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Which quadrant of the image contains the primary finding? A. Upper left quadrant B. Upper right quadrant C. Lower left quadrant D. Lower right quadrant
I examine the circular image to identify the prominent labeled structure. The text label "Rotator Cuff" is visible near the top portion of the image and points to a cluster of tendon-like, braided structures. Next, I divide the circular view mentally into four quadrants (upper left, upper right, lower left, lower righ...
B
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An adult with subacute respiratory symptoms received a trial of antibiotics without clinical improvement. After initiation of moderate-dose glucocorticoids the patient improved within several days. Based on the CT image shown and this clinical course, which of the following diagnoses is most likely? A. Acute fibrinous...
I examine the CT image. The axial lung-window image shows bilateral, patchy areas of increased lung attenuation consistent with consolidation and ground-glass change, with a peripheral and lower-lung predominance; there is preserved intervening aerated lung and no dense focal lobar consolidation or large pleural effusi...
A
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Which underlying mechanism best explains MRI's superior soft-tissue delineation of the prostate compared with CT? A. Differences in proton relaxation times (T2-weighted contrast) B. Higher inherent spatial resolution than CT C. Dependence on intravenous contrast enhancement D. Use of ionizing radiation for improved co...
I examine the image for how the prostate and surrounding tissues appear. The axial pelvic scan shows a clearly delineated prostate with differing signal intensities between the gland and adjacent structures; tissue boundaries are well defined by variation in signal rather than by brightness from an injected agent. Nex...
A
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Over 4 months following an exacerbation of left iliac fossa pain, a patient is scheduled for operative management after outpatient evaluation. Prior to surgery, which empiric intravenous antibiotic regimen is most appropriate? A. Piperacillin–tazobactam IV B. Metronidazole IV alone C. Vancomycin IV plus cefepime IV D....
I examine the provided CT image. I see a well-defined, rim-enhancing, multiloculated fluid collection in the left lower abdomen/pelvis (left iliac fossa) with internal air-fluid levels and gas locules, and the collection abuts pelvic structures. These imaging features are most consistent with an infected/abscessed proc...
A
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How many distinct lesions are visible on this image? A. None B. One C. Two D. Three or more
I examine the ultrasound image for focal abnormalities. I see a single, discrete hypoechoic (darker) focal lesion in the superficial tissue near the top/center of the image. The lesion is clearly demarcated from surrounding echogenic tissue and is the only distinct mass-like structure visible. Next, I relate these fin...
B
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Which cardiac valve is visualized in this image? A. Mitral valve B. Tricuspid valve C. Aortic valve D. Pulmonary valve
I examine the image for anatomic and device landmarks. This is a 3D echocardiographic view showing a circular/oval valvular orifice with leaflet tissue in the center and a continuous implant attached around part of the annulus; two annotations in the image label a "Cardioband implant" and a "Cardioband delivery system"...
A
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How many discrete focal areas are present on this image? A. 0 B. 1 C. 2 D. 3
I examine the axial PET-CT image for discrete focal areas of increased tracer uptake. I look systematically across the field of view (both axillae, neck base and mediastinal regions visible on this slice) to identify distinct, localized hotspots. Next, I relate these observations to the question, which asks for the nu...
B
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Based on this image, are the findings normal or abnormal? A. Normal B. Abnormal
I examine the image carefully. This is an axial MRI through the pelvis. Bone anatomy appears symmetric, but there is a focal abnormality indicated by the arrow: a region of increased signal intensity (bright) within the pelvic soft tissues. Next, I describe what I see around that focal bright area: there are streaky/l...
B
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Which region of the displayed image best localizes the finding? A. Central (midline/deep) region of image B. Upper left quadrant of image C. Upper right quadrant of image D. Lower left quadrant of image E. Lower right quadrant of image
I examine the coronal brain image for the location of the abnormal signal. I note symmetric, relatively bright signal changes situated deep in the cerebral hemispheres immediately adjacent to the lateral ventricles and midline structures. These signal abnormalities are focused near the center of the image rather than i...
A
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An overweight 15-year-old girl presents with severe headache and progressive visual loss with papilledema. She underwent cranial MRI as part of the diagnostic evaluation. Based on the clinical presentation and the MRI image, which diagnosis is most likely? A. Idiopathic intracranial hypertension B. Cerebral venous sin...
I examine the provided sagittal cranial MRI. The midline structures (corpus callosum, brainstem, cerebellum) are intact and I do not see a discrete mass lesion, focal intracranial abnormality, or ventriculomegaly on this view. There is no obvious space-occupying lesion causing mass effect or midline shift on this sagit...
