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

image_id int64 1 947	date stringlengths 11 11	question stringlengths 22 850	relevant_context stringclasses 2 values	option_A_votes stringclasses 82 values	option_B_votes stringclasses 75 values	option_C_votes stringclasses 74 values	option_D_votes stringclasses 78 values	option_E_votes stringclasses 76 values	total_number_votes stringlengths 5 7	brier_score float64 0 0.22	image_hash stringlengths 32 32	options listlengths 5 5	answer stringlengths 7 74
701	may-29-2008	What is the diagnosis?	no	17%	13%	9%	41%	20%	135698	0.088	c5720a8b0b846c5521fb04ca7ef534e4	[ "A: Ludwig's angina", "B: Glossopharyngeal nerve palsy", "C: Pharyngeal gonorrhea", "D: Bilateral peritonsillar abscesses", "E: Infectious mononucleosis" ]	D: Bilateral peritonsillar abscesses
702	may-29-2014	What is the most likely diagnosis in this patient with cough?	yes	15%	21%	20%	36%	8%	84614	0.105	b9d856762787af56ff908308dc7063b9	[ "A: Aspergillosis", "B: Coccidioidomycosis", "C: Granuloma annulare", "D: Sarcoidosis", "E: Syphilis" ]	D: Sarcoidosis
703	may-30-2013	What is the cause of this patient's dyspnea?	yes	6%	17%	8%	58%	11%	81818	0.045	748db9eb1f302644282aa87f5614b81b	[ "A: Mitral stenosis", "B: Pneumonia", "C: Pneumothorax", "D: Pulmonary embolism", "E: Sarcoidosis" ]	D: Pulmonary embolism
704	may-30-2019	A 34-year-old man with a history of human immunodeficiency virus (HIV) infection presented to the emergency department with a 1-week history of headache, fever, and confusion. On physical examination, a large, ulcerative lesion was noted on his tongue (Panel A). The patient's CD4 count was 39 cells per cubic millimeter...	yes	7%	16%	49%	15%	14%	79627	0.067	6b8fcacaff4723da0409cfa57e776aae	[ "A: Sarcoidosis", "B: Lingual tuberculosis", "C: Disseminated coccidioidomycosis", "D: Disseminated aspergillosis", "E: B-cell lymphoma" ]	C: Disseminated coccidioidomycosis
705	may-31-2007	These lesions appeared spontaneously in a patient with untreated multiple myeloma. Coagulation studies were normal and platelet count was 80,000 per cubic millimeter. What is the diagnosis?	yes	21%	21%	3%	51%	5%	129620	0.066	e285e2ff8cf2dbf798e00838fe184b74	[ "A: Orbital fracture", "B: Disseminated intravascular coagulation", "C: Tuberous sclerosis", "D: Amyloid purpura", "E: Horner's syndrome" ]	D: Amyloid purpura
706	may-31-2012	What is the most likely diagnosis?	no	31%	8%	8%	5%	48%	107729	0.076	bde82b442603c01cb733016f81a2dcff	[ "A: Cat scratch disease", "B: Mumps", "C: Sarcoidosis", "D: Sjogren's syndrome", "E: Tuberculosis" ]	E: Tuberculosis
707	may-31-2018	A 44-year-old woman presented to the emergency department with acute chest pain after several months of progressive dyspnea. Her oxygen saturation was 92%, and she had diminished breath sounds on the right side. Chest CT revealed a large right-sided pneumothorax and diffuse, intraparenchymal pulmonary cysts. What is th...	yes	15%	14%	14%	49%	7%	98721	0.065	4eb7dc52e593a1a765aef9a53890cf6b	[ "A: Cystic fibrosis", "B: Pneumocystis pneumonia", "C: Emphysema", "D: Lymphangioleiomyomatosis", "E: Sjögren’s syndrome" ]	D: Lymphangioleiomyomatosis
708	nov-01-2007	Which one of the following drugs of abuse is most typically associated with the illustrated complication?	yes	3%	7%	81%	4%	4%	138895	0.009	8eb01bba69821c09fbda7058ae77b52f	[ "A: Ketamine", "B: Heroin", "C: Cocaine", "D: Phencyclidine", "E: Mescaline" ]	C: Cocaine
709	nov-01-2012	What is the diagnosis?	no	25%	21%	14%	23%	17%	104290	0.142	f13b03c8493ba04837c8b533711c1964	[ "A: Basilar artery aneurysm", "B: Central pontine myelinolysis", "C: Dandy-Walker malformation", "D: Glioma", "E: Pontine stroke" ]	A: Basilar artery aneurysm
710	nov-01-2018	A 39-year-old man presented to the emergency department with a 4-week history of abdominal pain and constipation. Physical examination of the abdomen was normal, but he was noted to have gray lines along the margins of his lower gum. What is the most likely diagnosis?	yes	13%	17%	8%	10%	53%	114980	0.057	7d083f57de870bcf2b02c9bc339fd63c	[ "A: Scurvy", "B: Bismuth poisoning", "C: Adults Still's disease", "D: Behçet's syndrome", "E: Lead poisoning" ]	E: Lead poisoning
711	nov-02-2006	What accounts for this patient's hand pain?	yes	21%	5%	61%	7%	5%	70173	0.041	12d88455b0a65ffdb4def4cea64721a3	[ "A: Ulnar artery occlusion", "B: Wrist fracture", "C: Radial artery thrombosis", "D: Carpal tunnel syndrome", "E: Reflex sympathetic dystrophy" ]	C: Radial artery thrombosis
712	nov-02-2017	A 58-year-old woman presented to the rheumatology clinic with long-standing joint pain and deformities of both hands and feet. What material has been used in acupuncture threading techniques for joint pain?	yes	17%	48%	11%	8%	15%	84461	0.068	2f187673454b015f2abe88e7f3eff27f	[ "A: Copper", "B: Gold", "C: Titanium", "D: Cobalt", "E: Silver nitrate" ]	B: Gold
713	nov-02-2023	A 38-year-old man with end-stage renal disease who was undergoing hemodialysis presented to the hospital with several years of progressive difficulty in walking. Four years before presentation, acute pain and swelling in both knees had developed after he had stepped off an auto rickshaw. At that time, he had opted for ...	yes	5%	7%	23%	5%	59%	19868	0.046	917b799a150babdb7f3e21824f0277c9	[ "A: Femoral nerve injuries", "B: Patellar stress fractures", "C: Patellar tendon ruptures", "D: Quadriceps strains", "E: Quadriceps tendon ruptures" ]	E: Quadriceps tendon ruptures
714	nov-03-2005	This radiograph was taken 12 minutes after infusion of intravenous contrast. What diagnosis is suggested?	yes	32%	20%	15%	5%	28%	88262	0.137	328de7be104eb4c8240523d2187420ef	[ "A: Left renal artery stenosis", "B: Right staghorn calculus", "C: Left hypernephroma", "D: Bladder carcinoma", "E: Right ureterovesical calculus" ]	E: Right ureterovesical calculus
715	nov-03-2011	What is the diagnosis in this infant who was born at term?	yes	4%	3%	4%	14%	75%	89405	0.017	0c7f06d1b5be254228bf19067188245d	[ "A: Bilateral cryptorchidism", "B: Congenital asplenia", "C: Congenital toxoplasmosis", "D: Neonatal epididymitis", "E: Retroperitoneal hemorrhage" ]	E: Retroperitoneal hemorrhage
716	nov-03-2016	A 68-year-old man presented with unilateral ptosis with no other symptoms. Application of an ice pack to the left eye improved his symptoms. What is the diagnosis?	yes	15%	53%	21%	4%	8%	120152	0.059	2b7908e14adfe8deea4cefc299ae9473	[ "A: Bell’s palsy", "B: Myasthenia gravis", "C: Benign essential blepharospasm", "D: Multiple sclerosis", "E: Myotonic dystrophy" ]	B: Myasthenia gravis
717	nov-03-2022	A 5-year-old boy from China with a history of IgA vasculitis at 2 years of age presented with a 1-month history of progressively painful skin ulcerations on his extremities. Two months prior, he had had an episode of nasal pustules that had not responded to antimicrobial therapy or surgical débridement, but had ultimat...	yes	13%	15%	9%	14%	48%	56303	0.068	57e3d7643f88914dce7e37001f5125bc	[ "A: Cutaneous leishmaniasis", "B: Cutaneous polyarteritis nodosa", "C: Cutaneous tuberculosis", "D: Ecthyma gangrenosum", "E: Pyoderma gangrenosum" ]	E: Pyoderma gangrenosum
718	nov-04-2010	What is the diagnosis?	no	32%	20%	4%	36%	7%	97195	0.112	0f320b9ed24aa002745d2737f1db412b	[ "A: Atrophic candidiasis", "B: Erythroplakia", "C: Lingual thyroid", "D: Median rhomboid glossitis", "E: Tertiary syphilis" ]	D: Median rhomboid glossitis
719	nov-04-2021	A 53-year-old woman presented with pain, swelling, and discoloration of her right fifth finger. Physical examination showed a demarcated, brightly erythematous plaque with a dusky center. What is the most likely diagnosis?	yes	13%	10%	19%	44%	15%	90485	0.08	b97ae3c17024717798a50f62c5513ae9	[ "A: Dactylitis", "B: Erythema multiforme", "C: Herpetic whitlow", "D: Spider bite", "E: Sporotrichosis" ]	D: Spider bite
720	nov-05-2009	What is the diagnosis?	no	48%	18%	17%	10%	7%	100116	0.069	9283dca8a12fe11ab338ffa0d3d00642	[ "A: Bowel infarction", "B: Crohn's disease", "C: Cystic fibrosis", "D: Echinococcosis", "E: Lead poisoning" ]	A: Bowel infarction
721	nov-05-2015	Which of the following choices is the least likely diagnosis for the sudden painless vision loss in this patient?	yes	14%	13%	16%	14%	44%	88058	0.079	0234ce6caa0a9674d140cb5569da751e	[ "A: Vitreous hemorrhage", "B: Retinal artery occlusion", "C: Retinal vein occlusion", "D: Occipital stroke", "E: Narrow angle glaucoma" ]	E: Narrow angle glaucoma
722	nov-05-2020	An 83-year-old man presented with food impaction after eating pork. He reported intermittent difficulty with swallowing ongoing for several months. An esophagogastroduodenoscopy was performed to relieve the obstruction. During the endoscopy, the duodenal mucosa was as shown. What is the diagnosis?	yes	11%	60%	10%	5%	15%	73463	0.041	bd4cc5c19b588567b13957898b801735	[ "A: Malignant melanoma", "B: Pseudomelanosis duodeni", "C: Hemochromatosis", "D: Chronic bowel ischemia", "E: Peutz-Jeghers syndrome" ]	B: Pseudomelanosis duodeni
723	nov-06-2008	What is the diagnosis?	no	24%	6%	14%	32%	24%	117102	0.12	eaea57e920bfaf1b16abc2c290b26336	[ "A: Angioid streaks", "B: Glaucoma", "C: Macular degeneration", "D: Ocular myiasis", "E: Pseudoxanthoma elasticum" ]	D: Ocular myiasis
724	nov-06-2014	What is the most likely underlying diagnosis in this 82-year-old patient with diabetes mellitus who had undergone a total hip replacement 10 years previously?	yes	20%	12%	29%	23%	15%	103196	0.163	45c0b5f4680bddce1a7e1504ab7524db	[ "A: Colon cancer", "B: Hypogammaglobulinemia", "C: Hypophosphatasia", "D: Osteosarcoma", "E: Tuberculosis" ]	A: Colon cancer
725	nov-07-2013	What are these crystals that were aspirated from the bursa of an elbow of a patient with rheumatoid arthritis?	yes	28%	13%	19%	24%	16%	187859	0.131	1ee5d956c4caa45f45da15d3be770a02	[ "A: Cholesterol", "B: Calcium apatite", "C: Calcium oxalate", "D: Calcium pyrophosphate dihydrate", "E: Monosodium urate" ]	A: Cholesterol
