis?

yes

14%

9%

5%

8%

64%

88392

0.033

ea82875c0456156849f1b95cfb2b63dd

[ "A: Coxsackie A", "B: Gonococcus", "C: Measles", "D: Parvovirus B19", "E: Treponema pallidum" ]

E: Treponema pallidum

237

dec-30-2021

A 48-year-old woman presented to the emergency department with a 1-week history of fatigue and painful, swollen gums. On examination, she was febrile and tachycardic with a well-demarcated region of gingival infiltration and whitening and submandibular lymphadenopathy. A white-cell count was 225,000 per cubic millimete...

yes

12%

57%

8%

14%

9%

98966

0.047

68f4cb085cab293e22312d0eed218474

[ "A: Gingival candidiasis", "B: Leukemic infiltration of the gingiva", "C: Oral lichen planus", "D: Proliferative verrucous leukoplakia", "E: White sponge nevus" ]

B: Leukemic infiltration of the gingiva

238

dec-31-2009

This patient had a 4-year history of diabetes. What is the diagnosis?

yes

12%

42%

31%

5%

10%

113453

0.136

5c93e6524b20191ec515cf4519042b93

[ "A: Bullous disease of diabetes", "B: Necrobiosis lipoidica diabeticorum", "C: Necrolytic migratory erythema", "D: Pigmented purpuric dermatosis", "E: Scleredema of diabetes" ]

C: Necrolytic migratory erythema

239

dec-31-2015

What is the most likely diagnosis in a 60-year-old man with blurry vision for 2 months and the findings seen here?

yes

6%

8%

9%

23%

53%

70457

0.058

6307cb79396e7f94d6a07a0b0921364b

[ "A: HIV", "B: Syphilis", "C: Closed-angle glaucoma", "D: Hypertensive crisis", "E: Waldenström’s macroglobulinemia" ]

E: Waldenström’s macroglobulinemia

240

dec-31-2020

A 45-year-old man presented to the emergency department after a motorcycle accident. Physical examination was notable for a bruise in the pubic area and severe pain in the anterior and posterior pelvic areas with manual compression. What is the diagnosis?

yes

68%

20%

3%

4%

46415

0.029

21e3228ebc6c5bea097fd6512270a4cc

[ "A: Open-book fracture", "B: Straddle pelvic fracture", "C: Avascular necrosis of the hip", "D: Femoral head fracture", "E: Hip dysplasia" ]

A: Open-book fracture

241

feb-01-2007

What is the diagnosis?

no

46%

21%

6%

10%

17%

100449

0.076

b7e672a63c76927c41487c98ca946aee

[ "A: Tinea barbae", "B: Herpes simplex infection", "C: Eczema", "D: Mycosis fungoides", "E: Impetigo" ]

A: Tinea barbae

242

feb-01-2018

A previously healthy 1-year-old girl was admitted to the hospital with a 4-day history of high fever accompanied by erythema and swelling of the left third finger, gingival inflammation, and tongue ulcerations. What is the likely diagnosis?

yes

15%

20%

13%

41%

10%

136996

0.088

d36d097e3274e777f9012bac35a4f6ce

[ "A: Bacterial cellulitis", "B: Hand, foot, and mouth disease", "C: Paronychia", "D: Herpetic whitlow", "E: Sporotrichosis" ]

D: Herpetic whitlow

243

feb-02-2006

This patient underwent computed tomography of the pelvis having presented with lower extremity edema. What diagnosis is suggested?

yes

21%

11%

48%

10%

71275

0.069

ab0b8b1773029521569d4b08352e871a

[ "A: Uterine fibroid", "B: Ovarian cyst", "C: Urinary retention", "D: Teratoma", "E: Aortic aneurysm" ]

C: Urinary retention

244

feb-02-2012

This 23-year-old man was involved in a motor vehicle accident. What is the diagnosis?

