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

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801	oct-05-2023	A 72-year-old man presented to the emergency department with a 2-day history of an itchy rash on his back. On physical examination, edematous, flagellate plaques and linear patches were present across the patient’s entire back and upper buttocks. There was no adenopathy, dermographism, or mucosal involvement. What subs...	yes	13%	19%	41%	19%	8%	66216	0.089	978d8abec2e6e6022f48531cbda3854c	[ "A: Phenytoin", "B: Shellfish", "C: Shiitake mushrooms", "D: Toxicodendron radicans (poison ivy)", "E: Warfarin" ]	C: Shiitake mushrooms
802	oct-06-2011	This patient was being treated by an endocrinologist for which one of the following conditions?	yes	10%	14%	35%	15%	25%	111047	0.107	0925137cf31e2451270ab57e9fe8e4c9	[ "A: Acromegaly", "B: Cushing's disease", "C: Graves' disease", "D: Hashimoto's thyroiditis", "E: Type 1 diabetes" ]	C: Graves' disease
803	oct-06-2016	A 60-year-old man presented with abdominal pain, hypotension, and deranged renal function. What is the diagnosis?	yes	15%	61%	2%	8%	14%	92697	0.04	36f755ebdee052a3fd70916f598cf7d8	[ "A: Pseudomembranous colitis", "B: Acute mesenteric ischemia", "C: Diverticulitis", "D: Ulcerative colitis", "E: Pseudomelanosis coli" ]	B: Acute mesenteric ischemia
804	oct-06-2022	A 34-year-old woman presented with a 3-year history of changes in skin color. Examination was notable for hypopigmented macules on a background of hyperpigmentation, creating a raindrop-like appearance on the chest and back. Neighbors who drank water from the same well had similar skin changes. What is the most likely ...	yes	38%	15%	15%	16%	15%	50306	0.096	a3db5d37738ab75fae98bfdf4242d281	[ "A: Arsenic toxicity", "B: Cadmium toxicity", "C: Copper toxicity", "D: Lead toxicity", "E: Mercury toxicity" ]	A: Arsenic toxicity
805	oct-07-2010	What is the diagnosis?	no	4%	8%	6%	70%	11%	78345	0.023	9f0606b348711510911992eab1c91b8d	[ "A: Achondroplasia", "B: Ankylosing spondylitis", "C: Osteogenesis imperfecta", "D: Pectus excavatum", "E: Pneumothorax" ]	D: Pectus excavatum
806	oct-07-2021	A 80-year-old man undergoing treatment for multiple myeloma presented with fevers and confusion. Magnetic resonance imaging (MRI) of the head showed ring-enhancing lesions. Gram stain of cerebrospinal fluid (CSF) showed gram-positive bacilli. What is the most likely diagnosis?	yes	13%	22%	45%	11%	8%	58937	0.077	7e8859e8852e7433740ee153111ff60c	[ "A: Clostridium septicum", "B: Listeriosis", "C: Nocardiosis", "D: Peptostreptococcus species", "E: Propionibacterium acnes" ]	C: Nocardiosis
807	oct-08-2009	This appearance was noticed during routine colonoscopy. What is the diagnosis?	yes	8%	23%	42%	14%	14%	130078	0.087	519a43ce81dc542468236627ddda5433	[ "A: Addison's disease", "B: Hemochromatosis", "C: Laxative use", "D: Metastatic melanoma", "E: von Hippel-Lindau disease" ]	C: Laxative use
808	oct-08-2015	Which one of the following is the least likely cause of this patient’s symptoms of retrobulbar swelling and diplopia?	yes	49%	8%	18%	12%	13%	115706	0.066	6a4cfbbf289678257e10b6151c06c370	[ "A: Dermatomyositis", "B: Cancer", "C: Oral contraceptive use", "D: Facial trauma", "E: Sinusitis" ]	A: Dermatomyositis
809	oct-08-2020	A 53-year-old woman with metastatic signet-ring appendiceal cancer receiving treatment with panitumumab presents with a 2-month history of trichomegaly. What is the cause of this physical examination finding?	yes	14%	4%	21%	10%	51%	74640	0.063	567a463debca6f9112031eeaf72c196e	[ "A: Cornelia de Lange syndrome", "B: Dermatomyositis", "C: Cytokine immunotherapy", "D: Familial trichomegaly", "E: EGFR inhibition" ]	E: EGFR inhibition
810	oct-09-2008	What is the diagnosis?	no	17%	5%	71%	2%	5%	115918	0.024	2ad4b48b8c54f9ad79c37f34ff742705	[ "A: Amelanotic melanoma", "B: Cicatricial pemphigoid", "C: Keratoacanthoma", "D: Hidrocystoma", "E: Papular mucinosis" ]	C: Keratoacanthoma
811	oct-09-2014	What is the diagnosis?	no	13%	23%	4%	4%	56%	99671	0.053	a5041dc9121d841588afca43263b2a6e	[ "A: Erythema chronicum migrans", "B: Granuloma annulare", "C: Pityriasis rosea", "D: Sarcoidosis", "E: Tinea circinata" ]	E: Tinea circinata
812	oct-10-2013	What is the diagnosis in this patient who appeared sick, had a bull neck, and was tachycardic?	yes	55%	7%	14%	4%	20%	81297	0.054	ec83d86f8046bb0286c9377c0a365b7d	[ "A: Diphtheria", "B: Epiglottitis", "C: Infectious mononucleosis", "D: Rheumatic fever", "E: Streptococcal pharyngitis" ]	A: Diphtheria
813	oct-10-2019	A 64-year-old man presented to the oral medicine clinic with a painful, smooth, red tongue and a burning sensation around his lips that had developed 6 months earlier. No deficits were found on neurologic examination. What is the most likely diagnosis?	yes	14%	10%	8%	57%	12%	81313	0.047	bc389086a130ba70b9a9441c6a8f4297	[ "A: Oral lichen planus", "B: Sjögren's syndrome", "C: Squamous-cell carcinoma of the tongue", "D: Pernicious anemia", "E: Amyloidosis" ]	D: Pernicious anemia
814	oct-11-2007	What is the diagnosis?	no	34%	19%	28%	11%	9%	137019	0.174	c9b92a67a6cd0d99ecf1c144fab177fa	[ "A: Cholangiocarcinoma", "B: Cirrhosis", "C: Echinococcosis", "D: Hepatocellular carcinoma", "E: Tuberculosis" ]	B: Cirrhosis
815	oct-11-2012	What is the most likely diagnosis?	no	43%	18%	8%	14%	17%	88263	0.082	fd1ffe8436d9583e1630e1652f001a65	[ "A: Angioedema", "B: Facial palsy", "C: Frey's syndrome", "D: Parotid adenoma", "E: Parotitis" ]	A: Angioedema
816	oct-11-2018	A 42-year-old man who was undergoing treatment for non-Hodgkin’s lymphoma presented to the oncology clinic with changes in his fingernails. Five months earlier, he had presented with gastric-outlet obstruction and had received a diagnosis of high-grade B-cell non-Hodgkin’s lymphoma. What is the most likely underlying c...	yes	49%	17%	7%	12%	14%	102483	0.066	fcd1de0e2e98d048424f164625075eda	[ "A: Chemotherapy", "B: Paraneoplastic syndrome", "C: Metastatic disease of the nail bed", "D: Hepatic dysfunction", "E: Tetracycline" ]	A: Chemotherapy
817	oct-12-2006	An elderly woman presented with abdominal pain and vomiting for three days. A computed tomogram of the abdomen was obtained. What is the diagnosis?	yes	24%	14%	11%	41%	9%	74713	0.089	4a6869311150c033f90a322942ab9600	[ "A: Cecal volvulus", "B: Intussusception", "C: Mesenteric ischemia", "D: Obturator hernia", "E: Ovarian cancer" ]	D: Obturator hernia
818	oct-12-2017	A 61-year-old woman with hypertension and hypothyroidism presented with acute onset of severe chest pain after the death of her dog. Electrocardiography showed ST-segment elevation in anterolateral leads, and left ventriculography showed severe apical hypokinesis. What is the likely diagnosis?	yes	5%	7%	17%	5%	65%	64701	0.032	da254f2ad7ed8525402dd230fb691183	[ "A: Acute coronary syndrome", "B: Myocardial infarction", "C: Ventricular aneurysm", "D: Thyrotoxic cardiomyopathy", "E: Takotsubo cardiomyopathy" ]	E: Takotsubo cardiomyopathy
819	oct-12-2023	A 44-year-old man with diabetes and end-stage kidney disease presented with a 2-week history of pain and blurry vision in his left eye, fevers, and back pain. An ophthalmologic examination was notable for conjunctival injection and corneal clouding in the left eye. Visual acuity was 20/60 in the right eye and was reduc...	yes	55%	10%	15%	12%	8%	27423	0.051	3018cf15b2b0afc861b77e76da5e447c	[ "A: Intravitreal antimicrobial injections", "B: Intravitreal steroid injection", "C: Removal of intraocular lens", "D: Topical antimicrobial drops", "E: Topicals steroid drops" ]	A: Intravitreal antimicrobial injections
820	oct-13-2005	What is the diagnosis?	no	13%	34%	13%	25%	16%	65998	0.148	5f5455f1bbc42ef7ee50a5d33819df78	[ "A: Left facial palsy", "B: Cavernous sinus thrombosis", "C: Orbital lymphoma", "D: Herpes zoster ophthalmicus", "E: Orbital fracture" ]	D: Herpes zoster ophthalmicus
821	oct-13-2011	These skin changes developed during treatment for end-stage renal failure. What is the diagnosis?	yes	15%	52%	1%	9%	23%	79452	0.063	7138fd135114e2367c2d41c81c76e834	[ "A: Amyloidosis", "B: Nephrogenic fibrosing dermopathy", "C: Syphilis", "D: Scleroderma", "E: Uremic arteriopathy" ]	B: Nephrogenic fibrosing dermopathy
822	oct-13-2016	A 28-year-old woman had a painful vesicular lesion that erupted into this erythematous rash, which did not improve with antibiotics. What is the diagnosis?	yes	53%	14%	8%	14%	11%	134125	0.056	644dc6a4be27d8a50c0daf598bacb2eb	[ "A: Cutaneous lupus", "B: Erysipelas", "C: Dermatomyositis", "D: Rosacea", "E: Fixed drug eruption" ]	A: Cutaneous lupus
823	oct-13-2022	A 19-year-old woman presented with a 6-month history of a slowly growing asymptomatic dark spot on her left palm.	yes	19%	11%	10%	50%	10%	32456	0.064	2304d78db4af59ce96dcfbf63ffa3cbd	[ "A: Acral lentiginous melanoma", "B: Lichen planus", "C: Secondary syphilis", "D: Tinea nigra", "E: Tinea versicolor" ]	D: Tinea nigra
824	oct-14-2010	This patient was recovering from diabetic ketoacidosis (DKA). What is the diagnosis?	yes	9%	20%	3%	61%	7%	78991	0.041	53c16346f9ed6565562557abd2fa21fa	[ "A: Basilar artery thrombosis", "B: Cerebral edema", "C: Cobalamin deficiency", "D: Osmotic demyelination syndrome", "E: Vermian atrophy" ]	D: Osmotic demyelination syndrome
825	oct-14-2021	An 82-year-old man with diabetes presented to the emergency department with fever and confusion. Liver function test showed aspartate aminotransferase level of 1380 u/l (reference range, 5 to 40) and alanine aminotransferase level of 1121 u/l (reference range, 5 to 40). A computed tomographic scan of the abdomen was pe...	yes	15%	6%	48%	18%	12%	52417	0.069	ad21c1774149c2fb65d3ebe1b61600ff	[ "A: Acute hepatic necrosis", "B: Cholecystoduodenal fistula", "C: Emphysematous hepatitis", "D: Pyogenic liver abscess", "E: Ruptured hydatid cyst" ]	C: Emphysematous hepatitis
826	oct-15-2009	What is the diagnosis?	no	6%	32%	12%	25%	25%	126,985	0.149	8d2edfe1bea7c85916985ad4057cdddd	[ "A: Acanthosis nigricans", "B: Lymphogranuloma venereum", "C: Seborrheic keratoses", "D: Secondary syphilis", "E: Bowenoid papulosis" ]	E: Bowenoid papulosis