A
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Based on this image, are the findings normal or abnormal? A. Normal B. Abnormal
I examine the axial CT image for anatomic detail and any deviations from expected uniform contrast filling. I see a round, contrast-opacified tubular structure anterior-left of the midline that contains a central, well-defined low-attenuation area that does not enhance with the surrounding contrast (white arrow). This ...
B
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A 68-year-old woman who underwent median sternotomy one year earlier has recurrent symptomatic bulging through her lower midline incision with repeated episodes relieved by manual reduction but recurring soon after. She is obese (BMI 37) and ASA class 3; hospitalization was required for recurrent incarceration and defi...
I examine the CT images. The axial and sagittal views show an anterior midline (subxiphoid) abdominal wall defect with the left hepatic lobe protruding through the defect and sitting immediately beneath/through the diaphragm and lower sternum region. The herniated liver is clearly intraperitoneal tissue passing through...
A
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Based on this image, which artery is most likely identified at the level of the knee? A. Popliteal artery B. Anterior tibial artery C. Posterior tibial artery D. Peroneal (fibular) artery
I examine the image for the location and course of the highlighted artery. The image shows a 3D vascular/bony reconstruction of both lower extremities; a single prominent artery is highlighted at the level of the knee on the right limb, positioned posterior to the distal femur and in the region behind the knee joint. ...
A
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Based on this image, is there midline shift of the cerebral hemispheres? A. Yes B. No
I examine the image for midline landmarks that indicate symmetry: the falx cerebri and the expected midline position of the lateral ventricles/septum pellucidum. I also look for asymmetric compression of sulci or mass lesions that could produce displacement. Next, I note that the falx and the midline ventricular/septa...
A
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Which pathophysiologic mechanism most likely explains these imaging findings? A. Diabetic microangiopathy causing capillary dropout B. Embolic occlusion of a major retinal artery C. Inflammatory occlusive retinal vasculitis D. Hypertensive arteriolosclerosis with focal narrowing
I examine the image for the vascular pattern and areas of perfusion. The optic disc is visible on the left, larger retinal vessels radiate outward, and between those vessels there is a fine capillary meshwork. Notably, there are patchy, irregular regions where the fine capillary network is sparse or absent, producing d...
A
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Based on this image, are the findings normal or abnormal? A. Normal B. Abnormal
I examine the axial CT image of the chest. I note a discrete, rounded soft-tissue density in the anterior/superior mediastinum just posterior to the sternum and above the heart. Next, I scrutinize the internal characteristics of that lesion: it contains numerous very high-attenuation foci clustered within the mass, w...
B
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Which of the following best describes the dominant fibrin network pattern in this image? A. Dense, highly branched network with small pores B. Loose, coarse network with large pores C. Predominantly globular fibrin aggregates D. Absent or nearly absent fibrin network
I examine the image for macroscopic and microscopic features. The field shows a green, continuous fibrillar meshwork filling most of the frame; individual fibers appear thin and interlinked, creating a pervasive, reticular pattern. The scale bar at the lower right is 25 μm, which allows assessment of pore size: the voi...
A
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Which ocular structure is most centrally located in this image? A. Fovea B. Optic disc (optic nerve head) C. Macula D. Peripheral retina
I examine the image for central landmarks: there is a clearly visible pale, circular disk near the exact center of the image from which multiple retinal blood vessels radiate outward. Two concentric rings are drawn and centered on that same pale circular area, emphasizing it as the image’s central reference point. Nex...
B
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What does the arrow indicate on this image? A. Susceptibility vessel sign (intraluminal thrombus) B. Cavernous malformation C. Cortical contusion D. Normal arterial flow void
I examine the image for the lesion indicated by the arrow. The arrow points to a linear/tubular dark (hypointense) signal located within a cortical/lateral vessel in the lateral convexity region. The abnormality is confined to the expected vessel lumen and appears distinctly darker than the surrounding brain parenchyma...
A
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Which best describes the dominant imaging pattern on this CT perfusion study? A. Small infarct core with large penumbra (perfusion mismatch) B. Large completed infarction without penumbra C. Global cerebral hypoperfusion D. Hemorrhagic transformation with mass effect
I examine the CT perfusion image for asymmetry and the color-coded perfusion patterns. I see a relatively small, focal region of markedly reduced signal (very dark/black) within one hemisphere, surrounded by a much larger area of cooler colors (blue/purple) that extend through that hemisphere, while the contralateral s...
A
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Based on this image, are the imaging findings normal or abnormal? A. Normal B. Abnormal
I examine the axial contrast-enhanced CT image at the level of the upper chest, noting the lungs, central airways, mediastinum, and chest wall structures. Next, I look for symmetry and expected appearances. The left hemithorax appears largely aerated and free of large focal soft-tissue opacities, whereas the right sid...