yes

12%

5%

25%

55%

4%

89149

0.057

ccc0298ea33b84f5e18118db25c563ff

[ "A: Aortic dissection", "B: Cardiac rupture", "C: Diaphragmatic rupture", "D: Pneumothorax", "E: Vertebral fractures" ]

D: Pneumothorax

245

feb-02-2017

A 15-year-old boy presented with decreased vision in both eyes, and a slit lamp examination revealed this finding. What is the diagnosis?

yes

12%

10%

8%

60%

92107

0.04

0cd29c498c2a9a7b5e7567009e7d7586

[ "A: Juvenile xanthogranuloma", "B: Persistent hyperplastic primary vitreous", "C: Protruding iris collarette", "D: Iris duplication", "E: Persistent pupillary membranes" ]

E: Persistent pupillary membranes

246

feb-02-2023

A previously healthy 42-year-old woman presented to the dental clinic with a 6-month history of swelling and pain on the right side of her chin (left). She reported no history of chin trauma, tooth pain, or fevers, but did recall injuring her right lateral incisor 10 years prior. Palpation of the lesion caused pain and...

yes

83%

6%

4%

3%

4%

31485

0.007

27215623165fc49bc8ca53c49af5091c

[ "A: Odontogenic cutaneous fistula", "B: Osteosarcoma", "C: Pilar cyst", "D: Sebaceous cyst", "E: Squamous cell carcinoma" ]

A: Odontogenic cutaneous fistula

247

feb-03-2011

What is the diagnosis?

no

10%

8%

11%

60%

88537

0.04

bf791fb000703f24dd75c1b94952794b

[ "A: Bancroftian filariasis", "B: Deep-vein thrombosis", "C: Erythema ab igne", "D: Lipodermatosclerosis", "E: Superficial thrombophlebitis" ]

E: Superficial thrombophlebitis

248

feb-03-2022

A 60-year-old man with HIV presented to the ophthalmology clinic with eyelid and facial lesions. His CD4 cell count was 20 per cubic millimeter and his HIV viral load was 120,000 copies/ml. Physical exam showed numerous dome-shaped papules with central umbilication. What is the most likely diagnosis?

yes

4%

10%

8%

69%

8%

40046

0.024

c905b6e02329bb34795f1f7f82633c62

[ "A: Basal-cell carcinoma", "B: Cryptococcosis", "C: Histoplasmosis", "D: Molluscum contagiosum", "E: Verruca vulgaris" ]

D: Molluscum contagiosum

249

feb-04-2010

What is the diagnosis?

no

55%

9%

12%

10%

14%

118427

0.051

1a537b0b7da9249f232276177f427b20

[ "A: Cutaneous leishmaniasis", "B: Leprosy", "C: Leukemia cutis", "D: Syphilis", "E: Yaws" ]

A: Cutaneous leishmaniasis

250

feb-04-2016

Which of the following choices is the most likely diagnosis in a patient presenting with 3 months of headache, jaw claudication, and these scalp findings?

yes

8%

9%

15%

7%

61%

77244

0.039

e498454a63978b74589e4640770afdcc

[ "A: Behcet's syndrome", "B: Polyarteritis nodosa", "C: Granulomatosis with polyangiitis", "D: Takayasu arteritis", "E: Giant-cell arteritis" ]

E: Giant-cell arteritis

251

feb-04-2021

A 37-year-old man presented with a 14-month history of painful, thickened, and cracked skin on the fingertips of both hands. He also had low-grade fevers and muscle weakness. Laboratory testing showed that the creatine kinase level was above 20,000 U per liter (reference range, 51 to 298). What is the diagnosis?

yes

13%

61%

7%

9%

85429

0.038

8b6be3a6030e3e357ede357164b11782

[ "A: Psoriasis", "B: Antisynthetase syndrome", "C: Rheumatoid arthritis", "D: Overuse from manual labor", "E: Eczema" ]

B: Antisynthetase syndrome

252

feb-05-2009

What is the diagnosis?