827	oct-15-2015	Which one of the following is the best test to diagnose the condition seen in this image?	yes	9%	24%	4%	6%	56%	97072	0.053	cb82586885576a909069785d32521b47	[ "A: Skin wound culture", "B: Autoantibodies to desmosomes in the epidermis", "C: Epicutaneous patch testing", "D: HSV serology", "E: IgG and complement deposition at the dermis-epidermis junction" ]	E: IgG and complement deposition at the dermis-epidermis junction
828	oct-15-2020	A 64-year-old woman presented with a 5-month history of photophobia with ocular pain and a foreign-body sensation in both eyes. The visual acuity was 20/25 in each eye, and slit-lamp examination showed conjunctival hyperemia, corneal epithelial erosions, and corneal endothelial folds. What is the diagnosis?	yes	10%	51%	16%	18%	6%	47778	0.062	a40150bbc792a7e0f57110dba84890bd	[ "A: Cat scratch disease", "B: Sjögren's syndrome", "C: Trachoma", "D: Behçet's disease", "E: Multiple sclerosis" ]	B: Sjögren's syndrome
829	oct-16-2008	What diagnosis is suggested by this corneal photograph?	yes	8%	13%	12%	49%	19%	111454	0.067	198c7663677ed6bba1c478398d3d300c	[ "A: Anterior uveitis", "B: Chlamydia trachomatis infection", "C: Cytomegalovirus retinitis", "D: Herpes simplex virus infection", "E: Toxocariasis" ]	D: Herpes simplex virus infection
830	oct-16-2014	What is the diagnosis in this patient with axillary lymphadenopathy?	yes	24%	12%	54%	4%	6%	92629	0.058	6b0929d9f3abaae61fe3f7c3497543bf	[ "A: Bacterial felon", "B: Erysipelas", "C: Herpetic whitlow", "D: Paronychia", "E: Scabies" ]	C: Herpetic whitlow
831	oct-17-2013	What serologic test is most likely to be positive in this patient?	yes	42%	16%	13%	19%	10%	97173	0.085	2f5ab1d1f0b84671cae7485e0d4370f0	[ "A: Anticentromere antibody", "B: Anti-double stranded DNA", "C: Anti-ribonucleoprotein antibody", "D: Anti-Ro antibody", "E: Anti-Smith antibody" ]	A: Anticentromere antibody
832	oct-17-2019	A 77-year-old woman presented to a clinic with a 2-year history of slowly progressive, painful swelling of her fingertips. Physical examination of the hands showed thickening of the skin on her right hand as well as soft-tissue swelling of the tips of the fingers of both hands. A plain radiograph of the hands is shown....	yes	17%	48%	11%	7%	16%	73023	0.068	e986d94b56b26b9c98ff4944087866f8	[ "A: Tophaceous gout", "B: Calcinosis", "C: Metastatic chondrosarcoma", "D: Vitamin D toxicity", "E: Myositis ossificans" ]	B: Calcinosis
833	oct-18-2007	What is the diagnosis?	no	8%	48%	11%	24%	10%	107449	0.071	fc6fcafa536fa4be1aea39959befe07d	[ "A: Graves' ophthalmopathy", "B: Retinal detachment", "C: Choroidal melanoma", "D: Ocular implant", "E: Angle closure glaucoma" ]	B: Retinal detachment
834	oct-18-2012	What presentation is most likely to accompany this angiographic finding?	yes	59%	10%	15%	5%	11%	69384	0.043	a215bf2244e86e07bcd845aedff0dfb7	[ "A: Binocular visual loss", "B: Hemineglect", "C: Paratonic rigidity", "D: Urinary incontinence", "E: Verbal agnosia" ]	A: Binocular visual loss
835	oct-18-2018	A 35-year-old male presented to the emergency psychiatry service with paranoid delusions and was found to have patchy, irregular alopecia of the scalp. What is the most likely diagnosis?	yes	8%	14%	43%	26%	10%	108080	0.086	036bb9e3478336f7252c72fee56ce8cb	[ "A: Androgenic alopecia", "B: Central centrifugal cicatricial alopecia", "C: Syphilitic alopecia", "D: Trichotillomania", "E: Hypothyroidism" ]	C: Syphilitic alopecia
836	oct-19-2006	This patient presented with lower extremity edema. What is the diagnosis?	yes	11%	6%	65%	10%	8%	76169	0.031	229e3b0cab09b000d4edebf1d31f7b7c	[ "A: Cardiac amyloidosis", "B: Mitral stenosis", "C: Constrictive pericarditis", "D: Left ventricular aneurysm", "E: Mediastinal lymphoma" ]	C: Constrictive pericarditis
837	oct-19-2017	An 11-year-old boy was brought to the emergency department with epistaxis and severe nasal pain. What is the likely diagnosis?	yes	1%	2%	7%	17%	73%	59920	0.021	be2bf336fbf591f6c7baa777db880f6f	[ "A: Nasal polyps", "B: Nasal septum fracture", "C: Pills in the nasal cavity", "D: Coins in the nasal cavity", "E: Button magnets in the nasal cavity" ]	E: Button magnets in the nasal cavity
838	oct-19-2023	An 8-year-old girl was brought to the dermatology clinic with a 3-day history of painful lip crusting, oral ulcers, rash, and genital pain. Ten days before presentation, a fever and cough had developed. She had no history of medication use. Physical examination was notable for conjunctivitis in both eyes and ulcers in ...	yes	18%	11%	13%	37%	22%	52967	0.101	367ed218f7f1f240eb6e5616121f5996	[ "A: Administration of systemic glucocorticoids", "B: Allergy/immunology consultation", "C: Skin biopsy", "D: Testing for bacterial and viral respiratory pathogens", "E: Testing for herpes simplex virus" ]	D: Testing for bacterial and viral respiratory pathogens
839	oct-20-2005	What process is illustrated in the radiograph?	yes	29%	15%	15%	31%	10%	85114	0.123	255cefbfec1e3ea9dab175d080189f8c	[ "A: Paget's disease", "B: Osteopetrosis", "C: Hyperparathyroidism", "D: Bone marrow hyperplasia", "E: Acromegaly" ]	D: Bone marrow hyperplasia
840	oct-20-2011	What is the diagnosis?	no	5%	66%	6%	4%	18%	104319	0.031	a6a8040c6c3307b723a40b8974632b43	[ "A: Bowenoid papulosis", "B: Condyloma acuminatum", "C: Molluscum contagiosum", "D: Seborrheic keratosis", "E: Verrucous carcinoma" ]	B: Condyloma acuminatum
841	oct-20-2016	A 51-year-old male with diabetes presented with 2 weeks of general malaise and fever. What is the diagnosis?	yes	6%	69%	7%	8%	10%	75413	0.024	7e7c19c8c8287168bda6193a529e3bb7	[ "A: Small bowel obstruction", "B: Emphysematous pyelonephritis", "C: Paralytic ileus", "D: Renocolic fistula", "E: Splenic abscess" ]	B: Emphysematous pyelonephritis
842	oct-20-2022	A 37-year-old man presented to the emergency department with a 1-week history of pain and swelling in the left upper arm that had started after blunt trauma during soccer practice. The heart rate was 120 beats per minute, the blood pressure 96/54 mm Hg, and the body temperature 37.9°C. Examination of the left upper arm...	yes	81%	7%	4%	3%	6%	31338	0.009	7a9aee4c5b9be352663de0328b7483f8	[ "A: Delay in surgical intervention >24 hours", "B: Involvement of the upper extremity", "C: Negative Blood Cultures", "D: Patient age <60 years", "E: Presence of erythema" ]	A: Delay in surgical intervention >24 hours
843	oct-21-2010	This patient had hypertension. What is the diagnosis?	yes	8%	44%	10%	29%	8%	88051	0.084	ea7c106cbfab5a84a7003acfdb5565c7	[ "A: Coarctation of the aorta", "B: Pheochromocytoma", "C: Primary hyperaldosteronism", "D: Renal artery stenosis", "E: Systemic sclerosis" ]	B: Pheochromocytoma
844	oct-21-2021	A 49-year-old woman, who had undergone kidney transplantation 4 months earlier, presented to the emergency department with a 2-week history of headache, dizziness, and rash. On exam she had diffuse, umbilicated papules. What is the most likely pathogen?	yes	17%	38%	14%	22%	9%	54394	0.098	071202b521b941fab80bb0f01c91e045	[ "A: Blastomyces dermatitidis", "B: Cryptococcus neoformans", "C: Histoplasma capsulatum", "D: Molluscum contagiosum", "E: Mycobacterium tuberculosis" ]	B: Cryptococcus neoformans
845	oct-22-2009	What is the diagnosis?	no	8%	6%	34%	9%	43%	116309	0.128	9f5eef0026021a67370aaa767b32fc0c	[ "A: Brachial plexopathy", "B: Clavicular fracture", "C: Lipodystrophy", "D: Polyostotic fibrous dysplasia", "E: Rupture of the trapezius muscle" ]	C: Lipodystrophy
846	oct-22-2015	Which of the following is incorrect statement related to painful vesicular toe rash of 3 months' duration?	yes	12%	14%	14%	10%	50%	99938	0.063	f0c13830fec5783a00a96583d08b7c56	[ "A: Infection is associated with immunosuppressant use.", "B: Infection is typically localized to the site of inoculation.", "C: Transmission occurs with contaminated water contact.", "D: Infection may travel along the lymphatic system leading to lymphangitis.", "E: Transmission is associated with aerosoliz...	E: Transmission is associated with aerosolized contaminated soil exposure.
847	oct-22-2020	A 4-month-old boy who was exclusively breast-fed presented to the clinic with a 6-week history of a worsening rash. Physical examination revealed extensive erosive plaques throughout the body. What is the diagnosis?	yes	13%	19%	16%	38%	15%	107688	0.097	4cf522f672729dfb7407ca0e8d067dcf	[ "A: Atopic dermatitis", "B: Epidermolysis bullosa", "C: Stevens-Johnson Syndrome", "D: Zinc deficiency", "E: Erythema infectiosum" ]	D: Zinc deficiency
848	oct-23-2008	What is the diagnosis?	no	11%	7%	18%	3%	61%	126239	0.04	7e5913b5cea165c7cad903d0cc826a2e	[ "A: Chronic paronychia", "B: Dermatomyositis", "C: Selenium deficiency", "D: Rheumatoid arthritis", "E: Psoriasis" ]	E: Psoriasis
849	oct-23-2014	What is the diagnosis in this asymptomatic male from North Africa?	yes	53%	12%	9%	11%	15%	84553	0.056	160ed3a42c77ffd3802c402c8d5d6c49	[ "A: Cutaneous leishmaniasis", "B: Myiasis", "C: Paronychia", "D: Syphilis", "E: Yaws" ]	A: Cutaneous leishmaniasis
850	oct-24-2013	What is the diagnosis in this patient who had a relative afferent pupillary defect?	yes	12%	28%	22%	8%	31%	89731	0.137	5d60bc4acb629945f9fb9898b0a49bdb	[ "A: Multiple sclerosis", "B: Retinal ischemia", "C: Retinitis pigmentosa", "D: Toxoplasmosis", "E: Wilson's disease" ]	B: Retinal ischemia
851	oct-24-2019	A previously healthy 36-year-old woman presented to the infectious diseases clinic with a 3-day history of fever, arthralgias, myalgias, and headache. She denied any recent travel or new sexual partners but admitted to having a pet rat. Physical examination revealed swollen and tender joints as well as a maculopapular ...	yes	10%	41%	18%	17%	14%	107809	0.088	785672d2716d9e50b671ad3bfc5ea918	[ "A: The plague", "B: Rat bite fever", "C: Leptospirosis", "D: Tularemia", "E: Hantavirus" ]	B: Rat bite fever