726	nov-07-2019	A 73-year-old woman presented to the dermatology clinic with a 9-month history of pruritic and painful lesions on the palms of her hands. Physical examination showed sharp demarcation of the folds in the lines of her hands, a velvety appearance of palmar surfaces, and ridging of the skin. What is the most likely diagno...	yes	16%	35%	11%	24%	14%	102944	0.107	de6d69c826041ceee480538ed9e9c08b	[ "A: Palmar psoriasis", "B: Tripe palms", "C: Acromegaly", "D: Palmoplantar keratoderma", "E: Tinea manuum" ]	B: Tripe palms
727	nov-08-2007	This 81-year-old woman presented with swelling and pain in the left foot a week after treatment for acute bronchitis. Which one of the following treatments is most likely to have been contributory?	yes	7%	9%	10%	6%	68%	95753	0.026	ab4795999ce849674c6a42d5e9c65796	[ "A: Beta-adrenergic agonist", "B: Cephalosporin antibiotic", "C: Leukotriene receptor antagonist", "D: Guaifenesin expectorant", "E: Fluoroquinolone antibiotic" ]	E: Fluoroquinolone antibiotic
728	nov-08-2012	What procedure was most recently performed on this patient?	yes	70%	7%	12%	6%	5%	69249	0.023	73916c26a8c4eefec2115e7a0fea7efd	[ "A: Mitral-valve repair", "B: Pancreatectomy", "C: Roux-en-Y gastric bypass", "D: Thyroidectomy", "E: Total hip replacement" ]	A: Mitral-valve repair
729	nov-08-2018	A 56-year-old woman with no significant past medical history presented to the emergency department with worsening shortness of breath over 8 months. She had no prior history of tobacco use. Physical examination was notable for bronchial breath sounds in both lungs with oxygen saturation of 93% on 3 liters of supplement...	yes	28%	22%	20%	19%	10%	169614	0.131	cc41e0166dd32677135ed1c2066d0ef5	[ "A: Non–small-cell lung cancer", "B: Sarcoidosis", "C: Langerhans cell histiocytosis", "D: Histoplasmosis", "E: Septic embolization" ]	A: Non–small-cell lung cancer
730	nov-09-2006	Treatment with what antibiotic is most likely to have resulted in this patient's skin changes?	yes	14%	30%	13%	31%	12%	107053	0.123	a9842621de284148e24ed9878310600f	[ "A: Rifampin", "B: Chloramphenicol", "C: Nitrofurantoin", "D: Minocycline", "E: Trimethoprim" ]	D: Minocycline
731	nov-09-2017	An 87-year-old woman with a history of peptic ulcer disease presented with severe abdominal pain. An examination showed hypotension and diffuse abdominal tenderness. Computed tomography of the abdomen revealed a classic sign of pneumoperitoneum outlining which ligament?	yes	14%	10%	14%	53%	9%	71028	0.056	bb7332bd8c7f73368a9d8ebed49d9874	[ "A: Round ligament of the liver", "B: Gastrohepatic ligament", "C: Ligament of Trietz", "D: Falciform ligament", "E: Hepatoduodenal ligament" ]	D: Falciform ligament
732	nov-09-2023	A 60-year-old woman with hypertension and chronic kidney disease of unknown cause was referred to the emergency department because of a serum creatinine level of 7.8 mg per deciliter (reference range, 0.5 to 0.9). She had been feeling well before presentation. A urinalysis showed 2+ protein and more than 180 red cells ...	yes	53%	11%	14%	9%	13%	18769	0.056	8a6b71bf51cacbcb109b9218e1c3ed96	[ "A: Chest imaging", "B: Echocardiogram", "C: Ophthalmologic exam", "D: Otorhinolaryngology evaluation", "E: Skin biopsy" ]	A: Chest imaging
733	nov-10-2005	What is the most important diagnosis to exclude in this 81-year-old woman?	yes	50%	30%	6%	3%	10%	69491	0.071	eded5fd24ca4c0293c656922c7c6de63	[ "A: Lentigo maligna", "B: Basal cell carcinoma", "C: Varicella zoster", "D: Systemic sclerosis", "E: Actinic keratosis" ]	A: Lentigo maligna
734	nov-10-2011	What is the diagnosis?	no	29%	16%	28%	13%	13%	111658	0.132	b0ea122806c0af9ccfab9474b982b7e2	[ "A: Cholesteatoma", "B: Globus tympanicus", "C: Herpes zoster", "D: Otitis media", "E: Squamous-cell carcinoma" ]	C: Herpes zoster
735	nov-10-2016	A man presented with difficulty walking and urinary incontinence. On examination, his pupils were nonreactive to bright light but constricted when focusing on a near object. What is the diagnosis?	yes	13%	57%	15%	4%	11%	116908	0.048	4dda19aa8a9fa02b002a13233c709b74	[ "A: Multiple sclerosis", "B: Tabes dorsalis", "C: Parinaud's syndrome", "D: Sarcoidosis", "E: Horner’s syndrome" ]	B: Tabes dorsalis
736	nov-10-2022	A previously healthy 25-year-old man presented to the general medicine clinic with a 3-month history of worsening fatigue, nausea, and dry cough following administration of a folk remedy for tinea cruris. Laboratory studies showed a hemoglobin level of 6.5 g per deciliter (reference range, 12.0 to 16.0), and normal ren...	yes	66%	10%	9%	11%	5%	36384	0.03	a55ce186250727825758ea402b969556	[ "A: Chelation Therapy", "B: Exchange Transfusion", "C: Hemodialysis", "D: Plasma Exchange Therapy", "E: Therapeutic Phlebotomy" ]	A: Chelation Therapy
737	nov-11-2010	This 10-year-old presented with abdominal pain. What is the diagnosis?	yes	25%	43%	5%	21%	7%	96183	0.088	6e50e6955b1aaf6c99709d6d40758c9f	[ "A: Hirschsprung's disease", "B: Meckel's diverticulum", "C: Peptic ulceration", "D: Pyloric outlet obstruction", "E: Situs inversus" ]	B: Meckel's diverticulum
738	nov-11-2021	A 61-year-old woman presented with discoloration along her gums that had rapidly expanded over the past year. What is the diagnosis?	yes	9%	56%	11%	19%	6%	69108	0.051	8eb627ccbd5994a241d519d325b0614b	[ "A: Amalgam tattoo", "B: Gingival melanoma", "C: Kaposi’s sarcoma", "D: Oral melanoacanthoma", "E: Physiologic pigmentation" ]	B: Gingival melanoma
739	nov-12-2009	What is the diagnosis?	no	8%	61%	6%	6%	19%	119165	0.04	fea8c7100790bb8e9d63084ca7e4c359	[ "A: Cellulitis", "B: Gout", "C: Osteoarthritis", "D: Rheumatoid arthritis", "E: Septic arthritis" ]	B: Gout
740	nov-12-2015	Which one of the following treatments is the treatment of choice for the ulcerated breast lesions seen in this image?	yes	16%	12%	39%	21%	11%	120263	0.094	6b1e16d68bef378cbcb014acc0e43c5f	[ "A: Radiation therapy", "B: Doxorubicin", "C: Penicillin", "D: Mastectomy", "E: Hydrocortisone cream" ]	C: Penicillin
741	nov-12-2020	A 3-day-old male infant presented to the hospital with vomiting and inability to pass stools. Physical exam revealed a distended abdomen without bowel sounds. Exploratory laparotomy was done. What is the diagnosis?	yes	10%	58%	13%	8%	11%	54831	0.044	c1253f48c8120e49306ab712d1d752f8	[ "A: Bowel obstruction", "B: Hirschsprung’s disease", "C: Toxic megacolon", "D: Meckel’s diverticulum", "E: Meconium ileus" ]	B: Hirschsprung’s disease
742	nov-13-2008	What diagnosis is suggested by this barium swallow?	yes	4%	9%	73%	5%	9%	107647	0.019	887b05e6cd73b2863e3f9a22a62de57e	[ "A: Ingested foreign body", "B: Esophageal diverticula", "C: Diffuse esophageal spasm", "D: Gastric linitis plastica", "E: Esophageal carcinoma" ]	C: Diffuse esophageal spasm
743	nov-13-2014	What is the most likely diagnosis?	no	16%	48%	18%	5%	14%	74969	0.07	b60b397aff52f1eb4ea225b2ab285fe0	[ "A: Achalasia", "B: Diffuse esophageal spasm", "C: Esophageal stricture", "D: Hiatal hernia", "E: Systemic sclerosis" ]	B: Diffuse esophageal spasm
744	nov-14-2013	What is the diagnosis?	no	3%	41%	10%	40%	6%	98765	0.109	6700bd888ea3e990c4386185e9f0cf30	[ "A: Chronic aortic dissection", "B: Cirrhosis", "C: Hypoplastic right heart syndrome", "D: Superior vena caval obstruction", "E: Transposition of the great vessels" ]	D: Superior vena caval obstruction
745	nov-14-2019	A previously healthy 22-year-old man presented with a 6-month history of palpitations and chest discomfort. He denied any dyspnea or syncope. On examination, a midsystolic click was heard at the cardiac apex. An image from a transthoracic echocardiogram is shown. What is the most likely diagnosis?	yes	14%	10%	48%	9%	19%	73472	0.069	84f5140b083c2dc378b94ff2ff399f79	[ "A: Infective endocarditis valvular vegetation", "B: Intracardiac helminth", "C: Redundant mitral valve", "D: Propagated valvular thrombus", "E: Papillary fibroelastoma" ]	C: Redundant mitral valve
746	nov-15-2007	What is the diagnosis?	no	57%	6%	13%	16%	7%	114205	0.047	49e3ceadc94586159b47243972d8739a	[ "A: Bezoar", "B: Pericardial effusion", "C: Pneumatosis coli", "D: Gastric carcinoma", "E: Pheochromocytoma" ]	A: Bezoar
747	nov-15-2012	What is the diagnosis?	no	20%	12%	4%	13%	51%	88975	0.063	3885714e9ec9fcaa73b4cfeef6530b6a	[ "A: Chlamydial cervicitis", "B: Endometriosis", "C: Mesonephric remnant", "D: Syphilitic chancre", "E: Squamous-cell carcinoma" ]	E: Squamous-cell carcinoma
748	nov-15-2018	A 72-year-old man presented to the emergency department with an 11-hour history of periumbilical abdominal pain and inability to pass flatus. The pulse was 155 beats per minute, and the blood pressure 83/52 mm Hg. On physical examination, his abdomen was diffusely tender, with the most severe pain in the right upper qu...	yes	10%	12%	55%	12%	11%	92292	0.051	ec018ea2ca89a2832a63eac84459b861	[ "A: Inflammatory bowel disease", "B: Colonoscopy", "C: Bowel ischemia", "D: Intra-abdominal abscess", "E: Peptic ulcer disease" ]	C: Bowel ischemia
749	nov-16-2006	What is the diagnosis?	no	29%	29%	8%	6%	28%	88418	0.139	c5c57663c5b3d9c79dd12197a51a0923	[ "A: Pericardial hydatid cysts", "B: Diaphragmatic rupture", "C: Empyema thoracis", "D: Cystic fibrosis", "E: Pericardial metastases" ]	E: Pericardial metastases
750	nov-16-2017	A 7-year-old boy with a history of atopic dermatitis presented with a 3-month history of widespread, mildly pruritic papular skin rash. What is the likely diagnosis?	yes	57%	9%	18%	11%	6%	104407	0.048	d90015cd6ce5b9442d90acd0d2d0e1ff	[ "A: Molluscum contagiosum", "B: Pityriasis rosea", "C: Papular acrodermatitis", "D: Varicella zoster", "E: Neurofibromatosis" ]	A: Molluscum contagiosum