no

10%

21%

12%

51%

6%

122136

0.062

db356d6cdeb36ed91940b119dcfba60d

[ "A: Contact dermatitis", "B: Discoid lupus erythematosus", "C: Melanoma", "D: Nummular eczema", "E: Tinea corporis" ]

D: Nummular eczema

253

feb-05-2015

What is the diagnosis?

no

57%

5%

2%

32%

90419

0.059

c89969a65cd63e2862c3e40ab095e856

[ "A: Acute lymphangitis", "B: Cellulitis", "C: Deep vein thrombosis", "D: Myositis", "E: Superficial thrombophlebitis" ]

A: Acute lymphangitis

254

feb-06-2014

What is the most likely underlying cause of this problem?

no

15%

9%

36%

21%

20%

82188

0.105

3fbce8a70255cdaf79f82410ebb0c34d

[ "A: Cavernous sinus thrombosis", "B: Graves' disease", "C: Rheumatoid arthritis", "D: Syphilis", "E: Vitamin E deficiency" ]

C: Rheumatoid arthritis

255

feb-06-2020

A 73-year-old woman presented to the emergency department with difficulty in speaking, which had progressively worsened over a period of 4 days. Physical examination showed a large, fluctuant, painless swelling of the anterior floor of the mouth. Contrast-enhanced computed tomography of the neck is shown. What is the d...

yes

48%

13%

15%

10%

14%

72135

0.068

2ca134f30f714070b31dbc2dcfd53abb

[ "A: Sublingual epidermoid cyst", "B: Carcinoma of the tongue", "C: Beckwith-Wiedemann syndrome", "D: Diphtheria", "E: Tuberculosis of the tongue" ]

A: Sublingual epidermoid cyst

256

feb-07-2008

This 43-year-old patient presented with bilateral pain, swelling, and stiffness in the hands and feet. Her chest radiograph was abnormal. What is the most likely diagnosis?

yes

19%

10%

14%

47%

127033

0.071

988b65ebde46909a780b5400efc3ed4d

[ "A: Miliary tuberculosis", "B: Psoriasis", "C: Syphilis", "D: Reiter syndrome", "E: Sarcoidosis" ]

E: Sarcoidosis

257

feb-07-2013

These oral ulcers were painless. What is the most likely diagnosis?

yes

17%

13%

8%

9%

53%

94370

0.056

da3ce5fdb772834db7e5f6669a74bba4

[ "A: Chancroid", "B: Herpes simplex", "C: Iron deficiency", "D: Squamous cell cancer", "E: Syphilis" ]

E: Syphilis

258

feb-07-2019

A 3-year-old girl presented to the emergency department after she had ingested a metal pendant. She had not vomited and had no pain in her chest. A physical examination was unremarkable. A radiograph of the chest confirmed a heart-shaped foreign body in the proximal thoracic esophagus. Ingestions of foreign bodies are ...

yes

47%

18%

10%

11%

15%

93463

0.072

9ef990e1cfcfd72fe9081d80d367515c

[ "A: Foreign bodies that have been present for longer than 24 hours", "B: Small coins (e.g., a penny)", "C: Chewing gum", "D: Smooth plastic button", "E: Pencil-top eraser" ]

A: Foreign bodies that have been present for longer than 24 hours

259

feb-08-2007

What is the diagnosis?

no

18%

11%

21%

19%

30%

212268

0.123

0529d11a14a70f451f4744df8fc37511

[ "A: Digitalis intoxication", "B: Dextrocardia", "C: Pacemaker malfunction", "D: Electrical alternans", "E: Cardiac allograft" ]

E: Cardiac allograft

260

feb-08-2018

An 81-year-old man with hypertension presented with pain and swelling of the left thigh and lower leg that had developed during the previous several hours. He had no history of recent surgery or trauma and no known personal or family history of clotting disorders. The left lower leg was tender, cold, and swollen, and t...

yes

14%

9%

64%

7%

6%

110734

0.033

72bcd34d904aa110c7f37eed1a447c17

[ "A: Polycythemia vera", "B: Generalized essential telangiectasia", "C: Phlegmasia cerulea dolens", "D: Rhabdomyolysis", "E: Cellulitis" ]