852	oct-25-2007	This patient presented with a 10-day history of left foot discoloration that resolved with elevation. What is the most likely diagnosis?	yes	14%	33%	9%	13%	31%	142697	0.118	db5a223093f2d64b3ea1876a27990d80	[ "A: Angioneurotic edema", "B: Arterial insufficiency", "C: Erysipelas", "D: Peripheral microembolization", "E: Phlegmasia cerulea dolens" ]	B: Arterial insufficiency
853	oct-25-2012	What is the diagnosis?	no	12%	22%	8%	5%	53%	80598	0.059	7fcda34829f3f183cbec3b88b94db3e0	[ "A: Addison's disease", "B: Arsenic poisoning", "C: Carotenemia", "D: Glaucoma", "E: Ochronosis" ]	E: Ochronosis
854	oct-25-2018	A 52-year-old man presented to the emergency department with painless, bloody tears from both eyes. The bleeding had begun spontaneously approximately 2 hours earlier, had lasted a few minutes, and had recurred just before presentation. He was taking captopril for mild hypertension, and his blood pressure was normal. T...	yes	18%	14%	36%	10%	22%	188375	0.104	e1cb427cf2371d5c495508926bd7a845	[ "A: Hemangioma", "B: Infection", "C: Adverse reaction to systemic antibiotics", "D: Trauma to eye or surrounding structures", "E: Retrograde epistaxis" ]	C: Adverse reaction to systemic antibiotics
855	oct-26-2006	These lesions were neither pruritic nor painful. What is the diagnosis?	yes	16%	7%	10%	56%	12%	84756	0.05	31c5e126e851423f2efb55ef2427da99	[ "A: Pyoderma gangrenosus", "B: Phlegmasia cerulea dolens", "C: Pretibial myxedema", "D: Necrobiosis lipoidica diabeticorum", "E: Erythema nodosum" ]	D: Necrobiosis lipoidica diabeticorum
856	oct-26-2017	A 62-year-old woman presented to the breast-surgery clinic with stiffness of the left nipple. Palpation of the left breast, mammography, and ultrasonography revealed no abnormalities. A pigmented macule that measured 5 mm was noted on the left areola. What is the diagnosis?	yes	5%	11%	36%	37%	11%	134811	0.111	2d56a0371336bbd5f4c11d72a7c8aa44	[ "A: Inflammatory mastitis", "B: Traumatic fat necrosis", "C: Cutaneous malignant melanoma", "D: Invasive ductal carcinoma", "E: Blue nevus" ]	D: Invasive ductal carcinoma
857	oct-26-2023	An 83-year-old woman with a history of type 2 diabetes mellitus presented with a 4-month history of a pruritic rash on her back. Physical examination showed a linear array of crateriform lesions containing crusted material on an erythematous base. A skin biopsy showed a cup-shaped ulceration with transepidermal elimina...	yes	9%	6%	19%	47%	19%	25007	0.073	1eef9d979bf552e0cf4a6e7143e84cd9	[ "A: Dermatofibroma", "B: Folliculitis", "C: Keratoacanthoma", "D: Reactive perforating collagenosis", "E: Prurigo nodularis" ]	D: Reactive perforating collagenosis
858	oct-27-2005	The pictured patient suffered a traumatic head injury. What underlying diagnosis is suggested by the examination findings?	yes	27%	28%	5%	26%	14%	94567	0.14	d469aa9d3501668c04912beb72f36b32	[ "A: Skull fracture", "B: Infratentorial hemorrhage", "C: Intraorbital foreign body", "D: Uncal herniation", "E: Carotid dissection" ]	A: Skull fracture
859	oct-27-2011	What is the diagnosis?	no	13%	16%	12%	49%	10%	108426	0.065	b8528bd50a638e71a6ffeabff958b7e6	[ "A: Aphthous stomatitis", "B: Foliate papillae", "C: Fordyce granules", "D: Herpes zoster", "E: Syphilis" ]	D: Herpes zoster
860	oct-27-2016	A 53-year-old woman presented with intensely itchy skin lesions and burning in her mouth. The following appearances are noted on examination of her wrist. What is the diagnosis?	yes	15%	60%	9%	9%	7%	96302	0.041	c157d4b087a4b6a438b0a6735d3c9fc2	[ "A: Lichen sclerosus", "B: Lichen planus", "C: Psoriasis", "D: Eczema", "E: Tinea cruris" ]	B: Lichen planus
861	oct-27-2022	A 75-year-old man presented to the emergency department with a 6-month history of epigastric pain, watery diarrhea, and weight loss. Esophagogastroduodenoscopy revealed severe esophagitis, antral erosions, and duodenal ulcers (left). The gastric pH was below 2, and a fasting serum gastrin level was above 1000 pg per mi...	yes	10%	44%	18%	15%	12%	32210	0.079	25a3ac64b75631d25edcffdff906ab24	[ "A: Li–Fraumeni syndrome", "B: Multiple endocrine neoplasia type 1", "C: Multiple endocrine neoplasia type 2A", "D: Multiple endocrine neoplasia type 2B", "E: Von Hippel–Lindau syndrome" ]	B: Multiple endocrine neoplasia type 1
862	oct-28-2010	This patient was found to have new-onset hyperglycemia. What is the diagnosis?	yes	16%	42%	12%	21%	8%	106225	0.085	b88b269da4cb99e9957da3bc318671e7	[ "A: Hemochromatosis", "B: Necrolytic migratory erythema", "C: Psoriasis", "D: Scleredema of diabetes", "E: Tinea versicolor" ]	B: Necrolytic migratory erythema
863	oct-28-2021	A 26-year-old woman presented with recurrent hemoptysis coinciding with her menstrual cycles. Noncontrast computed tomography (CT) imaging of the lungs showed a cavitary nodule with ground-glass appearance in the right lower lobe. What is the most likely diagnosis?	yes	3%	7%	3%	4%	83%	38302	0.007	c1c2aa4eea181c764a24010712c36f78	[ "A: Accessory breast tissue", "B: Catamenial pneumothorax", "C: Ectopic pregnancy", "D: Progestogen hypersensitivity", "E: Thoracic endometriosis" ]	E: Thoracic endometriosis
864	oct-29-2009	What is the diagnosis?	no	77%	9%	7%	5%	3%	111818	0.014	215c7cbafd77817a9a6f9ff9ae190b5d	[ "A: Lipoatrophy", "B: Myositis ossificans", "C: Rhabdomyolysis", "D: Sarcoma", "E: Syphilitic gumma" ]	A: Lipoatrophy
865	oct-29-2015	Which one of the following choices would be the least useful diagnostic test for this heel ulcer of 2 years' duration?	yes	12%	18%	12%	44%	13%	124378	0.078	c8a463ab128d0d087de1b7031376ede2	[ "A: Hemoglobin A1c", "B: Skin biopsy", "C: Duplex ultrasound of the lower extremity", "D: Wound culture", "E: Ankle-brachial index" ]	D: Wound culture
866	oct-29-2020	A 73-year-old woman with rheumatoid arthritis presented with a 1-month history of pain in her right eye. She had stopped immunosuppressive treatment a few years earlier. There was no recent history of trauma. Slit-lamp examination showed hyperemia, inflammation, and marked scleral thinning with exposure of the underlyi...	yes	88%	4%	3%	2%	3%	47199	0.004	589bf59b7dcaf8e80e5ea755cdf202e1	[ "A: Necrotizing anterior scleritis", "B: Posterior scleritis", "C: Hyphema", "D: Conjuctival hemorrhage", "E: Acute angle closure glaucoma" ]	A: Necrotizing anterior scleritis
867	oct-30-2008	This man had cervical adenopathy. What is the most likely diagnosis?	yes	12%	10%	20%	52%	6%	153611	0.06	693f4c3a02c51d1b3843c9c04f781f02	[ "A: Arteriovenous malformation", "B: Cellulitis", "C: Graves' disease", "D: Lymphoma", "E: Orbital fracture" ]	D: Lymphoma
868	oct-30-2014	What is the most likely diagnosis in this patient who had suffered a blunt head trauma 2 months earlier?	yes	9%	50%	14%	25%	2%	94622	0.068	727e07d58073417d63bc6409779801e5	[ "A: Acute angle-closure glaucoma", "B: Carotid cavernous fistula", "C: Ocular lymphoma", "D: Periorbital cellulitis", "E: Thyroid ophthalmopathy" ]	B: Carotid cavernous fistula
869	oct-31-2013	What is the diagnosis in this patient who had abdominal pain?	yes	4%	72%	6%	7%	10%	74766	0.02	b155216b95cc5b6280c58b86673f7c39	[ "A: Familial Mediterranean fever", "B: Henoch-Schönlein purpura", "C: Meningococcemia", "D: Polyarteritis nodosa", "E: Rocky Mountain spotted fever" ]	B: Henoch-Schönlein purpura
870	oct-31-2019	A 52-year old man presented to the clinic with a bleeding mass on his right great toe. Two months earlier, the patient had noticed a pink nodule on the dorsum of the toe. One month later, his toe was stepped on, after which the nodule grew rapidly and bled intermittently. On examination, the lesion was red and ulcerate...	yes	4%	13%	8%	13%	62%	58981	0.037	cfebc84d9bdaee9e9ec65ce19377a5ae	[ "A: Tophaceous gout", "B: Subungual hematoma", "C: Neurofibroma", "D: Subungual exostosis", "E: Acral lentiginous melanoma" ]	E: Acral lentiginous melanoma
871	sep-01-2011	Which one of the following medications is most likely to be responsible for this appearance?	yes	11%	8%	34%	21%	27%	103376	0.114	cff1b72ca72454b1aae62651dd7fec14	[ "A: Clarithromycin", "B: Dexamethasone", "C: Doxorubicin", "D: Efavirenz", "E: Ferrous sulfate" ]	C: Doxorubicin
872	sep-01-2016	A 64-year-old man presented with a two-year history of this asymptomatic skin condition, which was symmetrically distributed over his trunk, arms and legs. Laboratory tests demonstrated a raised fasting blood glucose level. What is the most likely diagnosis?	yes	5%	15%	10%	8%	63%	88642	0.036	fedb5b58c5d9b45ff4a05d49c1297a2c	[ "A: Chronic urticaria", "B: Pityriasis rosea", "C: Cutaneous sarcoidosis", "D: Systemic lupus erythematosus", "E: Generalized granuloma annulare" ]	E: Generalized granuloma annulare
873	sep-01-2022	A 59-year-old woman was admitted to the hospital with unheralded syncope. She had lost a son to sudden cardiac death when he was 29 years of age. On hospital day 2, the patient developed sustained monomorphic ventricular tachycardia treated with synchronized cardioversion and intravenous amiodarone. An electrocardiogra...	yes	63%	16%	5%	8%	8%	28322	0.036	cbbf7de65581ac86854bb277b6eb91de	[ "A: Arrhythmogenic right ventricular cardiomyopathy", "B: Brugada Syndrome", "C: Cardiac sarcoidosis", "D: Inferior Myocardial Infarction", "E: Pulmonary Embolism" ]	A: Arrhythmogenic right ventricular cardiomyopathy
874	sep-02-2010	This 20-year-old man was evaluated for fever. What is the diagnosis?	yes	19%	14%	4%	17%	46%	89317	0.076	862e56a185a4ba6196357efc8e0799c6	[ "A: Allergic bronchopulmonary aspergillosis", "B: Cystic fibrosis", "C: Primary hyperparathyroidism", "D: Sarcoidosis", "E: Tuberculosis" ]	E: Tuberculosis
875	sep-02-2021	A 7-year-old girl presented with an itchy rash while taking amoxicillin for pharyngitis. Physical exam showed purulent tonsils, along with a maculopapular rash involving her face, trunk, arms, and legs. What is the most likely diagnosis?	yes	68%	2%	4%	16%	9%	55598	0.028	f24c2c91db697d990b0601dc8767adf1	[ "A: Amoxicillin rash in infectious mononucleosis", "B: Guttate psoriasis", "C: Hand, foot, and mouth disease", "D: Scarlet fever", "E: Serum sickness-like reaction" ]	A: Amoxicillin rash in infectious mononucleosis