751	nov-16-2023	A 53-year-old man presented with a 3-year history of an itchy rash, Raynaud's phenomenon, dysphagia, and a burning sensation in his hands. Physical examination was notable for firm, greasy papules across his forehead that led to the formation of glabellar grooves (left). There were waxy papules on his hands, with assoc...	yes	21%	9%	16%	39%	16%	32129	0.095	44d77fc761a829ef8651eb7e7342b0a1	[ "A: Light chain (AL) amyloidosis", "B: Multiple myeloma", "C: Scleredema", "D: Scleromyxedema", "E: Systemic sclerosis" ]	D: Scleromyxedema
752	nov-17-2005	What is the diagnosis?	no	13%	12%	3%	68%	4%	75401	0.027	850e9c7b5342325ae3d51f7599da1845	[ "A: Budd chiari syndrome", "B: Cutaneous larva migrans", "C: Umbilical hernia", "D: Portal hypertension", "E: Gastric carcinoma" ]	D: Portal hypertension
753	nov-17-2011	What is the diagnosis?	no	4%	3%	10%	80%	3%	97011	0.011	9791267de4a1bb25bd6f3a85b3ef4cc2	[ "A: Klippel-Trénaunay-Weber syndrome", "B: McCune-Albright syndrome", "C: Multiple lipomatosis", "D: Neurofibromatosis", "E: Proteus syndrome" ]	D: Neurofibromatosis
754	nov-17-2016	An 81-year-old woman presented with a 1-week history of vomiting. What is the diagnosis?	yes	3%	19%	12%	60%	6%	88350	0.043	71721217e8367ef6d044881044224cf5	[ "A: Lung abscess", "B: Perforated duodenal ulcer", "C: Epiphrenic diverticulum", "D: Paraesophageal hernia", "E: Esophageal duplication cyst" ]	D: Paraesophageal hernia
755	nov-17-2022	A 45-year-old woman presented with a 6-week history of a painless upper-lip lesion. The lesion had rapidly increased in size over the previous 3 weeks and bled when lightly touched. Examination showed an erythematous, round, smooth, pedunculated mass that was friable and non-tender. What is the most likely diagnosis?	yes	13%	21%	10%	37%	19%	65764	0.101	a898cb41b5a12f5a47ad0d5bb555e9b3	[ "A: Arteriovenous malformation", "B: Cherry hemangioma", "C: Malignant melanoma", "D: Pyogenic granuloma", "E: Strawberry hemangioma" ]	D: Pyogenic granuloma
756	nov-18-2010	What is the diagnosis?	no	22%	31%	10%	35%	2%	110944	0.115	9a9d5f5fc6aeee2a97de315f435852b6	[ "A: Meningioma", "B: Osteitis fibrosa cystica", "C: Paget's disease", "D: Plasmacytoma", "E: Thalassemia" ]	D: Plasmacytoma
757	nov-18-2021	A 50-year-old woman with a history of Crohn’s disease presented with 10 days of tongue and inner cheek pain. Laboratory studies showed an absolute eosinophil count of 870 per cubic millimeter (reference range, 50 to 500). What is the most likely diagnosis?	yes	13%	17%	13%	14%	43%	84948	0.081	50edab405b326fa98e5564c998406a51	[ "A: Herpes simplex gingivostomatitis", "B: Herpetic geometric glossitis", "C: Lichen planus", "D: Oral candidiasis", "E: Pyostomatitis vegetans" ]	E: Pyostomatitis vegetans
758	nov-19-2009	What is the diagnosis?	no	12%	12%	38%	12%	26%	122527	0.099	485fd4ec755ae6b7b61e734d8f189891	[ "A: Amebic liver abscess", "B: Diffuse biloma", "C: Echinococcosis", "D: Hepatocellular carcinoma", "E: Polycystic liver disease" ]	C: Echinococcosis
759	nov-19-2015	What is the most likely diagnosis associated with symptoms of pruritic skin changes seen in these images?	yes	46%	19%	11%	9%	15%	104276	0.074	5c07907fce04fe0c7d1f3edb500cb281	[ "A: Malignancy", "B: Psoriasis", "C: Inflammatory bowel disease", "D: Acute hepatitis C infection", "E: Cutaneous sarcoidosis" ]	A: Malignancy
760	nov-19-2020	A 29-year-old male presented with a 6-month history of progressive painless skin lesions over his face, back, trunk, and limbs. He had no systemic symptoms such as night sweats or weight loss. Skin biopsy showed diffuse dermal infiltrate with blast-like cells extending to the hypodermis. Immunohistochemical analysis sh...	yes	4%	3%	47%	34%	11%	123467	0.082	e5bcdf04d9f1fb5981d24bf0e9ca226f	[ "A: Lichen planus", "B: Pustular psoriasis", "C: Blastic plasmacytoid dendritic-cell neoplasm", "D: Cutaneous lymphoblastic T-cell lymphoma", "E: Subacute cutaneous lupus erythematosus" ]	C: Blastic plasmacytoid dendritic-cell neoplasm
761	nov-20-2014	What is the diagnosis?	no	4%	6%	2%	73%	15%	65689	0.02	a1da434d5fc2bb0086b97909e2995fc1	[ "A: Adrenal carcinoma", "B: Autosplenectomy", "C: Diverticular abscess", "D: Emphysematous pyelonephritis", "E: Renal vein thrombosis" ]	D: Emphysematous pyelonephritis
762	nov-21-2013	What is the diagnosis in this patient who had presented with a sore throat?	yes	3%	24%	23%	17%	33%	86469	0.118	625d45d1162ecfbeb43554f4f3417c59	[ "A: Acne", "B: Discoid lupus", "C: Impetigo", "D: Mastocytosis", "E: Syphilis" ]	E: Syphilis
763	nov-21-2019	A 6-month-old girl was referred to the hospital for evaluation and treatment of a perirectal mass which had first been noted at 2 weeks of age. Physical examination showed frontal bossing but no rash, hepatosplenomegaly, lymphadenopathy, or limitation of limb movement. A lateral radiograph of the right tibia showed sev...	yes	11%	5%	18%	45%	20%	75959	0.078	1a0168ef28da211af3214bc1f63ad6ea	[ "A: Infantile hemangioma", "B: Imperforate hymen", "C: Perianal hamartomatous polyps", "D: Congenital syphilis", "E: Perianal rhabdomyosarcoma" ]	D: Congenital syphilis
764	nov-22-2007	What diagnosis is suggested by the findings on this anteroposterior radiograph of the right tibia?	yes	14%	23%	17%	30%	17%	173014	0.152	44fda10c8de9b03453854f8bacb45fe1	[ "A: Ewing's sarcoma", "B: Marrow hyperplasia", "C: Osteomalacia", "D: Polyostotic fibrous dysplasia", "E: Osteopetrosis" ]	B: Marrow hyperplasia
765	nov-22-2012	What is the most likely diagnosis?	no	64%	6%	14%	7%	9%	70797	0.033	f77fa2161d60cd765364e6b9577f9f3e	[ "A: Hairy-cell leukemia", "B: Hodgkin's lymphoma", "C: Infectious mononucleosis", "D: Multiple myeloma", "E: Pernicious anemia" ]	A: Hairy-cell leukemia
766	nov-22-2018	The following is a cast of what anatomical structure?	yes	8%	23%	4%	9%	56%	89523	0.053	385c1d7a09f7cc275e07a653fbae5584	[ "A: Portal vein", "B: Left bronchial tree", "C: Femoral vein", "D: Hepatic artery", "E: Right bronchial tree" ]	E: Right bronchial tree
767	nov-23-2006	This patient presented with severe jaw pain while being treated for osteoporosis. What is the diagnosis?	yes	15%	45%	11%	17%	12%	94313	0.076	21dfa58f65faf338c1a9435cdf587570	[ "A: Submandibular abscess", "B: Osteonecrosis", "C: Behcet's disease", "D: Accessory tooth", "E: Calciphylaxis" ]	B: Osteonecrosis
768	nov-23-2017	A 67-year-old man presented with progressive dysphagia, weight loss, regurgitation, and halitosis. A barium swallow examination showed stasis of barium in the upper esophagus with an outpouching lesion anterior to the C5 and C6 vertebrae. Upper gastrointestinal endoscopy revealed a Zenker’s diverticulum. These divertic...	yes	10%	37%	9%	27%	17%	80870	0.103	cc42040e8ffbefb00e2886505cd9eb45	[ "A: Thyrohyoid membrane", "B: Killian’s triangle", "C: Laimer’s triangle", "D: Killian-Jamieson’s triangle", "E: Cricothyroid membrane" ]	B: Killian’s triangle
769	nov-23-2023	A 69-year-old woman with a history of asbestos exposure presented to the emergency department with a 3-year history of dyspnea on exertion. Physical examination showed signs of volume overload. A chest radiograph showed circumferential calcification of the pericardium and pleural effusions. Simultaneous left and right ...	yes	8%	52%	15%	14%	11%	18203	0.058	16efeec1d085af5b7d22140339ea9519	[ "A: Cardiac Tamponade", "B: Constrictive Pericarditis", "C: Effusive-Constrictive Pericarditis", "D: Primary Pericardial Mesothelioma", "E: Restrictive Cardiomyopathy" ]	B: Constrictive Pericarditis
770	nov-24-2005	This 61-year-old man is receiving care for an arrhythmia. What is the cause of his appearance?	yes	10%	7%	69%	4%	10%	62655	0.025	8bf3fafeac09d882e6d3d866de1a77e4	[ "A: Procainemide", "B: Bretylium", "C: Amiodarone", "D: Sotalol", "E: Hydralazine" ]	C: Amiodarone
771	nov-24-2011	This patient presented with a 1-day history of fever, acute painful symmetric polyarthritis, abdominal pain, and hematemesis. What is the diagnosis?	yes	7%	49%	16%	8%	21%	92286	0.068	f8123368c6e12f309443616cd7453c35	[ "A: Bacterial endocarditis", "B: Henoch-Schönlein purpura", "C: Purpura fulminans", "D: Rheumatic fever", "E: Rocky Mountain spotted fever" ]	B: Henoch-Schönlein purpura
772	nov-24-2016	A 44-year-old man with a history of quadriplegia presented to the emergency department with symptoms of a urinary tract infection. What is the diagnosis?	yes	19%	67%	6%	6%	2%	71312	0.031	0a1d7badd5f18c6edb777b9c394d31a6	[ "A: Bladder perforation", "B: Neurogenic megacolon", "C: Chronic constipation", "D: Gastric distention", "E: Ulcerative colitis" ]	B: Neurogenic megacolon
773	nov-24-2022	A 70-year-old woman with depression and irritable bowel syndrome presented to the emergency department with a 3-day history of altered mental status, shortness of breath, nausea, and vomiting. She had recently been self-medicating worsening irritable bowel symptoms. Physical examination was notable for a respiratory ra...	yes	52%	15%	8%	14%	11%	36977	0.058	d4de1128aafc354cbb8675c9268f39d5	[ "A: Bismuth Salicylate", "B: Calcium Carbonate", "C: Ferrous Sulfate", "D: Magnesium hydroxide", "E: Simethicone" ]	A: Bismuth Salicylate
774	nov-25-2010	A 65-year-old man presented with skin lesions six weeks after returning from a vacation in Belize at the beach and in the rain forest. What is the diagnosis?	yes	45%	32%	9%	2%	12%	101078	0.086	1f0d7fd090ef899ddca625520c6da6a7	[ "A: Bot fly", "B: Cutaneous leishmaniasis", "C: Onchocerciasis", "D: Plague", "E: Tungiasis" ]	A: Bot fly
775	nov-25-2021	A 38-year-old man presented to the otolaryngology clinic with chronic difficulty breathing through his right nostril. Physical examination showed nasal septal deviation, calcified septal spurs, and a 2-cm perforation in the posterior septum. On rhinoscopy, a hard, nontender, white mass was observed in the floor of the ...	yes	9%	8%	10%	10%	63%	37566	0.034	87209c081888075ce2be59a2396dca4d	[ "A: Calcified polyp", "B: Enchondroma", "C: Osteoma", "D: Rhinolith", "E: Tooth" ]	E: Tooth