C: Phlegmasia cerulea dolens

261

feb-09-2006

This 16-year-old boy presented with malaise and fever. What is the diagnosis?

yes

10%

17%

48%

9%

16%

75429

0.069

d930255751b12e6da289706513f631ae

[ "A: Scarlet fever", "B: Infectious mononucleosis", "C: Measles", "D: Mumps", "E: Coxsackie viral infection" ]

C: Measles

262

feb-09-2012

What is the diagnosis?

no

13%

27%

15%

30%

212769

0.125

27b2bfce3e889dcd9e18397efdbf9055

[ "A: Arcus juvenilus", "B: Calcific band keratopathy", "C: Herpetic keratitis", "D: Kayser-Fleischer ring", "E: Vernal conjunctivitis" ]

E: Vernal conjunctivitis

263

feb-09-2017

A 60-year-old man with atrial fibrillation presented with chest pain and numbness in both arms, then collapsed. This image from his CT scan shows air in which anatomical space?

yes

62%

15%

5%

6%

12%

72274

0.037

4790538f4d55325b25e7551236a7d104

[ "A: Left ventricle", "B: Right ventricle", "C: Right atrium", "D: Left atrium", "E: Pericardial space" ]

A: Left ventricle

264

feb-09-2023

A 77-year-old man with metastatic lung adenocarcinoma presented to the emergency department with a 2-week history of dyspnea. Imaging studies showed a pleural effusion on the right side, previously known liver metastases and perihepatic fluid, and new intrahepatic dilatation of the biliary ducts. A chest tube was place...

yes

10%

60%

13%

9%

8%

32267.

0.04

d408ddee154ab1c4a882db4a3f4ee9af

[ "A: Bacterial gram stain and culture", "B: Bilirubin", "C: Cytology", "D: Fungal stain and culture", "E: Triglycerides" ]

B: Bilirubin

265

feb-10-2011

What is the most likely diagnosis?

no

18%

14%

41%

23%

4%

114832

0.091

939024fd440f1793fd12c493c2144ae0

[ "A: Acromegaly", "B: Cystic fibrosis", "C: Eisenmenger's syndrome", "D: Squamous-cell lung cancer", "E: Ulcerative colitis" ]

C: Eisenmenger's syndrome

266

feb-10-2022

A 21-year-old woman with a history of surgically corrected Hirschsprung’s disease presented with 6-week history of abdominal pain and constipation. Her blood pressure was 162/108 mm Hg. She had an elevated creatinine and CT showed large subcapsular urinomas and hydronephrosis caused by distal ureteral obstruction from ...

yes

9%

16%

21%

45%

9%

51432

0.078

426fcc9f2f9d432d739d8945a42dc47b

[ "A: Atherosclerotic renal artery stenosis", "B: Fibromuscular dysplasia", "C: Medullary sponge kidney", "D: Page kidney", "E: Polycystic kidney disease" ]

D: Page kidney

267

feb-11-2010

What is the diagnosis?

no

23%

30%

23%

18%

7%

152548

0.175

79fafb15ba0132854d58e3c4a050bad4

[ "A: Gastric outlet obstruction", "B: Hirschsprung disease", "C: Ileal intussusception", "D: Ulcerative colitis", "E: Zollinger-Ellison syndrome" ]

D: Ulcerative colitis

268

feb-11-2016

What is the most likely diagnosis in a man with a 3-month history of migratory lesions on the tongue?

yes

54%

15%

10%

13%

7%

95386

0.053

b00a2783d9eaece3703545057f49d21d

[ "A: Geographic tongue", "B: Oral candidiasis", "C: Lichen planus", "D: Oral hairy leukoplakia", "E: Pemphigus vulgaris" ]

A: Geographic tongue

269

feb-11-2021

A 56-year-old man with a new diagnosis of acute monoblastic leukemia received induction chemotherapy and subsequently developed disseminated intravascular coagulation and tumor lysis syndrome. While his condition improved, he began having persistent lower back pain. A pelvic bone marrow specimen is as shown. What is th...