876	sep-03-2009	This patient with a history of rheumatoid arthritis presented with a several-month history of a painful left calf. What is the diagnosis?	yes	47%	20%	4%	19%	10%	115605	0.074	2971115222619f96e16b46b78368022e	[ "A: Baker's cyst", "B: Gastrocnemius tear", "C: Meniscal cyst", "D: Lipoblastoma", "E: Septic arthritis" ]	A: Baker's cyst
877	sep-03-2015	Which of the following is the most likely diagnosis for this incidental finding on an MRI?	yes	9%	15%	4%	5%	67%	87353	0.029	d703f549626d5261ad394df2917cac05	[ "A: Type 1 Chiari malformation", "B: Cavernous angioma", "C: Asymptomatic cortical infarct", "D: Aneurysm", "E: Arachnoid cyst" ]	E: Arachnoid cyst
878	sep-03-2020	A 44-year-old man presented with confusion and a cough a few days after swimming in an indoor pool. At presentation, he had a body temperature of 39.8°C and appeared drowsy. He did not respond to questions or blink to visual threat; however, brainstem reflexes were intact, and he withdrew both arms and both legs from p...	yes	17%	49%	18%	9%	6%	56703	0.067	22e420f0ee188da1a2dfa3195104430e	[ "A: Mycobacterium marinum", "B: Naegleria fowleri", "C: Legionella pneumophila", "D: Sappinia diploidea", "E: Escherichia coli" ]	B: Naegleria fowleri
879	sep-04-2008	This worm was identified in an endotracheal aspirate of a patient with pulmonary infiltrates. What is the infecting organism?	yes	45%	4%	7%	36%	8%	130441	0.125	059c441de70cf72f905330b762a6ad0f	[ "A: Ascaris lumbricoides", "B: Clonorchis sinensis", "C: Paragonimus westermani", "D: Strongyloides stercoralis", "E: Toxoplasma gondii" ]	D: Strongyloides stercoralis
880	sep-04-2014	What is the diagnosis?	no	8%	9%	52%	6%	26%	82342	0.063	9791c1ee444e7d171426386fb18ff928	[ "A: Aerophagia", "B: Congenital diaphragmatic hernia", "C: Duodenal atresia", "D: Gastroschesis", "E: Hypertrophic pyloric stenosis" ]	C: Duodenal atresia
881	sep-05-2013	What is the diagnosis?	no	22%	13%	6%	17%	41%	76370	0.089	1e3a255d3cb85635f2e6b3b554e7dcb8	[ "A: Cholesteatoma", "B: Glomus tumor", "C: Suppurative otitis media", "D: Serous otitis media", "E: Tympanic hyperectasis" ]	E: Tympanic hyperectasis
882	sep-05-2019	A 29-year-old man with a history of aplastic anemia, who was being treated with cyclosporine, presented to the emergency department with a 4-day history of fever, cough, and difficulty breathing at rest. One day before the onset of symptoms, a pruritic rash had developed on his face, trunk, and limbs. On physical exami...	yes	12%	53%	8%	14%	13%	91259	0.056	50963937d60e970db46c0eb1e6e1de4d	[ "A: Eosinophilic granulomatosis with polyangiitis", "B: Disseminated varicella infection", "C: Disseminated intravascular coagulation", "D: Drug-induced hypersensitivity syndrome", "E: Immune thrombocytopenic purpura" ]	B: Disseminated varicella infection
883	sep-06-2007	What is the diagnosis?	no	5%	3%	65%	9%	19%	136678	0.034	2976c8efdd605d7db44d757c31ab7ebb	[ "A: Cutis laxa", "B: Turner's syndrome", "C: Ehlers-Danlos syndrome", "D: Pseudoxanthoma elasticum", "E: Marfan syndrome" ]	C: Ehlers-Danlos syndrome
884	sep-06-2012	What is the diagnosis?	no	57%	16%	6%	12%	8%	87258	0.047	d28b30888fda7df9a49caf330cb54165	[ "A: Bedbug bites", "B: Dermatitis herpetiformis", "C: Ecthyma", "D: Guttate psoriasis", "E: Lichen planus" ]	A: Bedbug bites
885	sep-06-2018	A 58-year-old man presented to the outpatient pulmonary clinic with a productive cough and a history of weight loss of 10 kg during the preceding 3 months. He was an active smoker and for the preceding 4 years had worked in a factory processing cotton.	yes	16%	44%	15%	13%	13%	61353	0.079	85eac561e8f36cb3414debaa914607ac	[ "A: Nocardiosis", "B: Actinomycosis", "C: Aspergillosis", "D: Histoplasmosis", "E: Blastomycosis" ]	B: Actinomycosis
886	sep-07-2006	What is the diagnosis?	no	20%	42%	16%	13%	10%	104424	0.174	6ae8277f8338a93d38f3932d2487c584	[ "A: Cardiac tamponade", "B: Tension hydrothorax", "C: Diaphragmatic eventeration", "D: Pulmonary hydatid disease", "E: Lymphangioleiomyomatosis" ]	A: Cardiac tamponade
887	sep-07-2017	A 41-year-old man presented with progressive loss of vision in both eyes. Physical examination was notable for pectus excavatum and elongated digits. His uncorrected visual acuity was 6/200 in the right eye and 20/100 in the left eye. What is the diagnosis?	yes	6%	15%	70%	4%	6%	56775	0.024	db2d3f2cabb5ec7d534b819a90b24be4	[ "A: Pseudoexfoliation glaucoma", "B: Retinal detachment", "C: Ectopia lentis", "D: Traumatic cataract", "E: Iridocyclitis" ]	C: Ectopia lentis
888	sep-07-2023	A 34-year-old man presented to the emergency department with a 10-day history of shortness of breath that worsened when he bent forward or laid supine and abated when he sat upright. His respiratory rate was 36 breath per minute, and his oxygen saturation was 98% when sitting upright and 88% when supine in room air. On...	yes	15%	14%	42%	13%	17%	42830	0.085	b75e15cee7cde57e25a63bbc4865a496	[ "A: Chest radiography", "B: Measurement of inspiratory pressures", "C: Polysomnography", "D: Pulmonary function tests", "E: Ultrasonography of the diaphragm" ]	C: Polysomnography
889	sep-08-2011	Polarized microscopical examination of a specimen from a patient's elbow revealed what type of crystals?	yes	8%	17%	22%	7%	47%	82035	0.074	a0da4ff46a17cdbe8016ec5d1a468628	[ "A: Calcium apatite", "B: Calcium oxalate", "C: Calcium pyrophosphate dihydrate", "D: Iron sulfide", "E: Monosodium urate" ]	E: Monosodium urate
890	sep-08-2016	An 88-year-old man with a history of a quadruple coronary-artery bypass grafting procedure and transapical transcatheter aortic-valve replacement presented with this skin condition. What is the cause of this appearance?	yes	10%	21%	7%	50%	11%	118603	0.064	f397560d3867342cc65d5cf7375e621c	[ "A: Warfarin necrosis", "B: Subacute bacterial endocarditis", "C: Cryoglobulinaemia", "D: Cholesterol embolization", "E: Heparin-induced thrombocytopenia" ]	D: Cholesterol embolization
891	sep-08-2022	A 79-year-old woman with a history of prior stroke was referred for an abnormal X-ray finding along the left heart border, first noticed 6 years prior. In the absence of symptoms, the patient was monitored with serial radiographs which showed a gradual increase in size of the finding. Which of the following is the most...	yes	40%	17%	9%	23%	11%	60473	0.092	7d5341e78de224e5875e02ce60699fb5	[ "A: Giant Coronary Aneurysm", "B: Left Atrial Appendage Thrombus", "C: Mediastinal Hematoma", "D: Pericardial Cyst", "E: Teratoma" ]	A: Giant Coronary Aneurysm
892	sep-09-2010	What laboratory evaluation is most likely to be abnormal in this 10-year-old patient who also had discrete facial erythema?	yes	15%	32%	26%	6%	21%	105023	0.12	23337a95f6ae2d7c2839d52d4102e964	[ "A: CD4 count", "B: Creatine kinase", "C: Rheumatoid factor", "D: Thyrotropin", "E: Zinc" ]	B: Creatine kinase
893	sep-09-2021	A 50-year-old man presented with a lesion on his eye that developed over the preceding month. He also had violaceous plaques on his back and lower limbs. Testing for HIV was positive. What is the diagnosis?	yes	9%	11%	11%	53%	16%	56036	0.056	f61a6baafd6b9f778328b24b84b53132	[ "A: Angiosarcoma", "B: Bacillary angiomatosis", "C: Herpes simplex keratoconjunctivitis", "D: Kaposi’s sarcoma", "E: Ocular surface squamous neoplasia" ]	D: Kaposi’s sarcoma
894	sep-10-2009	Which one of the following medications is most characteristically associated with the illustrated finding?	yes	13%	21%	16%	8%	42%	124550	0.086	eab479d6540bb2ecbf038a9ee7d2c70b	[ "A: Alendronate", "B: Carbamazepine", "C: Imatinib", "D: Ropinirole", "E: Zidovudine" ]	E: Zidovudine
895	sep-10-2015	Which of the following conditions is NOT commonly associated with this finding?	no	17%	11%	47%	10%	15%	119460	0.071	6be27f098e4dbea17b20c745477e814f	[ "A: Chronic liver disease", "B: Cutaneous collagenous vasculopathy", "C: Hemophilia A", "D: CREST syndrome", "E: Rosacea" ]	C: Hemophilia A
896	sep-10-2020	A 62-year-old man presented to the emergency department with a 1-day history of fever and 3-day history of chest pain. He had a history of coronary artery disease and splenectomy. On examination, he had three dog-bite wounds on his left hand. Laboratory studies revealed a white-cell count of 16,700 per cubic millimeter...	yes	17%	40%	21%	11%	11%	59753	0.091	eb782402a6cdb75da0b314788b6932c1	[ "A: Pasteurella multocida", "B: Capnocytophaga canimorsus", "C: Pasteurella canis", "D: Babesia microti", "E: Bacillus anthracis" ]	B: Capnocytophaga canimorsus
897	sep-11-2008	What is the diagnosis?	no	24%	15%	10%	35%	15%	134549	0.107	18910b955dd47b2f484a7115149d5c14	[ "A: Aspiration pneumonia", "B: Sarcoidosis", "C: Silicosis", "D: Idiopathic pulmonary fibrosis", "E: Lymphangioleiomyomatosis" ]	D: Idiopathic pulmonary fibrosis
898	sep-11-2014	What is the diagnosis?	no	5%	6%	3%	82%	4%	94533	0.008	332cc563750ad66dd9f203da27125607	[ "A: Angioedema", "B: Cardiac tamponade", "C: Necrotizing fasciitis", "D: Superior vena cava syndrome", "E: Toxic epidermal necrolysis" ]	D: Superior vena cava syndrome
899	sep-12-2013	What is the diagnosis in this 70-year-old patient who developed bilateral fluctuant masses over each elbow?	yes	38%	10%	10%	22%	20%	82187	0.099	d2260a78a689984cf75351fe86111dc5	[ "A: Gout nodulosis", "B: Lipoma", "C: Medial epicondylitis", "D: Pseudogout", "E: Rheumatoid nodules" ]	A: Gout nodulosis
900	sep-12-2019	A 60-year-old woman presented to the emergency department with a 2-month history of blurry vision in her left eye. Her medical history was notable for breast cancer treated 3 years earlier with lumpectomy, axillary-node dissection, radiation, and hormonal therapy. Physical exam on upward gaze is demonstrated. What is t...	yes	53%	13%	23%	3%	8%	84803	0.06	e0b9d5424434235de75493ceda1afc3c	[ "A: Orbital metastasis", "B: Unilateral Grave's ophthalmopathy", "C: Partial cranial nerve 3 palsy", "D: Orbital cellulitis", "E: Idiopathic orbital inflammatory disease" ]	A: Orbital metastasis