776	nov-26-2009	The appearance of this foot is most consistent with which one of the following diagnoses?	yes	6%	49%	13%	21%	11%	121493	0.067	67b0c2f9949be1114c36ffb0a9776f66	[ "A: Buruli ulcer", "B: Chromoblastomycosis", "C: Leishmaniasis", "D: Madura foot", "E: Swimming pool granuloma" ]	B: Chromoblastomycosis
777	nov-26-2015	What is the most likely diagnosis associated with fever and jaundice and these image findings?	yes	15%	5%	3%	23%	54%	74615	0.058	8ba7cc752eead1be11187493ccef551f	[ "A: Pancreatitis", "B: Pyelonephritis", "C: Pericarditis", "D: Pancreatic malignancy", "E: Pylephlebitis" ]	E: Pylephlebitis
778	nov-26-2020	A 62-year-old man with chronic obstructive pulmonary disease presented to the emergency department with a 2-day history of dyspnea. He required intubation and ventilation when he was found to be in hypercapnic respiratory failure. Five days after admission to the ICU, his urine became green. Which of the following medi...	yes	8%	11%	20%	49%	11%	89831	0.066	60bc0a593014399f495667fae4c3bc3b	[ "A: Omeprazole", "B: Morphine sulfate", "C: Ipratropium bromide", "D: Propofol", "E: Midazolam" ]	D: Propofol
779	nov-27-2008	This patient with chronic alcoholism presented with dysarthria and horizontal nystagmus. What is the diagnosis?	yes	17%	50%	5%	21%	7%	126310	0.066	dd458195f8b725f134b3deb348b0db27	[ "A: Brainstem glioma", "B: Central pontine myelinolysis", "C: Neurosarcoidosis", "D: Pontine stroke", "E: Tabes dorsalis" ]	B: Central pontine myelinolysis
780	nov-27-2014	What is the diagnosis in this 52-year-old man with epigastric pain?	yes	13%	5%	67%	8%	7%	69512	0.028	1ae32b997f1d52fe4a3294261ee5e2bd	[ "A: Bezoar", "B: Diverticulitis", "C: Intussusception", "D: Mesenteric infarction", "E: Pseudomembranous colitis" ]	C: Intussusception
781	nov-28-2013	What is the most likely diagnosis?	no	59%	7%	6%	6%	22%	68673	0.046	a3da004a0ce490946f709bab2d66ccf4	[ "A: Alopecia areata", "B: Androgenetic alopecia", "C: Telogen effluvium", "D: Tinea capitis", "E: Trichotillomania" ]	A: Alopecia areata
782	nov-28-2019	An 84-year-old woman presented with a painless red nodule over the base of the fourth finger on her right hand. The nodule developed rapidly over the course of 1 month and the patient denied trauma to the area or other lesions. What is the most likely diagnosis?	yes	18%	10%	43%	6%	23%	94215	0.085	754c696c9cfc2ffe3a0bd9ea663b1c55	[ "A: Basal-cell carcinoma", "B: Sporotrichosis", "C: Merkel-cell carcinoma", "D: Furuncle", "E: Pyogenic granuloma" ]	C: Merkel-cell carcinoma
783	nov-29-2007	Which one of following is typically associated with this finding?	no	8%	6%	33%	21%	32%	166175	0.125	2fd799d844bcd3e95d4b3880f94e97da	[ "A: Bulimia", "B: Recent endotracheal intubation", "C: Acquired immunodeficiency syndrome", "D: Treatment with a sulfonylurea", "E: Candida albicans infection" ]	E: Candida albicans infection
784	nov-29-2012	What is the most likely diagnosis?	no	4%	18%	12%	55%	11%	82202	0.053	32986a37345afcec8bb8994a285985af	[ "A: Pilonidal sinus", "B: Melanoma", "C: Molluscum contagiosum", "D: Keratoacanthoma", "E: Prurigo nodularis" ]	D: Keratoacanthoma
785	nov-29-2018	A 58-year-old man presented to an outpatient clinic with a 2-year history of progressive hoarseness and swelling on the left side of his neck. He worked as a farmer with no history of tobacco use. Physical examination was remarkable for nontender, compressible swelling in the left cervical region. What is the most like...	yes	15%	38%	18%	14%	14%	117105	0.096	1e64f1e2cdd5be61ccd16447bcc2600a	[ "A: Saccular cyst", "B: Laryngocele", "C: Thyroglossal cyst", "D: Scrofula", "E: Lymphadenopathy" ]	B: Laryngocele
786	nov-30-2006	What is the diagnosis?	no	8%	19%	58%	8%	8%	86229	0.046	5610fcf6ab20301806a08ee96e80c1b9	[ "A: Fabry's disease", "B: Hereditary hemorrhagic telangiectasia", "C: Peutz-Jeghers's syndrome", "D: Roseola", "E: Discoid lupus" ]	C: Peutz-Jeghers's syndrome
787	nov-30-2017	A 21-year-old woman with acute myeloid leukemia who was undergoing induction chemotherapy presented with a lesion on her left knee that had developed 5 days after initiation of therapy. Physical examination revealed a hemorrhagic patch with an erythematous border that progressed rapidly into a violaceous pustule. The p...	yes	6%	11%	5%	56%	21%	95176	0.051	ef658d2da1561dba5a953c4dbea89b62	[ "A: Cryoglobulinemia", "B: Necrotizing fasciitis", "C: Polyarteritis nodosa", "D: Ecthyma gangrenosum", "E: Pyoderma gangrenosum" ]	D: Ecthyma gangrenosum
788	nov-30-2023	A 53-year-old woman presented with a 3-month history of worsening vascular skin lesions and a 1-month history of fever.	yes	10%	10%	14%	15%	50%	23876	0.062	bcb08f1cf02651a5538748beb2bb4525	[ "A: Chronic lymphocytic leukemia", "B: Cutaneous small vessel vasculitis", "C: Idiopathic multicentric Castleman", "D: Intralymphatic histiocytosis", "E: Intravascular lymphoma" ]	E: Intravascular lymphoma
789	oct-01-2009	This patient had multiple myeloma. What diagnosis is suggested from this image of the axilla?	yes	16%	34%	5%	34%	11%	225045	0.118	767aaf3f524d4f066ca365d48ad9dff0	[ "A: Acanthosis nigricans", "B: Crusted scabies", "C: Erysipelas", "D: Malacoplakia", "E: Psoriasis" ]	B: Crusted scabies
790	oct-01-2015	Which one of the following is a typical step in the life cycle of ascaris as seen in this image?	yes	17%	43%	16%	18%	7%	103099	0.083	5334f35c04b5d5d28c9111f81b654d7a	[ "A: Eggs hatch in the large intestine", "B: Larvae penetrate the lungs", "C: Larvae develop into adult worms in the lungs", "D: Eggs hatch in the small intestine", "E: Larvae penetrate the perianal mucosal surface" ]	B: Larvae penetrate the lungs
791	oct-01-2020	A 46-year-old woman receiving atezolizumab for bladder cancer presented to the ophthalmology clinic with a 7-day history of pain, photophobia, and blurring of vision in both eyes. Slit-lamp examination showed conjunctival redness, pseudomembrane formation, and corneal epithelial damage. What is the diagnosis?	yes	38%	14%	22%	15%	11%	71380	0.097	011edcee20af357f1da91683f3140b35	[ "A: Autoimmune keratitis", "B: Herpes simplex virus", "C: Pseudomonas keratitis", "D: Acanthamoeba keratitis", "E: Bladder cancer metastases" ]	A: Autoimmune keratitis
792	oct-02-2008	This 8-year-old girl had a 2-year history of abdominal pain. What is the diagnosis?	yes	5%	38%	16%	17%	24%	128411	0.1	66072cbb5d4993ee9a2c80d3b8005541	[ "A: Crohn's disease", "B: Enteric duplication cyst", "C: Pancreatic pseudocyst", "D: Intestinal malrotation", "E: Wilms' tumor" ]	B: Enteric duplication cyst
793	oct-02-2014	What is the most likely diagnosis?	no	5%	8%	3%	76%	9%	73319	0.015	c32ed88986f79c947ac3ef9ff8f0188d	[ "A: Ankyloglossia", "B: Atrophic glossitis", "C: Creutzfeldt-Jakob disease", "D: Hypoglossal nerve palsy", "E: Motor neuron disease" ]	D: Hypoglossal nerve palsy
794	oct-03-2013	What is the diagnosis?	no	6%	7%	14%	58%	14%	87366	0.045	4369e6a77afb06cfa5091828d915ef56	[ "A: Chewing tobacco", "B: Implantation of amalgam", "C: Lead poisoning", "D: Melanoma", "E: Peutz-Jegher's syndrome" ]	D: Melanoma
795	oct-03-2019	A 65-year-old woman presented to the rheumatology service with complaints of progressive swelling in both hands and diffuse body pain. She had a history of lung transplantation 8 years earlier, and had received daily antifungal prophylaxis with voriconazole. On examination, there was prominent joint and soft-tissue swe...	yes	15%	18%	8%	46%	13%	68979	0.074	acd79971cc04669c6a85bd07f3b5af35	[ "A: Heterotopic ossification", "B: Post-transplant calcinosis cutis", "C: Malignant fibrous histiocytoma", "D: Voriconazole-induced periostitis", "E: Chronic graft versus host disease polyarthritis" ]	D: Voriconazole-induced periostitis
796	oct-04-2007	What is the diagnosis?	no	12%	8%	7%	8%	65%	92795	0.031	73ad3888c5d51e85eab7e3059f3cc03b	[ "A: Pancreatic pseudocyst", "B: Duodenal torsion", "C: Cholangiocarcinoma", "D: Gallbladder lipomatosis", "E: Emphysematous cholecystitis" ]	E: Emphysematous cholecystitis
797	oct-04-2012	Which one of the following medications is most likely to have led to this appearance?	yes	33%	35%	13%	8%	11%	102694	0.121	a5d5c5c4d9935f3b884d4b72f5ca150e	[ "A: Bicalutamide", "B: Clomiphene", "C: Glipizide", "D: Mesalamine", "E: Rifampin" ]	A: Bicalutamide
798	oct-04-2018	A 32-year-old man presented to the neurosurgery clinic with mild balance difficulties and hearing loss in the left ear. Evaluation of the patient's hearing revealed profound sensorineural loss on the left side and normal hearing on the right side. Magnetic resonance imaging of the brain performed after the administrati...	yes	7%	12%	21%	9%	51%	73952	0.062	82e925cc83ab5874f60ffca66e0c6f6f	[ "A: Multiple endocrine neoplasia type 1", "B: von Hippel-Lindau syndrome", "C: Neurofibromatosis type 1", "D: Li-Fraumeni syndrome", "E: Neurofibromatosis type 2" ]	E: Neurofibromatosis type 2
799	oct-05-2006	What is the diagnosis?	no	11%	15%	8%	5%	61%	92387	0.039	6163182332abe5226845a26fb689f27a	[ "A: Rocky mountain spotted fever", "B: Hand foot and mouth disease", "C: Infective endocarditis", "D: Psoriasis", "E: Secondary syphilis" ]	E: Secondary syphilis
800	oct-05-2017	A 59-year-old man with a remote history of melanoma presented to the dermatology clinic. He presented with lingual papillomas for many years, as well as multiple trichilemmomas on the face and chest, acral keratosis on the hands and feet, and macrocephaly. He also had a history of gastrointestinal polyps and a multinod...	yes	10%	46%	10%	15%	19%	113824	0.074	27f92b3a944d817fe76014bf59840a70	[ "A: Birt-Hogg Dube syndrome", "B: Cowden syndrome", "C: Tuberous sclerosis", "D: Peutz-Jeghers syndrome", "E: Hereditary mixed polyposis syndrome" ]	B: Cowden syndrome