yes

50%

10%

20%

11%

8%

40460

0.064

0835d404efde2e9fd78d640e727c2199

[ "A: Bone marrow necrosis", "B: Megaloblastic anemia", "C: Myelofibrosis", "D: Multiple Myeloma", "E: Essential thrombocythemia" ]

A: Bone marrow necrosis

270

feb-12-2009

This 22-year-old man presented with a 1-month history of severe pubic itch that was worst at night. What is the most appropriate topical treatment?

yes

4%

6%

73%

13%

111813

0.019

7acc8fab165c1e619c4d570cdced879a

[ "A: Hydrocortisone", "B: Hydroxyzine", "C: Mupirocin", "D: Permethrin", "E: Selenium sulfide" ]

D: Permethrin

271

feb-12-2015

What is the most likely diagnosis in this patient with hypothermia and bradycardia?

yes

12%

3%

77%

4%

94070

0.014

eb739d66781b0492d41abfcff66bf52d

[ "A: Cushing's syndrome", "B: Generalized lipodystrophy", "C: Hypothyroidism", "D: Primary systemic amyloidosis", "E: Superior vena cava syndrome" ]

C: Hypothyroidism

272

feb-13-2014

What diagnosis explains the loss of visual acuity in this woman who is at 36 weeks of gestation?

yes

17%

16%

4%

3%

60%

57502

0.043

7c9268bcca7d47661f956ebcedb83abb

[ "A: Central serous chorioretinitis", "B: Diabetes mellitus", "C: Glaucoma", "D: Graves' disease", "E: Preeclampsia" ]

E: Preeclampsia

273

feb-13-2020

A 74-year-old woman presented to the gastroenterology clinic with a long history of bloating and abdominal distention. On physical examination, the abdomen was found to be distended but was nontender on palpation, with normal bowel sounds. This image shows findings on computed tomography of the abdomen and pelvis. What...

yes

19%

12%

24%

37%

9%

95906

0.103

79054313345e6504b884f74f232b8e5b

[ "A: Diffuse mesenteric hydatid cyst disease", "B: Senile ileus", "C: Pneumatosis cystoides intestinalis", "D: Intestinal lipomatosis", "E: Food bolus obstruction" ]

D: Intestinal lipomatosis

274

feb-14-2008

This patient presented with transient, painless visual obscuration in the left eye. What is the diagnosis?

yes

7%

11%

61%

7%

14%

96057

0.039

a036a2c45452560ec3de06f1c8a0af90

[ "A: Papilledema", "B: Hypertensive retinopathy", "C: Cholesterol emboli", "D: Temporal arteritis", "E: Diabetic retinopathy" ]

C: Cholesterol emboli

275

feb-14-2013

What is the diagnosis?

no

9%

5%

3%

77%

6%

76706

0.014

4c78feacad33c4db55bbbd24acaa68a2

[ "A: Aphthous stomatitis", "B: Bullous pemphigoid", "C: Chickenpox", "D: Herpes zoster", "E: Paraneoplastic pemphigus" ]

D: Herpes zoster

276

feb-14-2019

A 65-year-old man who was otherwise healthy presented to the dermatology clinic with a 5-month history of a progressively enlarging annular rash over his right hand and forearm. He worked as a farmer in southern China and noted that the erythema had developed after trauma to his hand from agricultural work. What is the...

yes

16%

3%

60%

8%

13%

75552

0.042

2103e2f1229bb34d4b5d9eefe163ed0b

[ "A: Cutaneous leishmaniasis", "B: Sarcoidosis", "C: Sporotrichosis", "D: Tinea versicolor", "E: Scrofuladerma" ]

C: Sporotrichosis

277

feb-15-2007

This patient presented with loss of vision. What is the diagnosis?