801

oct-05-2023

A 72-year-old man presented to the emergency department with a 2-day history of an itchy rash on his back. On physical examination, edematous, flagellate plaques and linear patches were present across the patient’s entire back and upper buttocks. There was no adenopathy, dermographism, or mucosal involvement. What subs...

yes

13%

19%

41%

19%

8%

66216

0.089

978d8abec2e6e6022f48531cbda3854c

[ "A: Phenytoin", "B: Shellfish", "C: Shiitake mushrooms", "D: Toxicodendron radicans (poison ivy)", "E: Warfarin" ]

C: Shiitake mushrooms

802

oct-06-2011

This patient was being treated by an endocrinologist for which one of the following conditions?

yes

10%

14%

35%

15%

25%

111047

0.107

0925137cf31e2451270ab57e9fe8e4c9

[ "A: Acromegaly", "B: Cushing's disease", "C: Graves' disease", "D: Hashimoto's thyroiditis", "E: Type 1 diabetes" ]

C: Graves' disease

803

oct-06-2016

A 60-year-old man presented with abdominal pain, hypotension, and deranged renal function. What is the diagnosis?

yes

15%

61%

2%

8%

14%

92697

0.04

36f755ebdee052a3fd70916f598cf7d8

[ "A: Pseudomembranous colitis", "B: Acute mesenteric ischemia", "C: Diverticulitis", "D: Ulcerative colitis", "E: Pseudomelanosis coli" ]

B: Acute mesenteric ischemia

804

oct-06-2022

A 34-year-old woman presented with a 3-year history of changes in skin color. Examination was notable for hypopigmented macules on a background of hyperpigmentation, creating a raindrop-like appearance on the chest and back. Neighbors who drank water from the same well had similar skin changes. What is the most likely ...

yes

38%

15%

16%

15%

50306

0.096

a3db5d37738ab75fae98bfdf4242d281

[ "A: Arsenic toxicity", "B: Cadmium toxicity", "C: Copper toxicity", "D: Lead toxicity", "E: Mercury toxicity" ]

A: Arsenic toxicity

805

oct-07-2010

What is the diagnosis?

no

4%

8%

6%

70%

11%

78345

0.023

9f0606b348711510911992eab1c91b8d

[ "A: Achondroplasia", "B: Ankylosing spondylitis", "C: Osteogenesis imperfecta", "D: Pectus excavatum", "E: Pneumothorax" ]

D: Pectus excavatum

806

oct-07-2021

A 80-year-old man undergoing treatment for multiple myeloma presented with fevers and confusion. Magnetic resonance imaging (MRI) of the head showed ring-enhancing lesions. Gram stain of cerebrospinal fluid (CSF) showed gram-positive bacilli. What is the most likely diagnosis?

yes

13%

22%

45%

11%

8%

58937

0.077

7e8859e8852e7433740ee153111ff60c

[ "A: Clostridium septicum", "B: Listeriosis", "C: Nocardiosis", "D: Peptostreptococcus species", "E: Propionibacterium acnes" ]

C: Nocardiosis

807

oct-08-2009

This appearance was noticed during routine colonoscopy. What is the diagnosis?

yes

8%

23%

42%

14%

130078

0.087

519a43ce81dc542468236627ddda5433

[ "A: Addison's disease", "B: Hemochromatosis", "C: Laxative use", "D: Metastatic melanoma", "E: von Hippel-Lindau disease" ]

C: Laxative use

808

oct-08-2015

Which one of the following is the least likely cause of this patient’s symptoms of retrobulbar swelling and diplopia?

yes

49%

8%

18%

12%

13%

115706

0.066

6a4cfbbf289678257e10b6151c06c370

[ "A: Dermatomyositis", "B: Cancer", "C: Oral contraceptive use", "D: Facial trauma", "E: Sinusitis" ]

A: Dermatomyositis

809

oct-08-2020

A 53-year-old woman with metastatic signet-ring appendiceal cancer receiving treatment with panitumumab presents with a 2-month history of trichomegaly. What is the cause of this physical examination finding?

yes

14%

4%

21%

10%

51%

74640

0.063

567a463debca6f9112031eeaf72c196e

[ "A: Cornelia de Lange syndrome", "B: Dermatomyositis", "C: Cytokine immunotherapy", "D: Familial trichomegaly", "E: EGFR inhibition" ]

E: EGFR inhibition

810

oct-09-2008

What is the diagnosis?

no

17%

5%

71%

2%

5%

115918

0.024

2ad4b48b8c54f9ad79c37f34ff742705

[ "A: Amelanotic melanoma", "B: Cicatricial pemphigoid", "C: Keratoacanthoma", "D: Hidrocystoma", "E: Papular mucinosis" ]

C: Keratoacanthoma

811

oct-09-2014

What is the diagnosis?

no

13%

23%

4%

56%

99671

0.053

a5041dc9121d841588afca43263b2a6e

[ "A: Erythema chronicum migrans", "B: Granuloma annulare", "C: Pityriasis rosea", "D: Sarcoidosis", "E: Tinea circinata" ]

E: Tinea circinata

812

oct-10-2013

What is the diagnosis in this patient who appeared sick, had a bull neck, and was tachycardic?

yes

55%

7%

14%

4%

20%

81297

0.054

ec83d86f8046bb0286c9377c0a365b7d

[ "A: Diphtheria", "B: Epiglottitis", "C: Infectious mononucleosis", "D: Rheumatic fever", "E: Streptococcal pharyngitis" ]

A: Diphtheria

813

oct-10-2019

A 64-year-old man presented to the oral medicine clinic with a painful, smooth, red tongue and a burning sensation around his lips that had developed 6 months earlier. No deficits were found on neurologic examination. What is the most likely diagnosis?

yes

14%

10%

8%

57%

12%

81313

0.047

bc389086a130ba70b9a9441c6a8f4297

[ "A: Oral lichen planus", "B: Sjögren's syndrome", "C: Squamous-cell carcinoma of the tongue", "D: Pernicious anemia", "E: Amyloidosis" ]

D: Pernicious anemia

814

oct-11-2007

What is the diagnosis?

no

34%

19%

28%

11%

9%

137019

0.174

c9b92a67a6cd0d99ecf1c144fab177fa

[ "A: Cholangiocarcinoma", "B: Cirrhosis", "C: Echinococcosis", "D: Hepatocellular carcinoma", "E: Tuberculosis" ]

B: Cirrhosis

815

oct-11-2012

What is the most likely diagnosis?

no

43%

18%

8%

14%

17%

88263

0.082

fd1ffe8436d9583e1630e1652f001a65

[ "A: Angioedema", "B: Facial palsy", "C: Frey's syndrome", "D: Parotid adenoma", "E: Parotitis" ]

A: Angioedema

816

oct-11-2018

A 42-year-old man who was undergoing treatment for non-Hodgkin’s lymphoma presented to the oncology clinic with changes in his fingernails. Five months earlier, he had presented with gastric-outlet obstruction and had received a diagnosis of high-grade B-cell non-Hodgkin’s lymphoma. What is the most likely underlying c...

yes

49%

17%

7%

12%

14%

102483

0.066

fcd1de0e2e98d048424f164625075eda

[ "A: Chemotherapy", "B: Paraneoplastic syndrome", "C: Metastatic disease of the nail bed", "D: Hepatic dysfunction", "E: Tetracycline" ]

A: Chemotherapy

817

oct-12-2006

An elderly woman presented with abdominal pain and vomiting for three days. A computed tomogram of the abdomen was obtained. What is the diagnosis?

yes

24%

14%

11%

41%

9%

74713

0.089

4a6869311150c033f90a322942ab9600

[ "A: Cecal volvulus", "B: Intussusception", "C: Mesenteric ischemia", "D: Obturator hernia", "E: Ovarian cancer" ]

D: Obturator hernia

818

oct-12-2017

A 61-year-old woman with hypertension and hypothyroidism presented with acute onset of severe chest pain after the death of her dog. Electrocardiography showed ST-segment elevation in anterolateral leads, and left ventriculography showed severe apical hypokinesis. What is the likely diagnosis?

yes

5%

7%

17%

5%

65%

64701

0.032

da254f2ad7ed8525402dd230fb691183

[ "A: Acute coronary syndrome", "B: Myocardial infarction", "C: Ventricular aneurysm", "D: Thyrotoxic cardiomyopathy", "E: Takotsubo cardiomyopathy" ]

E: Takotsubo cardiomyopathy

819

oct-12-2023

A 44-year-old man with diabetes and end-stage kidney disease presented with a 2-week history of pain and blurry vision in his left eye, fevers, and back pain. An ophthalmologic examination was notable for conjunctival injection and corneal clouding in the left eye. Visual acuity was 20/60 in the right eye and was reduc...

yes

55%

10%

15%

12%

8%

27423

0.051

3018cf15b2b0afc861b77e76da5e447c

[ "A: Intravitreal antimicrobial injections", "B: Intravitreal steroid injection", "C: Removal of intraocular lens", "D: Topical antimicrobial drops", "E: Topicals steroid drops" ]

A: Intravitreal antimicrobial injections

820

oct-13-2005

What is the diagnosis?

no

13%

34%

13%

25%

16%

65998

0.148

5f5455f1bbc42ef7ee50a5d33819df78

[ "A: Left facial palsy", "B: Cavernous sinus thrombosis", "C: Orbital lymphoma", "D: Herpes zoster ophthalmicus", "E: Orbital fracture" ]

D: Herpes zoster ophthalmicus

821

oct-13-2011

These skin changes developed during treatment for end-stage renal failure. What is the diagnosis?

yes

15%

52%

1%

9%

23%

79452

0.063

7138fd135114e2367c2d41c81c76e834

[ "A: Amyloidosis", "B: Nephrogenic fibrosing dermopathy", "C: Syphilis", "D: Scleroderma", "E: Uremic arteriopathy" ]

B: Nephrogenic fibrosing dermopathy

822

oct-13-2016

A 28-year-old woman had a painful vesicular lesion that erupted into this erythematous rash, which did not improve with antibiotics. What is the diagnosis?

yes

53%

14%

8%

14%

11%

134125

0.056

644dc6a4be27d8a50c0daf598bacb2eb

[ "A: Cutaneous lupus", "B: Erysipelas", "C: Dermatomyositis", "D: Rosacea", "E: Fixed drug eruption" ]

A: Cutaneous lupus

823

oct-13-2022

A 19-year-old woman presented with a 6-month history of a slowly growing asymptomatic dark spot on her left palm.

yes

19%

11%

10%

50%

10%

32456

0.064

2304d78db4af59ce96dcfbf63ffa3cbd

[ "A: Acral lentiginous melanoma", "B: Lichen planus", "C: Secondary syphilis", "D: Tinea nigra", "E: Tinea versicolor" ]

D: Tinea nigra

824

oct-14-2010

This patient was recovering from diabetic ketoacidosis (DKA). What is the diagnosis?

yes

9%

20%

3%

61%

7%

78991

0.041

53c16346f9ed6565562557abd2fa21fa

[ "A: Basilar artery thrombosis", "B: Cerebral edema", "C: Cobalamin deficiency", "D: Osmotic demyelination syndrome", "E: Vermian atrophy" ]

D: Osmotic demyelination syndrome

825

oct-14-2021

An 82-year-old man with diabetes presented to the emergency department with fever and confusion. Liver function test showed aspartate aminotransferase level of 1380 u/l (reference range, 5 to 40) and alanine aminotransferase level of 1121 u/l (reference range, 5 to 40). A computed tomographic scan of the abdomen was pe...

yes

15%

6%

48%

18%

12%

52417

0.069

ad21c1774149c2fb65d3ebe1b61600ff

[ "A: Acute hepatic necrosis", "B: Cholecystoduodenal fistula", "C: Emphysematous hepatitis", "D: Pyogenic liver abscess", "E: Ruptured hydatid cyst" ]