701

may-29-2008

What is the diagnosis?

no

17%

13%

9%

41%

20%

135698

0.088

c5720a8b0b846c5521fb04ca7ef534e4

[ "A: Ludwig's angina", "B: Glossopharyngeal nerve palsy", "C: Pharyngeal gonorrhea", "D: Bilateral peritonsillar abscesses", "E: Infectious mononucleosis" ]

D: Bilateral peritonsillar abscesses

702

may-29-2014

What is the most likely diagnosis in this patient with cough?

yes

15%

21%

20%

36%

8%

84614

0.105

b9d856762787af56ff908308dc7063b9

[ "A: Aspergillosis", "B: Coccidioidomycosis", "C: Granuloma annulare", "D: Sarcoidosis", "E: Syphilis" ]

D: Sarcoidosis

703

may-30-2013

What is the cause of this patient's dyspnea?

yes

6%

17%

8%

58%

11%

81818

0.045

748db9eb1f302644282aa87f5614b81b

[ "A: Mitral stenosis", "B: Pneumonia", "C: Pneumothorax", "D: Pulmonary embolism", "E: Sarcoidosis" ]

D: Pulmonary embolism

704

may-30-2019

A 34-year-old man with a history of human immunodeficiency virus (HIV) infection presented to the emergency department with a 1-week history of headache, fever, and confusion. On physical examination, a large, ulcerative lesion was noted on his tongue (Panel A). The patient's CD4 count was 39 cells per cubic millimeter...

yes

7%

16%

49%

15%

14%

79627

0.067

6b8fcacaff4723da0409cfa57e776aae

[ "A: Sarcoidosis", "B: Lingual tuberculosis", "C: Disseminated coccidioidomycosis", "D: Disseminated aspergillosis", "E: B-cell lymphoma" ]

C: Disseminated coccidioidomycosis

705

may-31-2007

These lesions appeared spontaneously in a patient with untreated multiple myeloma. Coagulation studies were normal and platelet count was 80,000 per cubic millimeter. What is the diagnosis?

yes

21%

3%

51%

5%

129620

0.066

e285e2ff8cf2dbf798e00838fe184b74

[ "A: Orbital fracture", "B: Disseminated intravascular coagulation", "C: Tuberous sclerosis", "D: Amyloid purpura", "E: Horner's syndrome" ]

D: Amyloid purpura

706

may-31-2012

What is the most likely diagnosis?

no

31%

8%

5%

48%

107729

0.076

bde82b442603c01cb733016f81a2dcff

[ "A: Cat scratch disease", "B: Mumps", "C: Sarcoidosis", "D: Sjogren's syndrome", "E: Tuberculosis" ]

E: Tuberculosis

707

may-31-2018

A 44-year-old woman presented to the emergency department with acute chest pain after several months of progressive dyspnea. Her oxygen saturation was 92%, and she had diminished breath sounds on the right side. Chest CT revealed a large right-sided pneumothorax and diffuse, intraparenchymal pulmonary cysts. What is th...

yes

15%

14%

49%

7%

98721

0.065

4eb7dc52e593a1a765aef9a53890cf6b

[ "A: Cystic fibrosis", "B: Pneumocystis pneumonia", "C: Emphysema", "D: Lymphangioleiomyomatosis", "E: Sjögren’s syndrome" ]

D: Lymphangioleiomyomatosis

708

nov-01-2007

Which one of the following drugs of abuse is most typically associated with the illustrated complication?

yes

3%

7%

81%

4%

138895

0.009

8eb01bba69821c09fbda7058ae77b52f

[ "A: Ketamine", "B: Heroin", "C: Cocaine", "D: Phencyclidine", "E: Mescaline" ]

C: Cocaine

709

nov-01-2012

What is the diagnosis?

no

25%

21%

14%

23%

17%

104290

0.142

f13b03c8493ba04837c8b533711c1964

[ "A: Basilar artery aneurysm", "B: Central pontine myelinolysis", "C: Dandy-Walker malformation", "D: Glioma", "E: Pontine stroke" ]

A: Basilar artery aneurysm

710

nov-01-2018

A 39-year-old man presented to the emergency department with a 4-week history of abdominal pain and constipation. Physical examination of the abdomen was normal, but he was noted to have gray lines along the margins of his lower gum. What is the most likely diagnosis?

yes

13%

17%

8%

10%

53%

114980

0.057

7d083f57de870bcf2b02c9bc339fd63c

[ "A: Scurvy", "B: Bismuth poisoning", "C: Adults Still's disease", "D: Behçet's syndrome", "E: Lead poisoning" ]

E: Lead poisoning

711

nov-02-2006

What accounts for this patient's hand pain?

yes

21%

5%

61%

7%

5%

70173

0.041

12d88455b0a65ffdb4def4cea64721a3

[ "A: Ulnar artery occlusion", "B: Wrist fracture", "C: Radial artery thrombosis", "D: Carpal tunnel syndrome", "E: Reflex sympathetic dystrophy" ]

C: Radial artery thrombosis

712

nov-02-2017

A 58-year-old woman presented to the rheumatology clinic with long-standing joint pain and deformities of both hands and feet. What material has been used in acupuncture threading techniques for joint pain?

yes

17%

48%

11%

8%

15%

84461

0.068

2f187673454b015f2abe88e7f3eff27f

[ "A: Copper", "B: Gold", "C: Titanium", "D: Cobalt", "E: Silver nitrate" ]

B: Gold

713

nov-02-2023

A 38-year-old man with end-stage renal disease who was undergoing hemodialysis presented to the hospital with several years of progressive difficulty in walking. Four years before presentation, acute pain and swelling in both knees had developed after he had stepped off an auto rickshaw. At that time, he had opted for ...

yes

5%

7%

23%

5%

59%

19868

0.046

917b799a150babdb7f3e21824f0277c9

[ "A: Femoral nerve injuries", "B: Patellar stress fractures", "C: Patellar tendon ruptures", "D: Quadriceps strains", "E: Quadriceps tendon ruptures" ]

E: Quadriceps tendon ruptures

714

nov-03-2005

This radiograph was taken 12 minutes after infusion of intravenous contrast. What diagnosis is suggested?

yes

32%

20%

15%

5%

28%

88262

0.137

328de7be104eb4c8240523d2187420ef

[ "A: Left renal artery stenosis", "B: Right staghorn calculus", "C: Left hypernephroma", "D: Bladder carcinoma", "E: Right ureterovesical calculus" ]

E: Right ureterovesical calculus

715

nov-03-2011

What is the diagnosis in this infant who was born at term?

yes

4%

3%

4%

14%

75%

89405

0.017

0c7f06d1b5be254228bf19067188245d

[ "A: Bilateral cryptorchidism", "B: Congenital asplenia", "C: Congenital toxoplasmosis", "D: Neonatal epididymitis", "E: Retroperitoneal hemorrhage" ]

E: Retroperitoneal hemorrhage

716

nov-03-2016

A 68-year-old man presented with unilateral ptosis with no other symptoms. Application of an ice pack to the left eye improved his symptoms. What is the diagnosis?

yes

15%

53%

21%

4%

8%

120152

0.059

2b7908e14adfe8deea4cefc299ae9473

[ "A: Bell’s palsy", "B: Myasthenia gravis", "C: Benign essential blepharospasm", "D: Multiple sclerosis", "E: Myotonic dystrophy" ]

B: Myasthenia gravis

717

nov-03-2022

A 5-year-old boy from China with a history of IgA vasculitis at 2 years of age presented with a 1-month history of progressively painful skin ulcerations on his extremities. Two months prior, he had had an episode of nasal pustules that had not responded to antimicrobial therapy or surgical débridement, but had ultimat...

yes

13%

15%

9%

14%

48%

56303

0.068

57e3d7643f88914dce7e37001f5125bc

[ "A: Cutaneous leishmaniasis", "B: Cutaneous polyarteritis nodosa", "C: Cutaneous tuberculosis", "D: Ecthyma gangrenosum", "E: Pyoderma gangrenosum" ]

E: Pyoderma gangrenosum

718

nov-04-2010

What is the diagnosis?

no

32%

20%

4%

36%

7%

97195

0.112

0f320b9ed24aa002745d2737f1db412b

[ "A: Atrophic candidiasis", "B: Erythroplakia", "C: Lingual thyroid", "D: Median rhomboid glossitis", "E: Tertiary syphilis" ]

D: Median rhomboid glossitis

719

nov-04-2021

A 53-year-old woman presented with pain, swelling, and discoloration of her right fifth finger. Physical examination showed a demarcated, brightly erythematous plaque with a dusky center. What is the most likely diagnosis?

yes

13%

10%

19%

44%

15%

90485

0.08

b97ae3c17024717798a50f62c5513ae9

[ "A: Dactylitis", "B: Erythema multiforme", "C: Herpetic whitlow", "D: Spider bite", "E: Sporotrichosis" ]

D: Spider bite

720

nov-05-2009

What is the diagnosis?

no

48%

18%

17%

10%

7%

100116

0.069

9283dca8a12fe11ab338ffa0d3d00642

[ "A: Bowel infarction", "B: Crohn's disease", "C: Cystic fibrosis", "D: Echinococcosis", "E: Lead poisoning" ]

A: Bowel infarction

721

nov-05-2015

Which of the following choices is the least likely diagnosis for the sudden painless vision loss in this patient?

yes

14%

13%

16%

14%

44%

88058

0.079

0234ce6caa0a9674d140cb5569da751e

[ "A: Vitreous hemorrhage", "B: Retinal artery occlusion", "C: Retinal vein occlusion", "D: Occipital stroke", "E: Narrow angle glaucoma" ]

E: Narrow angle glaucoma

722

nov-05-2020

An 83-year-old man presented with food impaction after eating pork. He reported intermittent difficulty with swallowing ongoing for several months. An esophagogastroduodenoscopy was performed to relieve the obstruction. During the endoscopy, the duodenal mucosa was as shown. What is the diagnosis?

yes

11%

60%

10%

5%

15%

73463

0.041

bd4cc5c19b588567b13957898b801735

[ "A: Malignant melanoma", "B: Pseudomelanosis duodeni", "C: Hemochromatosis", "D: Chronic bowel ischemia", "E: Peutz-Jeghers syndrome" ]

B: Pseudomelanosis duodeni

723

nov-06-2008

What is the diagnosis?

no

24%

6%

14%

32%

24%

117102

0.12

eaea57e920bfaf1b16abc2c290b26336

[ "A: Angioid streaks", "B: Glaucoma", "C: Macular degeneration", "D: Ocular myiasis", "E: Pseudoxanthoma elasticum" ]

D: Ocular myiasis

724

nov-06-2014

What is the most likely underlying diagnosis in this 82-year-old patient with diabetes mellitus who had undergone a total hip replacement 10 years previously?

yes

20%

12%

29%

23%

15%

103196

0.163

45c0b5f4680bddce1a7e1504ab7524db

[ "A: Colon cancer", "B: Hypogammaglobulinemia", "C: Hypophosphatasia", "D: Osteosarcoma", "E: Tuberculosis" ]

A: Colon cancer

725

nov-07-2013

What are these crystals that were aspirated from the bursa of an elbow of a patient with rheumatoid arthritis?

yes

28%

13%

19%

24%

16%

187859

0.131

1ee5d956c4caa45f45da15d3be770a02

[ "A: Cholesterol", "B: Calcium apatite", "C: Calcium oxalate", "D: Calcium pyrophosphate dihydrate", "E: Monosodium urate" ]