yes

48%

12%

16%

15%

9%

80792

0.068

cc885a3bf2bf801fb094443a3592abc7

[ "A: Central retinal artery occlusion", "B: Diabetic retinopathy", "C: Tay-Sach's disease", "D: Hypertensive retinopathy", "E: Papilledema" ]

A: Central retinal artery occlusion

278

feb-15-2018

A 19-year-old woman presented to the emergency department with a 7-year history of periodic lower abdominal and pelvic pain without fever, chills, or dysuria. She had not had menses nor vaginal intercourse. Physical exam revealed lower abdominal distention and a firm and tender suprapubic mass extending from the pelvis...

yes

7%

12%

11%

15%

56%

116641

0.049

aae77ba86c2512484391752796d88a5b

[ "A: Molar pregnancy", "B: Choriocarcinoma", "C: Endometrial cancer", "D: Uterine fibroids", "E: Hematometrocolpos" ]

E: Hematometrocolpos

279

feb-16-2006

This 75-year-old man presented with cough and hoarseness. What is the most likely cause of his appearance?

yes

55%

11%

14%

7%

13%

69790

0.051

775580444baf877a8efad0d0d9eefd24

[ "A: Superior vena cava syndrome", "B: Mitral stenosis", "C: Chronic obstructive airways disease", "D: Angioedema", "E: Systemic lupus erythematosus" ]

A: Superior vena cava syndrome

280

feb-16-2012

What is the most likely underlying diagnosis?

no

79%

4%

2%

8%

7%

84640

0.011

60141e51ee5dc9ff5cdc8125b2d3afd4

[ "A: Cirrhosis", "B: Chronic renal failure", "C: Hypothyroidism", "D: Myeloma", "E: Sickle cell disease" ]

A: Cirrhosis

281

feb-16-2017

A previously healthy 5-year-old boy presented with a 4-day history of nausea, vomiting, and intermittent abdominal pain. On examination he had mild periorbital edema. A computed tomography scan with contrast demonstrated these findings. What is the diagnosis?

yes

8%

4%

16%

58%

14%

73493

0.046

260989f322f2ed5ad09112754ea0a7be

[ "A: Hyperplastic polyps", "B: Reflux gastropathy", "C: Zollinger-Ellison syndrome", "D: Ménétrier’s disease", "E: Cronkite-Canada syndrome" ]

D: Ménétrier’s disease

282

feb-16-2023

An 80-year-old woman was admitted to the intensive care unit with severe second- and third-degree burns. On laboratory studies, she was noted to have a platelet count of 930,000 per cubic millimeter. Manual analysis of a subsequent peripheral-blood smear identified a platelet count of 115,000 per cubic millimeter. What...

yes

11%

12%

7%

59%

25569

0.042

be33ee5fe2b83923f695827a0dda08da

[ "A: Pseudothrombocytopenia due to giant platelets", "B: Pseudothrombocytopenia due to plate clumping associated with EDTA", "C: Pseudothrombocytosis due to cryoglobulin-related interference by cryoprecipitates", "D: Pseudothrombocytosis due to presence of microorganisms", "E: Pseudothrombocytosis due to red...

E: Pseudothrombocytosis due to red cell fragments

283

feb-17-2011

What is the diagnosis?

no

12%

31%

5%

20%

32%

109410

0.127

b5218ec9ac1dd179a48061fbc062ed15

[ "A: Anterior uveitis", "B: Carotid cavernous sinus fistula", "C: Graves' disease", "D: Orbital lymphoma", "E: Scleral rupture" ]

B: Carotid cavernous sinus fistula

284

feb-17-2022

A 50-year-old man with a history of several months of productive cough presented to the emergency department with stupor and hypercarbic respiratory failure. He was intubated. Chest radiograph several days later revealed complete collapse of the left lung. On bronchoscopy, several casts, as shown, were retrieved. Follo...

yes

4%

18%

14%

57%

7%

42400

0.049

585a0ddcb1f00b23061864dc6be2b834

[ "A: Asthma", "B: Bronchiectasis", "C: Cystic fibrosis", "D: Plastic bronchitis", "E: Tuberculosis" ]