C: Emphysematous hepatitis

826

oct-15-2009

What is the diagnosis?

no

6%

32%

12%

25%

126,985

0.149

8d2edfe1bea7c85916985ad4057cdddd

[ "A: Acanthosis nigricans", "B: Lymphogranuloma venereum", "C: Seborrheic keratoses", "D: Secondary syphilis", "E: Bowenoid papulosis" ]

E: Bowenoid papulosis

827

oct-15-2015

Which one of the following is the best test to diagnose the condition seen in this image?

yes

9%

24%

4%

6%

56%

97072

0.053

cb82586885576a909069785d32521b47

[ "A: Skin wound culture", "B: Autoantibodies to desmosomes in the epidermis", "C: Epicutaneous patch testing", "D: HSV serology", "E: IgG and complement deposition at the dermis-epidermis junction" ]

E: IgG and complement deposition at the dermis-epidermis junction

828

oct-15-2020

A 64-year-old woman presented with a 5-month history of photophobia with ocular pain and a foreign-body sensation in both eyes. The visual acuity was 20/25 in each eye, and slit-lamp examination showed conjunctival hyperemia, corneal epithelial erosions, and corneal endothelial folds. What is the diagnosis?

yes

10%

51%

16%

18%

6%

47778

0.062

a40150bbc792a7e0f57110dba84890bd

[ "A: Cat scratch disease", "B: Sjögren's syndrome", "C: Trachoma", "D: Behçet's disease", "E: Multiple sclerosis" ]

B: Sjögren's syndrome

829

oct-16-2008

What diagnosis is suggested by this corneal photograph?

yes

8%

13%

12%

49%

19%

111454

0.067

198c7663677ed6bba1c478398d3d300c

[ "A: Anterior uveitis", "B: Chlamydia trachomatis infection", "C: Cytomegalovirus retinitis", "D: Herpes simplex virus infection", "E: Toxocariasis" ]

D: Herpes simplex virus infection

830

oct-16-2014

What is the diagnosis in this patient with axillary lymphadenopathy?

yes

24%

12%

54%

4%

6%

92629

0.058

6b0929d9f3abaae61fe3f7c3497543bf

[ "A: Bacterial felon", "B: Erysipelas", "C: Herpetic whitlow", "D: Paronychia", "E: Scabies" ]

C: Herpetic whitlow

831

oct-17-2013

What serologic test is most likely to be positive in this patient?

yes

42%

16%

13%

19%

10%

97173

0.085

2f5ab1d1f0b84671cae7485e0d4370f0

[ "A: Anticentromere antibody", "B: Anti-double stranded DNA", "C: Anti-ribonucleoprotein antibody", "D: Anti-Ro antibody", "E: Anti-Smith antibody" ]

A: Anticentromere antibody

832

oct-17-2019

A 77-year-old woman presented to a clinic with a 2-year history of slowly progressive, painful swelling of her fingertips. Physical examination of the hands showed thickening of the skin on her right hand as well as soft-tissue swelling of the tips of the fingers of both hands. A plain radiograph of the hands is shown....

yes

17%

48%

11%

7%

16%

73023

0.068

e986d94b56b26b9c98ff4944087866f8

[ "A: Tophaceous gout", "B: Calcinosis", "C: Metastatic chondrosarcoma", "D: Vitamin D toxicity", "E: Myositis ossificans" ]

B: Calcinosis

833

oct-18-2007

What is the diagnosis?

no

8%

48%

11%

24%

10%

107449

0.071

fc6fcafa536fa4be1aea39959befe07d

[ "A: Graves' ophthalmopathy", "B: Retinal detachment", "C: Choroidal melanoma", "D: Ocular implant", "E: Angle closure glaucoma" ]

B: Retinal detachment

834

oct-18-2012

What presentation is most likely to accompany this angiographic finding?

yes

59%

10%

15%

5%

11%

69384

0.043

a215bf2244e86e07bcd845aedff0dfb7

[ "A: Binocular visual loss", "B: Hemineglect", "C: Paratonic rigidity", "D: Urinary incontinence", "E: Verbal agnosia" ]

A: Binocular visual loss

835

oct-18-2018

A 35-year-old male presented to the emergency psychiatry service with paranoid delusions and was found to have patchy, irregular alopecia of the scalp. What is the most likely diagnosis?

yes

8%

14%

43%

26%

10%

108080

0.086

036bb9e3478336f7252c72fee56ce8cb

[ "A: Androgenic alopecia", "B: Central centrifugal cicatricial alopecia", "C: Syphilitic alopecia", "D: Trichotillomania", "E: Hypothyroidism" ]

C: Syphilitic alopecia

836

oct-19-2006

This patient presented with lower extremity edema. What is the diagnosis?

yes

11%

6%

65%

10%

8%

76169

0.031

229e3b0cab09b000d4edebf1d31f7b7c

[ "A: Cardiac amyloidosis", "B: Mitral stenosis", "C: Constrictive pericarditis", "D: Left ventricular aneurysm", "E: Mediastinal lymphoma" ]

C: Constrictive pericarditis

837

oct-19-2017

An 11-year-old boy was brought to the emergency department with epistaxis and severe nasal pain. What is the likely diagnosis?

yes

1%

2%

7%

17%

73%

59920

0.021

be2bf336fbf591f6c7baa777db880f6f

[ "A: Nasal polyps", "B: Nasal septum fracture", "C: Pills in the nasal cavity", "D: Coins in the nasal cavity", "E: Button magnets in the nasal cavity" ]

E: Button magnets in the nasal cavity

838

oct-19-2023

An 8-year-old girl was brought to the dermatology clinic with a 3-day history of painful lip crusting, oral ulcers, rash, and genital pain. Ten days before presentation, a fever and cough had developed. She had no history of medication use. Physical examination was notable for conjunctivitis in both eyes and ulcers in ...

yes

18%

11%

13%

37%

22%

52967

0.101

367ed218f7f1f240eb6e5616121f5996

[ "A: Administration of systemic glucocorticoids", "B: Allergy/immunology consultation", "C: Skin biopsy", "D: Testing for bacterial and viral respiratory pathogens", "E: Testing for herpes simplex virus" ]

D: Testing for bacterial and viral respiratory pathogens

839

oct-20-2005

What process is illustrated in the radiograph?

yes

29%

15%

31%

10%

85114

0.123

255cefbfec1e3ea9dab175d080189f8c

[ "A: Paget's disease", "B: Osteopetrosis", "C: Hyperparathyroidism", "D: Bone marrow hyperplasia", "E: Acromegaly" ]

D: Bone marrow hyperplasia

840

oct-20-2011

What is the diagnosis?

no

5%

66%

6%

4%

18%

104319

0.031

a6a8040c6c3307b723a40b8974632b43

[ "A: Bowenoid papulosis", "B: Condyloma acuminatum", "C: Molluscum contagiosum", "D: Seborrheic keratosis", "E: Verrucous carcinoma" ]

B: Condyloma acuminatum

841

oct-20-2016

A 51-year-old male with diabetes presented with 2 weeks of general malaise and fever. What is the diagnosis?

yes

6%

69%

7%

8%

10%

75413

0.024

7e7c19c8c8287168bda6193a529e3bb7

[ "A: Small bowel obstruction", "B: Emphysematous pyelonephritis", "C: Paralytic ileus", "D: Renocolic fistula", "E: Splenic abscess" ]

B: Emphysematous pyelonephritis

842

oct-20-2022

A 37-year-old man presented to the emergency department with a 1-week history of pain and swelling in the left upper arm that had started after blunt trauma during soccer practice. The heart rate was 120 beats per minute, the blood pressure 96/54 mm Hg, and the body temperature 37.9°C. Examination of the left upper arm...

yes

81%

7%

4%

3%

6%

31338

0.009

7a9aee4c5b9be352663de0328b7483f8

[ "A: Delay in surgical intervention >24 hours", "B: Involvement of the upper extremity", "C: Negative Blood Cultures", "D: Patient age <60 years", "E: Presence of erythema" ]

A: Delay in surgical intervention >24 hours

843

oct-21-2010

This patient had hypertension. What is the diagnosis?

yes

8%

44%

10%

29%

8%

88051

0.084

ea7c106cbfab5a84a7003acfdb5565c7

[ "A: Coarctation of the aorta", "B: Pheochromocytoma", "C: Primary hyperaldosteronism", "D: Renal artery stenosis", "E: Systemic sclerosis" ]

B: Pheochromocytoma

844

oct-21-2021

A 49-year-old woman, who had undergone kidney transplantation 4 months earlier, presented to the emergency department with a 2-week history of headache, dizziness, and rash. On exam she had diffuse, umbilicated papules. What is the most likely pathogen?

yes

17%

38%

14%

22%

9%

54394

0.098

071202b521b941fab80bb0f01c91e045

[ "A: Blastomyces dermatitidis", "B: Cryptococcus neoformans", "C: Histoplasma capsulatum", "D: Molluscum contagiosum", "E: Mycobacterium tuberculosis" ]

B: Cryptococcus neoformans

845

oct-22-2009

What is the diagnosis?

no

8%

6%

34%

9%

43%

116309

0.128

9f5eef0026021a67370aaa767b32fc0c

[ "A: Brachial plexopathy", "B: Clavicular fracture", "C: Lipodystrophy", "D: Polyostotic fibrous dysplasia", "E: Rupture of the trapezius muscle" ]

C: Lipodystrophy

846

oct-22-2015

Which of the following is incorrect statement related to painful vesicular toe rash of 3 months' duration?

yes

12%

14%

10%

50%

99938

0.063

f0c13830fec5783a00a96583d08b7c56

[ "A: Infection is associated with immunosuppressant use.", "B: Infection is typically localized to the site of inoculation.", "C: Transmission occurs with contaminated water contact.", "D: Infection may travel along the lymphatic system leading to lymphangitis.", "E: Transmission is associated with aerosoliz...

E: Transmission is associated with aerosolized contaminated soil exposure.

847

oct-22-2020

A 4-month-old boy who was exclusively breast-fed presented to the clinic with a 6-week history of a worsening rash. Physical examination revealed extensive erosive plaques throughout the body. What is the diagnosis?

yes

13%

19%

16%

38%

15%

107688

0.097

4cf522f672729dfb7407ca0e8d067dcf

[ "A: Atopic dermatitis", "B: Epidermolysis bullosa", "C: Stevens-Johnson Syndrome", "D: Zinc deficiency", "E: Erythema infectiosum" ]

D: Zinc deficiency

848

oct-23-2008

What is the diagnosis?

no

11%

7%

18%

3%

61%

126239

0.04

7e5913b5cea165c7cad903d0cc826a2e

[ "A: Chronic paronychia", "B: Dermatomyositis", "C: Selenium deficiency", "D: Rheumatoid arthritis", "E: Psoriasis" ]

E: Psoriasis

849

oct-23-2014

What is the diagnosis in this asymptomatic male from North Africa?

yes

53%

12%

9%

11%

15%

84553

0.056

160ed3a42c77ffd3802c402c8d5d6c49

[ "A: Cutaneous leishmaniasis", "B: Myiasis", "C: Paronychia", "D: Syphilis", "E: Yaws" ]

A: Cutaneous leishmaniasis

850

oct-24-2013

What is the diagnosis in this patient who had a relative afferent pupillary defect?

yes

12%

28%

22%

8%

31%

89731

0.137

5d60bc4acb629945f9fb9898b0a49bdb

[ "A: Multiple sclerosis", "B: Retinal ischemia", "C: Retinitis pigmentosa", "D: Toxoplasmosis", "E: Wilson's disease" ]

B: Retinal ischemia

851

oct-24-2019

A previously healthy 36-year-old woman presented to the infectious diseases clinic with a 3-day history of fever, arthralgias, myalgias, and headache. She denied any recent travel or new sexual partners but admitted to having a pet rat. Physical examination revealed swollen and tender joints as well as a maculopapular ...