A: Cholesterol

726

nov-07-2019

A 73-year-old woman presented to the dermatology clinic with a 9-month history of pruritic and painful lesions on the palms of her hands. Physical examination showed sharp demarcation of the folds in the lines of her hands, a velvety appearance of palmar surfaces, and ridging of the skin. What is the most likely diagno...

yes

16%

35%

11%

24%

14%

102944

0.107

de6d69c826041ceee480538ed9e9c08b

[ "A: Palmar psoriasis", "B: Tripe palms", "C: Acromegaly", "D: Palmoplantar keratoderma", "E: Tinea manuum" ]

B: Tripe palms

727

nov-08-2007

This 81-year-old woman presented with swelling and pain in the left foot a week after treatment for acute bronchitis. Which one of the following treatments is most likely to have been contributory?

yes

7%

9%

10%

6%

68%

95753

0.026

ab4795999ce849674c6a42d5e9c65796

[ "A: Beta-adrenergic agonist", "B: Cephalosporin antibiotic", "C: Leukotriene receptor antagonist", "D: Guaifenesin expectorant", "E: Fluoroquinolone antibiotic" ]

E: Fluoroquinolone antibiotic

728

nov-08-2012

What procedure was most recently performed on this patient?

yes

70%

7%

12%

6%

5%

69249

0.023

73916c26a8c4eefec2115e7a0fea7efd

[ "A: Mitral-valve repair", "B: Pancreatectomy", "C: Roux-en-Y gastric bypass", "D: Thyroidectomy", "E: Total hip replacement" ]

A: Mitral-valve repair

729

nov-08-2018

A 56-year-old woman with no significant past medical history presented to the emergency department with worsening shortness of breath over 8 months. She had no prior history of tobacco use. Physical examination was notable for bronchial breath sounds in both lungs with oxygen saturation of 93% on 3 liters of supplement...

yes

28%

22%

20%

19%

10%

169614

0.131

cc41e0166dd32677135ed1c2066d0ef5

[ "A: Non–small-cell lung cancer", "B: Sarcoidosis", "C: Langerhans cell histiocytosis", "D: Histoplasmosis", "E: Septic embolization" ]

A: Non–small-cell lung cancer

730

nov-09-2006

Treatment with what antibiotic is most likely to have resulted in this patient's skin changes?

yes

14%

30%

13%

31%

12%

107053

0.123

a9842621de284148e24ed9878310600f

[ "A: Rifampin", "B: Chloramphenicol", "C: Nitrofurantoin", "D: Minocycline", "E: Trimethoprim" ]

D: Minocycline

731

nov-09-2017

An 87-year-old woman with a history of peptic ulcer disease presented with severe abdominal pain. An examination showed hypotension and diffuse abdominal tenderness. Computed tomography of the abdomen revealed a classic sign of pneumoperitoneum outlining which ligament?

yes

14%

10%

14%

53%

9%

71028

0.056

bb7332bd8c7f73368a9d8ebed49d9874

[ "A: Round ligament of the liver", "B: Gastrohepatic ligament", "C: Ligament of Trietz", "D: Falciform ligament", "E: Hepatoduodenal ligament" ]

D: Falciform ligament

732

nov-09-2023

A 60-year-old woman with hypertension and chronic kidney disease of unknown cause was referred to the emergency department because of a serum creatinine level of 7.8 mg per deciliter (reference range, 0.5 to 0.9). She had been feeling well before presentation. A urinalysis showed 2+ protein and more than 180 red cells ...

yes

53%

11%

14%

9%

13%

18769

0.056

8a6b71bf51cacbcb109b9218e1c3ed96

[ "A: Chest imaging", "B: Echocardiogram", "C: Ophthalmologic exam", "D: Otorhinolaryngology evaluation", "E: Skin biopsy" ]

A: Chest imaging

733

nov-10-2005

What is the most important diagnosis to exclude in this 81-year-old woman?

yes

50%

30%

6%

3%

10%

69491

0.071

eded5fd24ca4c0293c656922c7c6de63

[ "A: Lentigo maligna", "B: Basal cell carcinoma", "C: Varicella zoster", "D: Systemic sclerosis", "E: Actinic keratosis" ]

A: Lentigo maligna

734

nov-10-2011

What is the diagnosis?

no

29%

16%

28%

13%

111658

0.132

b0ea122806c0af9ccfab9474b982b7e2

[ "A: Cholesteatoma", "B: Globus tympanicus", "C: Herpes zoster", "D: Otitis media", "E: Squamous-cell carcinoma" ]

C: Herpes zoster

735

nov-10-2016

A man presented with difficulty walking and urinary incontinence. On examination, his pupils were nonreactive to bright light but constricted when focusing on a near object. What is the diagnosis?

yes

13%

57%

15%

4%

11%

116908

0.048

4dda19aa8a9fa02b002a13233c709b74

[ "A: Multiple sclerosis", "B: Tabes dorsalis", "C: Parinaud's syndrome", "D: Sarcoidosis", "E: Horner’s syndrome" ]

B: Tabes dorsalis

736

nov-10-2022

A previously healthy 25-year-old man presented to the general medicine clinic with a 3-month history of worsening fatigue, nausea, and dry cough following administration of a folk remedy for tinea cruris. Laboratory studies showed a hemoglobin level of 6.5 g per deciliter (reference range, 12.0 to 16.0), and normal ren...

yes

66%

10%

9%

11%

5%

36384

0.03

a55ce186250727825758ea402b969556

[ "A: Chelation Therapy", "B: Exchange Transfusion", "C: Hemodialysis", "D: Plasma Exchange Therapy", "E: Therapeutic Phlebotomy" ]

A: Chelation Therapy

737

nov-11-2010

This 10-year-old presented with abdominal pain. What is the diagnosis?

yes

25%

43%

5%

21%

7%

96183

0.088

6e50e6955b1aaf6c99709d6d40758c9f

[ "A: Hirschsprung's disease", "B: Meckel's diverticulum", "C: Peptic ulceration", "D: Pyloric outlet obstruction", "E: Situs inversus" ]

B: Meckel's diverticulum

738

nov-11-2021

A 61-year-old woman presented with discoloration along her gums that had rapidly expanded over the past year. What is the diagnosis?

yes

9%

56%

11%

19%

6%

69108

0.051

8eb627ccbd5994a241d519d325b0614b

[ "A: Amalgam tattoo", "B: Gingival melanoma", "C: Kaposi’s sarcoma", "D: Oral melanoacanthoma", "E: Physiologic pigmentation" ]

B: Gingival melanoma

739

nov-12-2009

What is the diagnosis?

no

8%

61%

6%

19%

119165

0.04

fea8c7100790bb8e9d63084ca7e4c359

[ "A: Cellulitis", "B: Gout", "C: Osteoarthritis", "D: Rheumatoid arthritis", "E: Septic arthritis" ]

B: Gout

740

nov-12-2015

Which one of the following treatments is the treatment of choice for the ulcerated breast lesions seen in this image?

yes

16%

12%

39%

21%

11%

120263

0.094

6b1e16d68bef378cbcb014acc0e43c5f

[ "A: Radiation therapy", "B: Doxorubicin", "C: Penicillin", "D: Mastectomy", "E: Hydrocortisone cream" ]

C: Penicillin

741

nov-12-2020

A 3-day-old male infant presented to the hospital with vomiting and inability to pass stools. Physical exam revealed a distended abdomen without bowel sounds. Exploratory laparotomy was done. What is the diagnosis?

yes

10%

58%

13%

8%

11%

54831

0.044

c1253f48c8120e49306ab712d1d752f8

[ "A: Bowel obstruction", "B: Hirschsprung’s disease", "C: Toxic megacolon", "D: Meckel’s diverticulum", "E: Meconium ileus" ]

B: Hirschsprung’s disease

742

nov-13-2008

What diagnosis is suggested by this barium swallow?

yes

4%

9%

73%

5%

9%

107647

0.019

887b05e6cd73b2863e3f9a22a62de57e

[ "A: Ingested foreign body", "B: Esophageal diverticula", "C: Diffuse esophageal spasm", "D: Gastric linitis plastica", "E: Esophageal carcinoma" ]

C: Diffuse esophageal spasm

743

nov-13-2014

What is the most likely diagnosis?

no

16%

48%

18%

5%

14%

74969

0.07

b60b397aff52f1eb4ea225b2ab285fe0

[ "A: Achalasia", "B: Diffuse esophageal spasm", "C: Esophageal stricture", "D: Hiatal hernia", "E: Systemic sclerosis" ]

B: Diffuse esophageal spasm

744

nov-14-2013

What is the diagnosis?

no

3%

41%

10%

40%

6%

98765

0.109

6700bd888ea3e990c4386185e9f0cf30

[ "A: Chronic aortic dissection", "B: Cirrhosis", "C: Hypoplastic right heart syndrome", "D: Superior vena caval obstruction", "E: Transposition of the great vessels" ]

D: Superior vena caval obstruction

745

nov-14-2019

A previously healthy 22-year-old man presented with a 6-month history of palpitations and chest discomfort. He denied any dyspnea or syncope. On examination, a midsystolic click was heard at the cardiac apex. An image from a transthoracic echocardiogram is shown. What is the most likely diagnosis?

yes

14%

10%

48%

9%

19%

73472

0.069

84f5140b083c2dc378b94ff2ff399f79

[ "A: Infective endocarditis valvular vegetation", "B: Intracardiac helminth", "C: Redundant mitral valve", "D: Propagated valvular thrombus", "E: Papillary fibroelastoma" ]

C: Redundant mitral valve

746

nov-15-2007

What is the diagnosis?

no

57%

6%

13%

16%

7%

114205

0.047

49e3ceadc94586159b47243972d8739a

[ "A: Bezoar", "B: Pericardial effusion", "C: Pneumatosis coli", "D: Gastric carcinoma", "E: Pheochromocytoma" ]

A: Bezoar

747

nov-15-2012

What is the diagnosis?

no

20%

12%

4%

13%

51%

88975

0.063

3885714e9ec9fcaa73b4cfeef6530b6a

[ "A: Chlamydial cervicitis", "B: Endometriosis", "C: Mesonephric remnant", "D: Syphilitic chancre", "E: Squamous-cell carcinoma" ]

E: Squamous-cell carcinoma

748

nov-15-2018

A 72-year-old man presented to the emergency department with an 11-hour history of periumbilical abdominal pain and inability to pass flatus. The pulse was 155 beats per minute, and the blood pressure 83/52 mm Hg. On physical examination, his abdomen was diffusely tender, with the most severe pain in the right upper qu...

yes

10%

12%

55%

12%

11%

92292

0.051

ec018ea2ca89a2832a63eac84459b861

[ "A: Inflammatory bowel disease", "B: Colonoscopy", "C: Bowel ischemia", "D: Intra-abdominal abscess", "E: Peptic ulcer disease" ]

C: Bowel ischemia

749

nov-16-2006

What is the diagnosis?

no

29%

8%

6%

28%

88418

0.139

c5c57663c5b3d9c79dd12197a51a0923

[ "A: Pericardial hydatid cysts", "B: Diaphragmatic rupture", "C: Empyema thoracis", "D: Cystic fibrosis", "E: Pericardial metastases" ]

E: Pericardial metastases

750

nov-16-2017

A 7-year-old boy with a history of atopic dermatitis presented with a 3-month history of widespread, mildly pruritic papular skin rash. What is the likely diagnosis?

yes

57%

9%

18%

11%

6%

104407

0.048

d90015cd6ce5b9442d90acd0d2d0e1ff

[ "A: Molluscum contagiosum", "B: Pityriasis rosea", "C: Papular acrodermatitis", "D: Varicella zoster", "E: Neurofibromatosis" ]

A: Molluscum contagiosum

751

nov-16-2023

A 53-year-old man presented with a 3-year history of an itchy rash, Raynaud's phenomenon, dysphagia, and a burning sensation in his hands. Physical examination was notable for firm, greasy papules across his forehead that led to the formation of glabellar grooves (left). There were waxy papules on his hands, with assoc...