B
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A 70-year-old woman underwent a pelvic speculum examination. Soon afterward she developed acute clinical deterioration. A photograph from the speculum exam is available. Based on the clinical course and the image, which complication most likely explains her deterioration? A. Hypovolemic shock from vaginal hemorrhage B...
I examine the image for visible findings. The speculum view shows a dark, elongated organism adherent to the cervical os and fresh blood on the speculum and vaginal vault. The photograph therefore demonstrates an intravaginal source of bleeding at the cervix at the time of the exam. Next, I relate those observations t...
A
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Based on this image, which pathophysiologic mechanism best explains the finding? A. Bronchopulmonary sequestration (systemic arterial supply) B. Pulmonary arteriovenous malformation (arteriovenous shunt) C. Neovascular tumor supply from abdominal vessels D. Chronic embolic disease with systemic collaterals
I examine the image for the vascular finding called out by the arrow. This is a sagittal contrast-enhanced CT MIP through the chest showing the central pulmonary arterial tree and a distinct, sizeable vascular channel arising from a subdiaphragmatic/upper abdominal location and coursing upward toward the posterior left...
A
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Based on this image, which description best classifies the dominant imaging appearance? A. Focal low-signal intensity resembling cortical bone B. Well-defined high T2/ fluid-like collection C. Diffuse marrow edema/high signal D. Heterogeneous intermediate-signal soft-tissue mass
I examine the provided shoulder MR image for dominant signal abnormalities. I see a single, small, well‑circumscribed focus of very low signal intensity located at the humeral head region; this focus is markedly dark compared with the surrounding marrow and soft tissues. Next, I relate these imaging findings to the qu...
A
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Based on this image, how many p6-trimers are contained within the marked unit cell? A. One B. Two C. Three D. Four
I examine the image for repeating structural motifs. The image shows a regular honeycomb-like lattice made of hexagonal clusters; the hexameric clusters (p6-trimers) are visible as the repeating hexagonal elements. Next, I locate the marked unit cell: a white dashed rhomboid is drawn on the image and labeled with a si...
B
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Based on this image, are the findings normal or abnormal? A. Normal B. Abnormal
I examine the axial contrast-enhanced CT image at the level of the heart and main pulmonary arteries. I look for the appearance of the pulmonary arterial lumen and surrounding cardiac structures. Next, I note a well-defined, low-attenuation intraluminal filling defect occupying the right pulmonary arterial branch: the...
B
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Based on this image, which of the following is the most likely diagnosis? A. Acute appendicitis B. Meckel diverticulitis C. Crohn disease of terminal ileum D. Ovarian torsion
I examine the coronal CT image focusing on the area marked by the arrow. I see a rounded tubular, fluid-filled structure in the right lower abdomen/pelvis region. The structure has a relatively well-defined wall and there is adjacent increased soft-tissue attenuation in the surrounding fat and a small amount of nearby ...
A
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Based on this image, what is the most likely diagnosis? A. Sigmoid sinus diverticulum B. Sigmoid sinus dehiscence C. Glomus jugulare tumor D. Dural arteriovenous fistula E. Temporal bone cholesteatoma
I examine the image for anatomic and surgical findings. I see a post-auricular surgical field with retracted soft tissues and exposed temporal bone. Within the dotted oval there is loss of the normal white cortical bone and a shiny purplish surface is visible directly beneath that defect, consistent with an underlying ...
B
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On this axial CT image, which structure is located immediately anterior and to the right of the portal vein at the porta hepatis? A. Common bile duct B. Proper hepatic artery C. Portal vein D. Common hepatic artery
I examine the axial CT image to find the portal vein: I identify a relatively large, rounded vascular structure located in the posterior-central region of the hepatic hilum. Next, I look immediately anterior and slightly to the right of that vessel and note a smaller, more rounded/tubular soft-tissue structure sitting...
A
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Based on this image, which diagnosis is most likely? A. Urachal adenocarcinoma B. Primary urothelial carcinoma C. Metastatic colorectal adenocarcinoma D. Infected urachal cyst
I examine the provided sagittal CT image. The bladder is partially opacified with contrast and there is a discrete soft-tissue nodularity centered at the anterior midline region of the bladder dome (arrowed), projecting outward from the dome rather than appearing as a simple fluid collection. Next, I relate these imag...
A
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Following endoscopic sinus surgery, a patient develops acute visual loss and clinical signs of increased intraorbital pressure. Which postoperative complication best explains these clinical and imaging findings? A. Retrobulbar hematoma B. Optic neuritis C. Central retinal artery occlusion D. Carotid-cavernous fistula
I examine the image: a sagittal CT of the anterior ethmoid region with labels showing the bulla ethmoidalis (BE) and the anterior ethmoidal artery (AEA) located just posterior to the bulla. The labelled AEA is clearly adjacent to the ethmoid surgical field. Next, I relate these imaging findings to the question, which ...