yes

10%

41%

18%

17%

14%

107809

0.088

785672d2716d9e50b671ad3bfc5ea918

[ "A: The plague", "B: Rat bite fever", "C: Leptospirosis", "D: Tularemia", "E: Hantavirus" ]

B: Rat bite fever

852

oct-25-2007

This patient presented with a 10-day history of left foot discoloration that resolved with elevation. What is the most likely diagnosis?

yes

14%

33%

9%

13%

31%

142697

0.118

db5a223093f2d64b3ea1876a27990d80

[ "A: Angioneurotic edema", "B: Arterial insufficiency", "C: Erysipelas", "D: Peripheral microembolization", "E: Phlegmasia cerulea dolens" ]

B: Arterial insufficiency

853

oct-25-2012

What is the diagnosis?

no

12%

22%

8%

5%

53%

80598

0.059

7fcda34829f3f183cbec3b88b94db3e0

[ "A: Addison's disease", "B: Arsenic poisoning", "C: Carotenemia", "D: Glaucoma", "E: Ochronosis" ]

E: Ochronosis

854

oct-25-2018

A 52-year-old man presented to the emergency department with painless, bloody tears from both eyes. The bleeding had begun spontaneously approximately 2 hours earlier, had lasted a few minutes, and had recurred just before presentation. He was taking captopril for mild hypertension, and his blood pressure was normal. T...

yes

18%

14%

36%

10%

22%

188375

0.104

e1cb427cf2371d5c495508926bd7a845

[ "A: Hemangioma", "B: Infection", "C: Adverse reaction to systemic antibiotics", "D: Trauma to eye or surrounding structures", "E: Retrograde epistaxis" ]

C: Adverse reaction to systemic antibiotics

855

oct-26-2006

These lesions were neither pruritic nor painful. What is the diagnosis?

yes

16%

7%

10%

56%

12%

84756

0.05

31c5e126e851423f2efb55ef2427da99

[ "A: Pyoderma gangrenosus", "B: Phlegmasia cerulea dolens", "C: Pretibial myxedema", "D: Necrobiosis lipoidica diabeticorum", "E: Erythema nodosum" ]

D: Necrobiosis lipoidica diabeticorum

856

oct-26-2017

A 62-year-old woman presented to the breast-surgery clinic with stiffness of the left nipple. Palpation of the left breast, mammography, and ultrasonography revealed no abnormalities. A pigmented macule that measured 5 mm was noted on the left areola. What is the diagnosis?

yes

5%

11%

36%

37%

11%

134811

0.111

2d56a0371336bbd5f4c11d72a7c8aa44

[ "A: Inflammatory mastitis", "B: Traumatic fat necrosis", "C: Cutaneous malignant melanoma", "D: Invasive ductal carcinoma", "E: Blue nevus" ]

D: Invasive ductal carcinoma

857

oct-26-2023

An 83-year-old woman with a history of type 2 diabetes mellitus presented with a 4-month history of a pruritic rash on her back. Physical examination showed a linear array of crateriform lesions containing crusted material on an erythematous base. A skin biopsy showed a cup-shaped ulceration with transepidermal elimina...

yes

9%

6%

19%

47%

19%

25007

0.073

1eef9d979bf552e0cf4a6e7143e84cd9

[ "A: Dermatofibroma", "B: Folliculitis", "C: Keratoacanthoma", "D: Reactive perforating collagenosis", "E: Prurigo nodularis" ]

D: Reactive perforating collagenosis

858

oct-27-2005

The pictured patient suffered a traumatic head injury. What underlying diagnosis is suggested by the examination findings?

yes

27%

28%

5%

26%

14%

94567

0.14

d469aa9d3501668c04912beb72f36b32

[ "A: Skull fracture", "B: Infratentorial hemorrhage", "C: Intraorbital foreign body", "D: Uncal herniation", "E: Carotid dissection" ]

A: Skull fracture

859

oct-27-2011

What is the diagnosis?

no

13%

16%

12%

49%

10%

108426

0.065

b8528bd50a638e71a6ffeabff958b7e6

[ "A: Aphthous stomatitis", "B: Foliate papillae", "C: Fordyce granules", "D: Herpes zoster", "E: Syphilis" ]

D: Herpes zoster

860

oct-27-2016

A 53-year-old woman presented with intensely itchy skin lesions and burning in her mouth. The following appearances are noted on examination of her wrist. What is the diagnosis?

yes

15%

60%

9%

7%

96302

0.041

c157d4b087a4b6a438b0a6735d3c9fc2

[ "A: Lichen sclerosus", "B: Lichen planus", "C: Psoriasis", "D: Eczema", "E: Tinea cruris" ]

B: Lichen planus

861

oct-27-2022

A 75-year-old man presented to the emergency department with a 6-month history of epigastric pain, watery diarrhea, and weight loss. Esophagogastroduodenoscopy revealed severe esophagitis, antral erosions, and duodenal ulcers (left). The gastric pH was below 2, and a fasting serum gastrin level was above 1000 pg per mi...

yes

10%

44%

18%

15%

12%

32210

0.079

25a3ac64b75631d25edcffdff906ab24

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

B: Multiple endocrine neoplasia type 1

862

oct-28-2010

This patient was found to have new-onset hyperglycemia. What is the diagnosis?

yes

16%

42%

12%

21%

8%

106225

0.085

b88b269da4cb99e9957da3bc318671e7

[ "A: Hemochromatosis", "B: Necrolytic migratory erythema", "C: Psoriasis", "D: Scleredema of diabetes", "E: Tinea versicolor" ]

B: Necrolytic migratory erythema

863

oct-28-2021

A 26-year-old woman presented with recurrent hemoptysis coinciding with her menstrual cycles. Noncontrast computed tomography (CT) imaging of the lungs showed a cavitary nodule with ground-glass appearance in the right lower lobe. What is the most likely diagnosis?

yes

3%

7%

3%

4%

83%

38302

0.007

c1c2aa4eea181c764a24010712c36f78

[ "A: Accessory breast tissue", "B: Catamenial pneumothorax", "C: Ectopic pregnancy", "D: Progestogen hypersensitivity", "E: Thoracic endometriosis" ]

E: Thoracic endometriosis

864

oct-29-2009

What is the diagnosis?

no

77%

9%

7%

5%

3%

111818

0.014

215c7cbafd77817a9a6f9ff9ae190b5d

[ "A: Lipoatrophy", "B: Myositis ossificans", "C: Rhabdomyolysis", "D: Sarcoma", "E: Syphilitic gumma" ]

A: Lipoatrophy

865

oct-29-2015

Which one of the following choices would be the least useful diagnostic test for this heel ulcer of 2 years' duration?

yes

12%

18%

12%

44%

13%

124378

0.078

c8a463ab128d0d087de1b7031376ede2

[ "A: Hemoglobin A1c", "B: Skin biopsy", "C: Duplex ultrasound of the lower extremity", "D: Wound culture", "E: Ankle-brachial index" ]

D: Wound culture

866

oct-29-2020

A 73-year-old woman with rheumatoid arthritis presented with a 1-month history of pain in her right eye. She had stopped immunosuppressive treatment a few years earlier. There was no recent history of trauma. Slit-lamp examination showed hyperemia, inflammation, and marked scleral thinning with exposure of the underlyi...

yes

88%

4%

3%

2%

3%

47199

0.004

589bf59b7dcaf8e80e5ea755cdf202e1

[ "A: Necrotizing anterior scleritis", "B: Posterior scleritis", "C: Hyphema", "D: Conjuctival hemorrhage", "E: Acute angle closure glaucoma" ]

A: Necrotizing anterior scleritis

867

oct-30-2008

This man had cervical adenopathy. What is the most likely diagnosis?

yes

12%

10%

20%

52%

6%

153611

0.06

693f4c3a02c51d1b3843c9c04f781f02

[ "A: Arteriovenous malformation", "B: Cellulitis", "C: Graves' disease", "D: Lymphoma", "E: Orbital fracture" ]

D: Lymphoma

868

oct-30-2014

What is the most likely diagnosis in this patient who had suffered a blunt head trauma 2 months earlier?

yes

9%

50%

14%

25%

2%

94622

0.068

727e07d58073417d63bc6409779801e5

[ "A: Acute angle-closure glaucoma", "B: Carotid cavernous fistula", "C: Ocular lymphoma", "D: Periorbital cellulitis", "E: Thyroid ophthalmopathy" ]

B: Carotid cavernous fistula

869

oct-31-2013

What is the diagnosis in this patient who had abdominal pain?

yes

4%

72%

6%

7%

10%

74766

0.02

b155216b95cc5b6280c58b86673f7c39

[ "A: Familial Mediterranean fever", "B: Henoch-Schönlein purpura", "C: Meningococcemia", "D: Polyarteritis nodosa", "E: Rocky Mountain spotted fever" ]

B: Henoch-Schönlein purpura

870

oct-31-2019

A 52-year old man presented to the clinic with a bleeding mass on his right great toe. Two months earlier, the patient had noticed a pink nodule on the dorsum of the toe. One month later, his toe was stepped on, after which the nodule grew rapidly and bled intermittently. On examination, the lesion was red and ulcerate...

yes

4%

13%

8%

13%

62%

58981

0.037

cfebc84d9bdaee9e9ec65ce19377a5ae

[ "A: Tophaceous gout", "B: Subungual hematoma", "C: Neurofibroma", "D: Subungual exostosis", "E: Acral lentiginous melanoma" ]

E: Acral lentiginous melanoma

871

sep-01-2011

Which one of the following medications is most likely to be responsible for this appearance?

yes

11%

8%

34%

21%

27%

103376

0.114

cff1b72ca72454b1aae62651dd7fec14

[ "A: Clarithromycin", "B: Dexamethasone", "C: Doxorubicin", "D: Efavirenz", "E: Ferrous sulfate" ]

C: Doxorubicin

872

sep-01-2016

A 64-year-old man presented with a two-year history of this asymptomatic skin condition, which was symmetrically distributed over his trunk, arms and legs. Laboratory tests demonstrated a raised fasting blood glucose level. What is the most likely diagnosis?

yes

5%

15%

10%

8%

63%

88642

0.036

fedb5b58c5d9b45ff4a05d49c1297a2c

[ "A: Chronic urticaria", "B: Pityriasis rosea", "C: Cutaneous sarcoidosis", "D: Systemic lupus erythematosus", "E: Generalized granuloma annulare" ]

E: Generalized granuloma annulare

873

sep-01-2022

A 59-year-old woman was admitted to the hospital with unheralded syncope. She had lost a son to sudden cardiac death when he was 29 years of age. On hospital day 2, the patient developed sustained monomorphic ventricular tachycardia treated with synchronized cardioversion and intravenous amiodarone. An electrocardiogra...

yes

63%

16%

5%

8%

28322

0.036

cbbf7de65581ac86854bb277b6eb91de

[ "A: Arrhythmogenic right ventricular cardiomyopathy", "B: Brugada Syndrome", "C: Cardiac sarcoidosis", "D: Inferior Myocardial Infarction", "E: Pulmonary Embolism" ]

A: Arrhythmogenic right ventricular cardiomyopathy

874

sep-02-2010

This 20-year-old man was evaluated for fever. What is the diagnosis?

yes

19%

14%

4%

17%

46%

89317

0.076

862e56a185a4ba6196357efc8e0799c6

[ "A: Allergic bronchopulmonary aspergillosis", "B: Cystic fibrosis", "C: Primary hyperparathyroidism", "D: Sarcoidosis", "E: Tuberculosis" ]

E: Tuberculosis

875

sep-02-2021

A 7-year-old girl presented with an itchy rash while taking amoxicillin for pharyngitis. Physical exam showed purulent tonsils, along with a maculopapular rash involving her face, trunk, arms, and legs. What is the most likely diagnosis?