yes

21%

9%

16%

39%

16%

32129

0.095

44d77fc761a829ef8651eb7e7342b0a1

[ "A: Light chain (AL) amyloidosis", "B: Multiple myeloma", "C: Scleredema", "D: Scleromyxedema", "E: Systemic sclerosis" ]

D: Scleromyxedema

752

nov-17-2005

What is the diagnosis?

no

13%

12%

3%

68%

4%

75401

0.027

850e9c7b5342325ae3d51f7599da1845

[ "A: Budd chiari syndrome", "B: Cutaneous larva migrans", "C: Umbilical hernia", "D: Portal hypertension", "E: Gastric carcinoma" ]

D: Portal hypertension

753

nov-17-2011

What is the diagnosis?

no

4%

3%

10%

80%

3%

97011

0.011

9791267de4a1bb25bd6f3a85b3ef4cc2

[ "A: Klippel-Trénaunay-Weber syndrome", "B: McCune-Albright syndrome", "C: Multiple lipomatosis", "D: Neurofibromatosis", "E: Proteus syndrome" ]

D: Neurofibromatosis

754

nov-17-2016

An 81-year-old woman presented with a 1-week history of vomiting. What is the diagnosis?

yes

3%

19%

12%

60%

6%

88350

0.043

71721217e8367ef6d044881044224cf5

[ "A: Lung abscess", "B: Perforated duodenal ulcer", "C: Epiphrenic diverticulum", "D: Paraesophageal hernia", "E: Esophageal duplication cyst" ]

D: Paraesophageal hernia

755

nov-17-2022

A 45-year-old woman presented with a 6-week history of a painless upper-lip lesion. The lesion had rapidly increased in size over the previous 3 weeks and bled when lightly touched. Examination showed an erythematous, round, smooth, pedunculated mass that was friable and non-tender. What is the most likely diagnosis?

yes

13%

21%

10%

37%

19%

65764

0.101

a898cb41b5a12f5a47ad0d5bb555e9b3

[ "A: Arteriovenous malformation", "B: Cherry hemangioma", "C: Malignant melanoma", "D: Pyogenic granuloma", "E: Strawberry hemangioma" ]

D: Pyogenic granuloma

756

nov-18-2010

What is the diagnosis?

no

22%

31%

10%

35%

2%

110944

0.115

9a9d5f5fc6aeee2a97de315f435852b6

[ "A: Meningioma", "B: Osteitis fibrosa cystica", "C: Paget's disease", "D: Plasmacytoma", "E: Thalassemia" ]

D: Plasmacytoma

757

nov-18-2021

A 50-year-old woman with a history of Crohn’s disease presented with 10 days of tongue and inner cheek pain. Laboratory studies showed an absolute eosinophil count of 870 per cubic millimeter (reference range, 50 to 500). What is the most likely diagnosis?

yes

13%

17%

13%

14%

43%

84948

0.081

50edab405b326fa98e5564c998406a51

[ "A: Herpes simplex gingivostomatitis", "B: Herpetic geometric glossitis", "C: Lichen planus", "D: Oral candidiasis", "E: Pyostomatitis vegetans" ]

E: Pyostomatitis vegetans

758

nov-19-2009

What is the diagnosis?

no

12%

38%

12%

26%

122527

0.099

485fd4ec755ae6b7b61e734d8f189891

[ "A: Amebic liver abscess", "B: Diffuse biloma", "C: Echinococcosis", "D: Hepatocellular carcinoma", "E: Polycystic liver disease" ]

C: Echinococcosis

759

nov-19-2015

What is the most likely diagnosis associated with symptoms of pruritic skin changes seen in these images?

yes

46%

19%

11%

9%

15%

104276

0.074

5c07907fce04fe0c7d1f3edb500cb281

[ "A: Malignancy", "B: Psoriasis", "C: Inflammatory bowel disease", "D: Acute hepatitis C infection", "E: Cutaneous sarcoidosis" ]

A: Malignancy

760

nov-19-2020

A 29-year-old male presented with a 6-month history of progressive painless skin lesions over his face, back, trunk, and limbs. He had no systemic symptoms such as night sweats or weight loss. Skin biopsy showed diffuse dermal infiltrate with blast-like cells extending to the hypodermis. Immunohistochemical analysis sh...

yes

4%

3%

47%

34%

11%

123467

0.082

e5bcdf04d9f1fb5981d24bf0e9ca226f

[ "A: Lichen planus", "B: Pustular psoriasis", "C: Blastic plasmacytoid dendritic-cell neoplasm", "D: Cutaneous lymphoblastic T-cell lymphoma", "E: Subacute cutaneous lupus erythematosus" ]

C: Blastic plasmacytoid dendritic-cell neoplasm

761

nov-20-2014

What is the diagnosis?

no

4%

6%

2%

73%

15%

65689

0.02

a1da434d5fc2bb0086b97909e2995fc1

[ "A: Adrenal carcinoma", "B: Autosplenectomy", "C: Diverticular abscess", "D: Emphysematous pyelonephritis", "E: Renal vein thrombosis" ]

D: Emphysematous pyelonephritis

762

nov-21-2013

What is the diagnosis in this patient who had presented with a sore throat?

yes

3%

24%

23%

17%

33%

86469

0.118

625d45d1162ecfbeb43554f4f3417c59

[ "A: Acne", "B: Discoid lupus", "C: Impetigo", "D: Mastocytosis", "E: Syphilis" ]

E: Syphilis

763

nov-21-2019

A 6-month-old girl was referred to the hospital for evaluation and treatment of a perirectal mass which had first been noted at 2 weeks of age. Physical examination showed frontal bossing but no rash, hepatosplenomegaly, lymphadenopathy, or limitation of limb movement. A lateral radiograph of the right tibia showed sev...

yes

11%

5%

18%

45%

20%

75959

0.078

1a0168ef28da211af3214bc1f63ad6ea

[ "A: Infantile hemangioma", "B: Imperforate hymen", "C: Perianal hamartomatous polyps", "D: Congenital syphilis", "E: Perianal rhabdomyosarcoma" ]

D: Congenital syphilis

764

nov-22-2007

What diagnosis is suggested by the findings on this anteroposterior radiograph of the right tibia?

yes

14%

23%

17%

30%

17%

173014

0.152

44fda10c8de9b03453854f8bacb45fe1

[ "A: Ewing's sarcoma", "B: Marrow hyperplasia", "C: Osteomalacia", "D: Polyostotic fibrous dysplasia", "E: Osteopetrosis" ]

B: Marrow hyperplasia

765

nov-22-2012

What is the most likely diagnosis?

no

64%

6%

14%

7%

9%

70797

0.033

f77fa2161d60cd765364e6b9577f9f3e

[ "A: Hairy-cell leukemia", "B: Hodgkin's lymphoma", "C: Infectious mononucleosis", "D: Multiple myeloma", "E: Pernicious anemia" ]

A: Hairy-cell leukemia

766

nov-22-2018

The following is a cast of what anatomical structure?

yes

8%

23%

4%

9%

56%

89523

0.053

385c1d7a09f7cc275e07a653fbae5584

[ "A: Portal vein", "B: Left bronchial tree", "C: Femoral vein", "D: Hepatic artery", "E: Right bronchial tree" ]

E: Right bronchial tree

767

nov-23-2006

This patient presented with severe jaw pain while being treated for osteoporosis. What is the diagnosis?

yes

15%

45%

11%

17%

12%

94313

0.076

21dfa58f65faf338c1a9435cdf587570

[ "A: Submandibular abscess", "B: Osteonecrosis", "C: Behcet's disease", "D: Accessory tooth", "E: Calciphylaxis" ]

B: Osteonecrosis

768

nov-23-2017

A 67-year-old man presented with progressive dysphagia, weight loss, regurgitation, and halitosis. A barium swallow examination showed stasis of barium in the upper esophagus with an outpouching lesion anterior to the C5 and C6 vertebrae. Upper gastrointestinal endoscopy revealed a Zenker’s diverticulum. These divertic...

yes

10%

37%

9%

27%

17%

80870

0.103

cc42040e8ffbefb00e2886505cd9eb45

[ "A: Thyrohyoid membrane", "B: Killian’s triangle", "C: Laimer’s triangle", "D: Killian-Jamieson’s triangle", "E: Cricothyroid membrane" ]

B: Killian’s triangle

769

nov-23-2023

A 69-year-old woman with a history of asbestos exposure presented to the emergency department with a 3-year history of dyspnea on exertion. Physical examination showed signs of volume overload. A chest radiograph showed circumferential calcification of the pericardium and pleural effusions. Simultaneous left and right ...

yes

8%

52%

15%

14%

11%

18203

0.058

16efeec1d085af5b7d22140339ea9519

[ "A: Cardiac Tamponade", "B: Constrictive Pericarditis", "C: Effusive-Constrictive Pericarditis", "D: Primary Pericardial Mesothelioma", "E: Restrictive Cardiomyopathy" ]

B: Constrictive Pericarditis

770

nov-24-2005

This 61-year-old man is receiving care for an arrhythmia. What is the cause of his appearance?

yes

10%

7%

69%

4%

10%

62655

0.025

8bf3fafeac09d882e6d3d866de1a77e4

[ "A: Procainemide", "B: Bretylium", "C: Amiodarone", "D: Sotalol", "E: Hydralazine" ]

C: Amiodarone

771

nov-24-2011

This patient presented with a 1-day history of fever, acute painful symmetric polyarthritis, abdominal pain, and hematemesis. What is the diagnosis?

yes

7%

49%

16%

8%

21%

92286

0.068

f8123368c6e12f309443616cd7453c35

[ "A: Bacterial endocarditis", "B: Henoch-Schönlein purpura", "C: Purpura fulminans", "D: Rheumatic fever", "E: Rocky Mountain spotted fever" ]

B: Henoch-Schönlein purpura

772

nov-24-2016

A 44-year-old man with a history of quadriplegia presented to the emergency department with symptoms of a urinary tract infection. What is the diagnosis?

yes

19%

67%

6%

2%

71312

0.031

0a1d7badd5f18c6edb777b9c394d31a6

[ "A: Bladder perforation", "B: Neurogenic megacolon", "C: Chronic constipation", "D: Gastric distention", "E: Ulcerative colitis" ]

B: Neurogenic megacolon

773

nov-24-2022

A 70-year-old woman with depression and irritable bowel syndrome presented to the emergency department with a 3-day history of altered mental status, shortness of breath, nausea, and vomiting. She had recently been self-medicating worsening irritable bowel symptoms. Physical examination was notable for a respiratory ra...

yes

52%

15%

8%

14%

11%

36977

0.058

d4de1128aafc354cbb8675c9268f39d5

[ "A: Bismuth Salicylate", "B: Calcium Carbonate", "C: Ferrous Sulfate", "D: Magnesium hydroxide", "E: Simethicone" ]

A: Bismuth Salicylate

774

nov-25-2010

A 65-year-old man presented with skin lesions six weeks after returning from a vacation in Belize at the beach and in the rain forest. What is the diagnosis?

yes

45%

32%

9%

2%

12%

101078

0.086

1f0d7fd090ef899ddca625520c6da6a7

[ "A: Bot fly", "B: Cutaneous leishmaniasis", "C: Onchocerciasis", "D: Plague", "E: Tungiasis" ]

A: Bot fly

775

nov-25-2021

A 38-year-old man presented to the otolaryngology clinic with chronic difficulty breathing through his right nostril. Physical examination showed nasal septal deviation, calcified septal spurs, and a 2-cm perforation in the posterior septum. On rhinoscopy, a hard, nontender, white mass was observed in the floor of the ...

yes

9%

8%

10%

63%

37566

0.034

87209c081888075ce2be59a2396dca4d

[ "A: Calcified polyp", "B: Enchondroma", "C: Osteoma", "D: Rhinolith", "E: Tooth" ]