D: Plastic bronchitis

285

feb-18-2010

This 12-year-old presented with decreased appetite and vomiting. What is the most likely diagnosis?

yes

7%

29%

5%

28%

31%

235472

0.141

221d5a60b62d8eedb1bc8a1604ba874e

[ "A: Endometrioma", "B: Hernia", "C: Keloid", "D: Intraabdominal cancer", "E: Urachal duct cyst" ]

D: Intraabdominal cancer

286

feb-18-2016

What is the most likely diagnosis in a man with recurrent facial flushing, foreign-body sensation, and blurry vision?

yes

45%

8%

19%

23%

6%

106297

0.08

b1247c5d6ee0f47aa8a053ed6889bee7

[ "A: Rosacea", "B: Blepharitis", "C: Sjogren’s syndrome", "D: Anterior uveitis", "E: Conjunctival hemorrhage" ]

A: Rosacea

287

feb-18-2021

An 80-year-old man presented to the emergency department with abdominal bloating and constipation. He had lost 5 kg during the previous 8 months. Examination of the abdomen was notable for a mass that extended from the epigastrium to the pelvis and was nontender and dull on percussion. What is the diagnosis?

yes

7%

10%

62%

7%

14%

75527

0.037

40b3c2b7967156b5e2261811f4b42400

[ "A: Abdominal aortic aneurysm", "B: Castleman disease", "C: Urachal mucinous cystic tumor", "D: Cysticercosis", "E: Wilms’s tumor" ]

C: Urachal mucinous cystic tumor

288

feb-19-2009

What clinical presentation would be expected in this patient?

no

9%

20%

10%

43%

17%

120280

0.082

c4d7c53446dbdc417a74cf88540a483f

[ "A: Asymmetrical mydriasis", "B: Ataxic hemiparesis", "C: Hypothermia", "D: Quadriplegia", "E: Upward gaze palsy" ]

D: Quadriplegia

289

feb-19-2015

What is the diagnosis in this 31-year-old woman with gradual bilateral vision loss?

yes

13%

30%

28%

18%

11%

116345

0.134

931e51c408328ad1f2f5b3ff94c0ea46

[ "A: Glaucoma", "B: Graves’ ophthalmopathy", "C: Marfan’s syndrome", "D: Retinitis pigmentosa", "E: Temporal arteritis" ]

C: Marfan’s syndrome

290

feb-20-2014

What is the most likely diagnosis in this patient who underwent fine-needle aspiration after reporting several weeks of submandibular pain?

yes

9%

17%

28%

41%

4%

86175

0.093

c6dbdf7f66ddc87dbe759572b2419ed5

[ "A: Adenoid cystic carcinoma", "B: Cat scratch disease", "C: Infectious mononucleosis", "D: Sclerosing sialadenitis", "E: Systemic lupus erythematosus" ]

D: Sclerosing sialadenitis

291

feb-20-2020

A 66-year-old man presented to the emergency department with a 4-day history of shortness of breath and swelling in the legs along with recent fatigue and a 15-kg weight loss. Over the course of hospitalization, the patient developed hemodynamic instability and, despite receiving maximal supportive therapy, died in the...

yes

13%

36%

21%

13%

17%

143005

0.103

ffb218ba6cdccc8adcab66cd4e3b9ae8

[ "A: Staphylococcus aureus septic emboli", "B: Angiosarcoma", "C: Pericardial mesothelioma", "D: Chronic Chagas' heart disease", "E: Cardiac amyloidosis" ]

B: Angiosarcoma

292

feb-21-2008

What is the most likely diagnosis?

no

37%

8%

24%

23%

127667

0.104

9cd3fc2cb389926339372abf764f91bb

[ "A: Chronic venous insufficiency", "B: Reiter syndrome", "C: Gunshot wound", "D: Chronic renal failure", "E: Pseudohypoparathyroidism" ]

A: Chronic venous insufficiency

293

feb-21-2013

What is the diagnosis?