yes

68%

2%

4%

16%

9%

55598

0.028

f24c2c91db697d990b0601dc8767adf1

[ "A: Amoxicillin rash in infectious mononucleosis", "B: Guttate psoriasis", "C: Hand, foot, and mouth disease", "D: Scarlet fever", "E: Serum sickness-like reaction" ]

A: Amoxicillin rash in infectious mononucleosis

876

sep-03-2009

This patient with a history of rheumatoid arthritis presented with a several-month history of a painful left calf. What is the diagnosis?

yes

47%

20%

4%

19%

10%

115605

0.074

2971115222619f96e16b46b78368022e

[ "A: Baker's cyst", "B: Gastrocnemius tear", "C: Meniscal cyst", "D: Lipoblastoma", "E: Septic arthritis" ]

A: Baker's cyst

877

sep-03-2015

Which of the following is the most likely diagnosis for this incidental finding on an MRI?

yes

9%

15%

4%

5%

67%

87353

0.029

d703f549626d5261ad394df2917cac05

[ "A: Type 1 Chiari malformation", "B: Cavernous angioma", "C: Asymptomatic cortical infarct", "D: Aneurysm", "E: Arachnoid cyst" ]

E: Arachnoid cyst

878

sep-03-2020

A 44-year-old man presented with confusion and a cough a few days after swimming in an indoor pool. At presentation, he had a body temperature of 39.8°C and appeared drowsy. He did not respond to questions or blink to visual threat; however, brainstem reflexes were intact, and he withdrew both arms and both legs from p...

yes

17%

49%

18%

9%

6%

56703

0.067

22e420f0ee188da1a2dfa3195104430e

[ "A: Mycobacterium marinum", "B: Naegleria fowleri", "C: Legionella pneumophila", "D: Sappinia diploidea", "E: Escherichia coli" ]

B: Naegleria fowleri

879

sep-04-2008

This worm was identified in an endotracheal aspirate of a patient with pulmonary infiltrates. What is the infecting organism?

yes

45%

4%

7%

36%

8%

130441

0.125

059c441de70cf72f905330b762a6ad0f

[ "A: Ascaris lumbricoides", "B: Clonorchis sinensis", "C: Paragonimus westermani", "D: Strongyloides stercoralis", "E: Toxoplasma gondii" ]

D: Strongyloides stercoralis

880

sep-04-2014

What is the diagnosis?

no

8%

9%

52%

6%

26%

82342

0.063

9791c1ee444e7d171426386fb18ff928

[ "A: Aerophagia", "B: Congenital diaphragmatic hernia", "C: Duodenal atresia", "D: Gastroschesis", "E: Hypertrophic pyloric stenosis" ]

C: Duodenal atresia

881

sep-05-2013

What is the diagnosis?

no

22%

13%

6%

17%

41%

76370

0.089

1e3a255d3cb85635f2e6b3b554e7dcb8

[ "A: Cholesteatoma", "B: Glomus tumor", "C: Suppurative otitis media", "D: Serous otitis media", "E: Tympanic hyperectasis" ]

E: Tympanic hyperectasis

882

sep-05-2019

A 29-year-old man with a history of aplastic anemia, who was being treated with cyclosporine, presented to the emergency department with a 4-day history of fever, cough, and difficulty breathing at rest. One day before the onset of symptoms, a pruritic rash had developed on his face, trunk, and limbs. On physical exami...

yes

12%

53%

8%

14%

13%

91259

0.056

50963937d60e970db46c0eb1e6e1de4d

[ "A: Eosinophilic granulomatosis with polyangiitis", "B: Disseminated varicella infection", "C: Disseminated intravascular coagulation", "D: Drug-induced hypersensitivity syndrome", "E: Immune thrombocytopenic purpura" ]

B: Disseminated varicella infection

883

sep-06-2007

What is the diagnosis?

no

5%

3%

65%

9%

19%

136678

0.034

2976c8efdd605d7db44d757c31ab7ebb

[ "A: Cutis laxa", "B: Turner's syndrome", "C: Ehlers-Danlos syndrome", "D: Pseudoxanthoma elasticum", "E: Marfan syndrome" ]

C: Ehlers-Danlos syndrome

884

sep-06-2012

What is the diagnosis?

no

57%

16%

6%

12%

8%

87258

0.047

d28b30888fda7df9a49caf330cb54165

[ "A: Bedbug bites", "B: Dermatitis herpetiformis", "C: Ecthyma", "D: Guttate psoriasis", "E: Lichen planus" ]

A: Bedbug bites

885

sep-06-2018

A 58-year-old man presented to the outpatient pulmonary clinic with a productive cough and a history of weight loss of 10 kg during the preceding 3 months. He was an active smoker and for the preceding 4 years had worked in a factory processing cotton.

yes

16%

44%

15%

13%

61353

0.079

85eac561e8f36cb3414debaa914607ac

[ "A: Nocardiosis", "B: Actinomycosis", "C: Aspergillosis", "D: Histoplasmosis", "E: Blastomycosis" ]

B: Actinomycosis

886

sep-07-2006

What is the diagnosis?

no

20%

42%

16%

13%

10%

104424

0.174

6ae8277f8338a93d38f3932d2487c584

[ "A: Cardiac tamponade", "B: Tension hydrothorax", "C: Diaphragmatic eventeration", "D: Pulmonary hydatid disease", "E: Lymphangioleiomyomatosis" ]

A: Cardiac tamponade

887

sep-07-2017

A 41-year-old man presented with progressive loss of vision in both eyes. Physical examination was notable for pectus excavatum and elongated digits. His uncorrected visual acuity was 6/200 in the right eye and 20/100 in the left eye. What is the diagnosis?

yes

6%

15%

70%

4%

6%

56775

0.024

db2d3f2cabb5ec7d534b819a90b24be4

[ "A: Pseudoexfoliation glaucoma", "B: Retinal detachment", "C: Ectopia lentis", "D: Traumatic cataract", "E: Iridocyclitis" ]

C: Ectopia lentis

888

sep-07-2023

A 34-year-old man presented to the emergency department with a 10-day history of shortness of breath that worsened when he bent forward or laid supine and abated when he sat upright. His respiratory rate was 36 breath per minute, and his oxygen saturation was 98% when sitting upright and 88% when supine in room air. On...

yes

15%

14%

42%

13%

17%

42830

0.085

b75e15cee7cde57e25a63bbc4865a496

[ "A: Chest radiography", "B: Measurement of inspiratory pressures", "C: Polysomnography", "D: Pulmonary function tests", "E: Ultrasonography of the diaphragm" ]

C: Polysomnography

889

sep-08-2011

Polarized microscopical examination of a specimen from a patient's elbow revealed what type of crystals?

yes

8%

17%

22%

7%

47%

82035

0.074

a0da4ff46a17cdbe8016ec5d1a468628

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

E: Monosodium urate

890

sep-08-2016

An 88-year-old man with a history of a quadruple coronary-artery bypass grafting procedure and transapical transcatheter aortic-valve replacement presented with this skin condition. What is the cause of this appearance?

yes

10%

21%

7%

50%

11%

118603

0.064

f397560d3867342cc65d5cf7375e621c

[ "A: Warfarin necrosis", "B: Subacute bacterial endocarditis", "C: Cryoglobulinaemia", "D: Cholesterol embolization", "E: Heparin-induced thrombocytopenia" ]

D: Cholesterol embolization

891

sep-08-2022

A 79-year-old woman with a history of prior stroke was referred for an abnormal X-ray finding along the left heart border, first noticed 6 years prior. In the absence of symptoms, the patient was monitored with serial radiographs which showed a gradual increase in size of the finding. Which of the following is the most...

yes

40%

17%

9%

23%

11%

60473

0.092

7d5341e78de224e5875e02ce60699fb5

[ "A: Giant Coronary Aneurysm", "B: Left Atrial Appendage Thrombus", "C: Mediastinal Hematoma", "D: Pericardial Cyst", "E: Teratoma" ]

A: Giant Coronary Aneurysm

892

sep-09-2010

What laboratory evaluation is most likely to be abnormal in this 10-year-old patient who also had discrete facial erythema?

yes

15%

32%

26%

6%

21%

105023

0.12

23337a95f6ae2d7c2839d52d4102e964

[ "A: CD4 count", "B: Creatine kinase", "C: Rheumatoid factor", "D: Thyrotropin", "E: Zinc" ]

B: Creatine kinase

893

sep-09-2021

A 50-year-old man presented with a lesion on his eye that developed over the preceding month. He also had violaceous plaques on his back and lower limbs. Testing for HIV was positive. What is the diagnosis?

yes

9%

11%

53%

16%

56036

0.056

f61a6baafd6b9f778328b24b84b53132

[ "A: Angiosarcoma", "B: Bacillary angiomatosis", "C: Herpes simplex keratoconjunctivitis", "D: Kaposi’s sarcoma", "E: Ocular surface squamous neoplasia" ]

D: Kaposi’s sarcoma

894

sep-10-2009

Which one of the following medications is most characteristically associated with the illustrated finding?

yes

13%

21%

16%

8%

42%

124550

0.086

eab479d6540bb2ecbf038a9ee7d2c70b

[ "A: Alendronate", "B: Carbamazepine", "C: Imatinib", "D: Ropinirole", "E: Zidovudine" ]

E: Zidovudine

895

sep-10-2015

Which of the following conditions is NOT commonly associated with this finding?

no

17%

11%

47%

10%

15%

119460

0.071

6be27f098e4dbea17b20c745477e814f

[ "A: Chronic liver disease", "B: Cutaneous collagenous vasculopathy", "C: Hemophilia A", "D: CREST syndrome", "E: Rosacea" ]

C: Hemophilia A

896

sep-10-2020

A 62-year-old man presented to the emergency department with a 1-day history of fever and 3-day history of chest pain. He had a history of coronary artery disease and splenectomy. On examination, he had three dog-bite wounds on his left hand. Laboratory studies revealed a white-cell count of 16,700 per cubic millimeter...

yes

17%

40%

21%

11%

59753

0.091

eb782402a6cdb75da0b314788b6932c1

[ "A: Pasteurella multocida", "B: Capnocytophaga canimorsus", "C: Pasteurella canis", "D: Babesia microti", "E: Bacillus anthracis" ]

B: Capnocytophaga canimorsus

897

sep-11-2008

What is the diagnosis?

no

24%

15%

10%

35%

15%

134549

0.107

18910b955dd47b2f484a7115149d5c14

[ "A: Aspiration pneumonia", "B: Sarcoidosis", "C: Silicosis", "D: Idiopathic pulmonary fibrosis", "E: Lymphangioleiomyomatosis" ]

D: Idiopathic pulmonary fibrosis

898

sep-11-2014

What is the diagnosis?

no

5%

6%

3%

82%

4%

94533

0.008

332cc563750ad66dd9f203da27125607

[ "A: Angioedema", "B: Cardiac tamponade", "C: Necrotizing fasciitis", "D: Superior vena cava syndrome", "E: Toxic epidermal necrolysis" ]

D: Superior vena cava syndrome

899

sep-12-2013

What is the diagnosis in this 70-year-old patient who developed bilateral fluctuant masses over each elbow?

yes

38%

10%

22%

20%

82187

0.099

d2260a78a689984cf75351fe86111dc5

[ "A: Gout nodulosis", "B: Lipoma", "C: Medial epicondylitis", "D: Pseudogout", "E: Rheumatoid nodules" ]

A: Gout nodulosis

900

sep-12-2019

A 60-year-old woman presented to the emergency department with a 2-month history of blurry vision in her left eye. Her medical history was notable for breast cancer treated 3 years earlier with lumpectomy, axillary-node dissection, radiation, and hormonal therapy. Physical exam on upward gaze is demonstrated. What is t...

yes

53%

13%

23%

3%

8%

84803

0.06

e0b9d5424434235de75493ceda1afc3c

[ "A: Orbital metastasis", "B: Unilateral Grave's ophthalmopathy", "C: Partial cranial nerve 3 palsy", "D: Orbital cellulitis", "E: Idiopathic orbital inflammatory disease" ]

A: Orbital metastasis