E: Tooth

776

nov-26-2009

The appearance of this foot is most consistent with which one of the following diagnoses?

yes

6%

49%

13%

21%

11%

121493

0.067

67b0c2f9949be1114c36ffb0a9776f66

[ "A: Buruli ulcer", "B: Chromoblastomycosis", "C: Leishmaniasis", "D: Madura foot", "E: Swimming pool granuloma" ]

B: Chromoblastomycosis

777

nov-26-2015

What is the most likely diagnosis associated with fever and jaundice and these image findings?

yes

15%

5%

3%

23%

54%

74615

0.058

8ba7cc752eead1be11187493ccef551f

[ "A: Pancreatitis", "B: Pyelonephritis", "C: Pericarditis", "D: Pancreatic malignancy", "E: Pylephlebitis" ]

E: Pylephlebitis

778

nov-26-2020

A 62-year-old man with chronic obstructive pulmonary disease presented to the emergency department with a 2-day history of dyspnea. He required intubation and ventilation when he was found to be in hypercapnic respiratory failure. Five days after admission to the ICU, his urine became green. Which of the following medi...

yes

8%

11%

20%

49%

11%

89831

0.066

60bc0a593014399f495667fae4c3bc3b

[ "A: Omeprazole", "B: Morphine sulfate", "C: Ipratropium bromide", "D: Propofol", "E: Midazolam" ]

D: Propofol

779

nov-27-2008

This patient with chronic alcoholism presented with dysarthria and horizontal nystagmus. What is the diagnosis?

yes

17%

50%

5%

21%

7%

126310

0.066

dd458195f8b725f134b3deb348b0db27

[ "A: Brainstem glioma", "B: Central pontine myelinolysis", "C: Neurosarcoidosis", "D: Pontine stroke", "E: Tabes dorsalis" ]

B: Central pontine myelinolysis

780

nov-27-2014

What is the diagnosis in this 52-year-old man with epigastric pain?

yes

13%

5%

67%

8%

7%

69512

0.028

1ae32b997f1d52fe4a3294261ee5e2bd

[ "A: Bezoar", "B: Diverticulitis", "C: Intussusception", "D: Mesenteric infarction", "E: Pseudomembranous colitis" ]

C: Intussusception

781

nov-28-2013

What is the most likely diagnosis?

no

59%

7%

6%

22%

68673

0.046

a3da004a0ce490946f709bab2d66ccf4

[ "A: Alopecia areata", "B: Androgenetic alopecia", "C: Telogen effluvium", "D: Tinea capitis", "E: Trichotillomania" ]

A: Alopecia areata

782

nov-28-2019

An 84-year-old woman presented with a painless red nodule over the base of the fourth finger on her right hand. The nodule developed rapidly over the course of 1 month and the patient denied trauma to the area or other lesions. What is the most likely diagnosis?

yes

18%

10%

43%

6%

23%

94215

0.085

754c696c9cfc2ffe3a0bd9ea663b1c55

[ "A: Basal-cell carcinoma", "B: Sporotrichosis", "C: Merkel-cell carcinoma", "D: Furuncle", "E: Pyogenic granuloma" ]

C: Merkel-cell carcinoma

783

nov-29-2007

Which one of following is typically associated with this finding?

no

8%

6%

33%

21%

32%

166175

0.125

2fd799d844bcd3e95d4b3880f94e97da

[ "A: Bulimia", "B: Recent endotracheal intubation", "C: Acquired immunodeficiency syndrome", "D: Treatment with a sulfonylurea", "E: Candida albicans infection" ]

E: Candida albicans infection

784

nov-29-2012

What is the most likely diagnosis?

no

4%

18%

12%

55%

11%

82202

0.053

32986a37345afcec8bb8994a285985af

[ "A: Pilonidal sinus", "B: Melanoma", "C: Molluscum contagiosum", "D: Keratoacanthoma", "E: Prurigo nodularis" ]

D: Keratoacanthoma

785

nov-29-2018

A 58-year-old man presented to an outpatient clinic with a 2-year history of progressive hoarseness and swelling on the left side of his neck. He worked as a farmer with no history of tobacco use. Physical examination was remarkable for nontender, compressible swelling in the left cervical region. What is the most like...

yes

15%

38%

18%

14%

117105

0.096

1e64f1e2cdd5be61ccd16447bcc2600a

[ "A: Saccular cyst", "B: Laryngocele", "C: Thyroglossal cyst", "D: Scrofula", "E: Lymphadenopathy" ]

B: Laryngocele

786

nov-30-2006

What is the diagnosis?

no

8%

19%

58%

8%

86229

0.046

5610fcf6ab20301806a08ee96e80c1b9

[ "A: Fabry's disease", "B: Hereditary hemorrhagic telangiectasia", "C: Peutz-Jeghers's syndrome", "D: Roseola", "E: Discoid lupus" ]

C: Peutz-Jeghers's syndrome

787

nov-30-2017

A 21-year-old woman with acute myeloid leukemia who was undergoing induction chemotherapy presented with a lesion on her left knee that had developed 5 days after initiation of therapy. Physical examination revealed a hemorrhagic patch with an erythematous border that progressed rapidly into a violaceous pustule. The p...

yes

6%

11%

5%

56%

21%

95176

0.051

ef658d2da1561dba5a953c4dbea89b62

[ "A: Cryoglobulinemia", "B: Necrotizing fasciitis", "C: Polyarteritis nodosa", "D: Ecthyma gangrenosum", "E: Pyoderma gangrenosum" ]

D: Ecthyma gangrenosum

788

nov-30-2023

A 53-year-old woman presented with a 3-month history of worsening vascular skin lesions and a 1-month history of fever.

yes

10%

14%

15%

50%

23876

0.062

bcb08f1cf02651a5538748beb2bb4525

[ "A: Chronic lymphocytic leukemia", "B: Cutaneous small vessel vasculitis", "C: Idiopathic multicentric Castleman", "D: Intralymphatic histiocytosis", "E: Intravascular lymphoma" ]

E: Intravascular lymphoma

789

oct-01-2009

This patient had multiple myeloma. What diagnosis is suggested from this image of the axilla?

yes

16%

34%

5%

34%

11%

225045

0.118

767aaf3f524d4f066ca365d48ad9dff0

[ "A: Acanthosis nigricans", "B: Crusted scabies", "C: Erysipelas", "D: Malacoplakia", "E: Psoriasis" ]

B: Crusted scabies

790

oct-01-2015

Which one of the following is a typical step in the life cycle of ascaris as seen in this image?

yes

17%

43%

16%

18%

7%

103099

0.083

5334f35c04b5d5d28c9111f81b654d7a

[ "A: Eggs hatch in the large intestine", "B: Larvae penetrate the lungs", "C: Larvae develop into adult worms in the lungs", "D: Eggs hatch in the small intestine", "E: Larvae penetrate the perianal mucosal surface" ]

B: Larvae penetrate the lungs

791

oct-01-2020

A 46-year-old woman receiving atezolizumab for bladder cancer presented to the ophthalmology clinic with a 7-day history of pain, photophobia, and blurring of vision in both eyes. Slit-lamp examination showed conjunctival redness, pseudomembrane formation, and corneal epithelial damage. What is the diagnosis?

yes

38%

14%

22%

15%

11%

71380

0.097

011edcee20af357f1da91683f3140b35

[ "A: Autoimmune keratitis", "B: Herpes simplex virus", "C: Pseudomonas keratitis", "D: Acanthamoeba keratitis", "E: Bladder cancer metastases" ]

A: Autoimmune keratitis

792

oct-02-2008

This 8-year-old girl had a 2-year history of abdominal pain. What is the diagnosis?

yes

5%

38%

16%

17%

24%

128411

0.1

66072cbb5d4993ee9a2c80d3b8005541

[ "A: Crohn's disease", "B: Enteric duplication cyst", "C: Pancreatic pseudocyst", "D: Intestinal malrotation", "E: Wilms' tumor" ]

B: Enteric duplication cyst

793

oct-02-2014

What is the most likely diagnosis?

no

5%

8%

3%

76%

9%

73319

0.015

c32ed88986f79c947ac3ef9ff8f0188d

[ "A: Ankyloglossia", "B: Atrophic glossitis", "C: Creutzfeldt-Jakob disease", "D: Hypoglossal nerve palsy", "E: Motor neuron disease" ]

D: Hypoglossal nerve palsy

794

oct-03-2013

What is the diagnosis?

no

6%

7%

14%

58%

14%

87366

0.045

4369e6a77afb06cfa5091828d915ef56

[ "A: Chewing tobacco", "B: Implantation of amalgam", "C: Lead poisoning", "D: Melanoma", "E: Peutz-Jegher's syndrome" ]

D: Melanoma

795

oct-03-2019

A 65-year-old woman presented to the rheumatology service with complaints of progressive swelling in both hands and diffuse body pain. She had a history of lung transplantation 8 years earlier, and had received daily antifungal prophylaxis with voriconazole. On examination, there was prominent joint and soft-tissue swe...

yes

15%

18%

8%

46%

13%

68979

0.074

acd79971cc04669c6a85bd07f3b5af35

[ "A: Heterotopic ossification", "B: Post-transplant calcinosis cutis", "C: Malignant fibrous histiocytoma", "D: Voriconazole-induced periostitis", "E: Chronic graft versus host disease polyarthritis" ]

D: Voriconazole-induced periostitis

796

oct-04-2007

What is the diagnosis?

no

12%

8%

7%

8%

65%

92795

0.031

73ad3888c5d51e85eab7e3059f3cc03b

[ "A: Pancreatic pseudocyst", "B: Duodenal torsion", "C: Cholangiocarcinoma", "D: Gallbladder lipomatosis", "E: Emphysematous cholecystitis" ]

E: Emphysematous cholecystitis

797

oct-04-2012

Which one of the following medications is most likely to have led to this appearance?

yes

33%

35%

13%

8%

11%

102694

0.121

a5d5c5c4d9935f3b884d4b72f5ca150e

[ "A: Bicalutamide", "B: Clomiphene", "C: Glipizide", "D: Mesalamine", "E: Rifampin" ]

A: Bicalutamide

798

oct-04-2018

A 32-year-old man presented to the neurosurgery clinic with mild balance difficulties and hearing loss in the left ear. Evaluation of the patient's hearing revealed profound sensorineural loss on the left side and normal hearing on the right side. Magnetic resonance imaging of the brain performed after the administrati...

yes

7%

12%

21%

9%

51%

73952

0.062

82e925cc83ab5874f60ffca66e0c6f6f

[ "A: Multiple endocrine neoplasia type 1", "B: von Hippel-Lindau syndrome", "C: Neurofibromatosis type 1", "D: Li-Fraumeni syndrome", "E: Neurofibromatosis type 2" ]

E: Neurofibromatosis type 2

799

oct-05-2006

What is the diagnosis?

no

11%

15%

8%

5%

61%

92387

0.039

6163182332abe5226845a26fb689f27a

[ "A: Rocky mountain spotted fever", "B: Hand foot and mouth disease", "C: Infective endocarditis", "D: Psoriasis", "E: Secondary syphilis" ]

E: Secondary syphilis

800

oct-05-2017

A 59-year-old man with a remote history of melanoma presented to the dermatology clinic. He presented with lingual papillomas for many years, as well as multiple trichilemmomas on the face and chest, acral keratosis on the hands and feet, and macrocephaly. He also had a history of gastrointestinal polyps and a multinod...

yes

10%

46%

10%

15%

19%

113824

0.074

27f92b3a944d817fe76014bf59840a70

[ "A: Birt-Hogg Dube syndrome", "B: Cowden syndrome", "C: Tuberous sclerosis", "D: Peutz-Jeghers syndrome", "E: Hereditary mixed polyposis syndrome" ]

B: Cowden syndrome