no

8%

9%

19%

12%

52%

75861

0.059

4931992172643cf0efb87c1fb95a3da9

[ "A: Parulis", "B: Pyogenic granuloma", "C: Peripheral ossifying fibroma", "D: Retrocuspid papillae", "E: Torus mandibularis" ]

E: Torus mandibularis

294

feb-21-2019

A 54-year-old man presented to the oral and maxillofacial clinic with a 2-month history of difficulty chewing his food. He reported a painless brown lesion had grown on his tongue in the center of a white patch that had been present for years. Examination of the oral cavity revealed a well-circumscribed hard mass, meas...

yes

17%

5%

9%

52%

16%

112843

0.059

6a0d57c0388f940e6085b85a7241ce58

[ "A: Dermoid cyst", "B: Oral candidiasis", "C: Lipoma", "D: Spindle-cell sarcoma", "E: Tongue mucocele" ]

D: Spindle-cell sarcoma

295

feb-22-2007

Which one of the following organs is enlarged?

yes

11%

6%

48%

29%

6%

110857

0.075

ca51f73bbd713e1804f19ca5500eedf8

[ "A: Colon", "B: Ovary", "C: Stomach", "D: Spleen", "E: Gall bladder" ]

C: Stomach

296

feb-22-2018

A 24-year-old woman with a 10-year history of intermittent episodes of redness and photophobia in both eyes presented to the ophthalmology clinic. On examination, the visual acuity was 20/30 in the right eye and 20/25 in the left eye. Slit-lamp examination revealed conjunctival hyperemia and peripheral corneal pacifica...

yes

13%

17%

53%

4%

89908

0.057

a236290455cd728dee2d2f2c1166ba74

[ "A: Syphilis", "B: Systemic lupus erythematosus", "C: High lead exposure", "D: Cogan’s syndrome", "E: Lymphoma" ]

D: Cogan’s syndrome

297

feb-23-2006

What nebulized medication is most likely to have caused this patient's anisocoria?

yes

21%

44%

7%

13%

15%

77563

0.08

9bf3456189aaf8ca6aa66a0a444ff758

[ "A: Racemic epinephrine", "B: Ipratropium", "C: Ribavirin", "D: Salbutamol", "E: Theophylline" ]

B: Ipratropium

298

feb-23-2012

This patient had diabetes. What is the diagnosis?

yes

11%

38%

8%

17%

26%

101947

0.1

cdab8b72eed25e1cb2e560a7d9da0c7f

[ "A: Diabetic bullae", "B: Eruptive xanthomas", "C: Lichen amyloidosis", "D: Necrobiosis lipoidica", "E: Pustular psoriasis" ]

B: Eruptive xanthomas

299

feb-23-2017

A 67-year-old man with a substantial cardiac history and renal disease presented to the emergency department with neck swelling, dysphagia, and hoarseness. Computed tomographic scans of his neck showed these findings. What is the diagnosis?

yes

13%

12%

44%

13%

18%

90233

0.079

35ac9783299c2b2bb6226008dad4bb44

[ "A: Acute bacterial sialadenitis", "B: Mumps", "C: Iodide-associated sialadenitis", "D: Sialolithiasis", "E: Mikulicz syndrome" ]

C: Iodide-associated sialadenitis

300

feb-23-2023

A 52-year-old woman with end-stage kidney disease that was being managed with peritoneal dialysis presented with a 1-month history of bloody dialysate. She had had 3 episodes of bacterial peritonitis in the past 12 years. Physical examination and laboratory studies were unremarkable. Computed tomography of the abdomen ...

yes

23%

55%

6%

8%

9%

27772

0.055

d0acc26097c8eba6f2a3aa8995d843a1

[ "A: Calciphylaxis", "B: Encapsulating peritoneal sclerosis", "C: Fungal peritonitis", "D: Peritoneal carcinomatosis", "E: Tuberculous peritonitis" ]

B: Encapsulating peritoneal sclerosis