A
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Based on this image, what is the most likely diagnosis? A. Pancreatic neuroendocrine tumor B. Pancreatic ductal adenocarcinoma C. Pancreatic pseudocyst D. Pancreatic metastasis (renal cell carcinoma) E. Focal chronic pancreatitis
I examine the axial CT image at the level of the pancreatic body. I see a small, round, well-circumscribed solid lesion within the pancreatic body that demonstrates relatively strong enhancement compared with the surrounding pancreatic parenchyma and adjacent bowel. The lesion does not have a cystic appearance, there i...
A
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Which of the following best describes the predominant green fluorescent signal in this image? A. Discrete nuclear puncta colocalizing with red B. Diffuse homogeneous nuclear staining C. Predominantly cytoplasmic punctate staining D. Perinuclear / nuclear envelope staining
I examine the image for the distribution of the three colors. The nuclei are shown in blue, green signal is largely confined within the nuclear boundaries, and small red foci are present in each nucleus. In the merged panels the green and red channels can be seen together, allowing assessment of overlap. Next, I relat...
A
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Based on this image, which pathophysiologic mechanism most likely explains the finding? A. Dystrophic calcification of necrotic metastatic lymph nodes B. Metastatic calcification from systemic hypercalcemia C. Psammoma-body deposition within tumor metastases D. Healed caseating granulomatous lymphadenitis
I examine the coronal CT image for the relevant abnormality. I see multiple discrete, well-defined calcified foci in the mesenteric/central abdominal nodal region adjacent to the expected course of the superior mesenteric vessels. There is also a complex soft-tissue mass in the lower abdomen/pelvis on the right side, v...
A
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Based on this image, should a neoplastic process be included in the differential diagnosis? A. Yes B. No
I examine the image: an axial contrast-enhanced CT through the upper abdomen shows a focal area of gastric wall thickening at the fundus (marked by the asterisk). Next, I characterize that finding: the thickening is focal and asymmetric with an irregular/nodular contour rather than a smooth, uniform wall thickening. T...
A
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Which of the following best describes the dominant fluorescence pattern? A. Membrane-associated (cell-border) actin staining B. Diffuse cytoplasmic actin staining C. Predominant nuclear fluorescence D. Extracellular matrix staining
I examine the image for the distribution of fluorescence signals. I see a bright green signal outlining individual cells, forming clear rings or borders around cell bodies; there is also a magenta signal localized to discrete round structures consistent with nuclei. The green signal is concentrated at the periphery of ...
A
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A patient with known small-cell lung cancer who recently received systemic therapy presents with symptoms suggestive of superior vena cava syndrome. Based on the imaging shown, which of the following prognostic statements is most likely? A. High immediate risk; needs urgent stenting B. Chronic obstruction with collate...
I examine the axial contrast-enhanced CT through the upper chest for evidence of vascular compromise. I note a bulky soft-tissue mass in the superior mediastinum (orange arrow) that lies immediately adjacent to and encases the expected course of the superior vena cava. The red arrow points to a focally narrowed SVC lum...
B
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Based on this axial contrast-enhanced CT image, which abdominal organ is seen centrally in the upper abdomen? A. Liver B. Stomach C. Pancreas D. Spleen
I examine the axial contrast-enhanced CT for orientation: the vertebral body is visible posteriorly, with large soft-tissue organs laterally on the right and left and bowel/gastric gas anteriorly. These landmarks establish the upper-abdominal axial level. Next, I relate these observations to the question, which asks w...
C
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Based on this transesophageal echocardiographic color Doppler image, which diagnosis is most likely? A. Mitral regurgitation B. Mitral stenosis C. Aortic regurgitation D. Normal valvular function
I examine the image: this is a transesophageal echocardiographic color Doppler view showing two adjacent cardiac chambers with a valve between them. I see a prominent, mosaic-colored (mixed red/blue/yellow) jet arising from the lower chamber and directed upward into the adjacent upper chamber through the atrioventricul...
A
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Based on this image, what is the most likely diagnosis? A. Locally recurrent rectal adenocarcinoma B. Primary prostate adenocarcinoma C. Anal squamous cell carcinoma D. Pelvic soft-tissue sarcoma
I examine the image for anatomic location and the treatment target. This is an axial pelvic CT with color-coded isodose lines; the highest-dose contours (red/orange) are concentrated around a curvilinear soft-tissue structure lying in the posterior midline pelvic lumen consistent with the rectum. The dose shells wrap t...
A
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Based on this image, is acute thrombosis of previously implanted drug-eluting coronary stents the most likely diagnosis? A. True B. False
I examine the angiographic image for anatomic and flow abnormalities. The study shows the left coronary circulation with multiple black arrows marking two distinct sites along coronary branches. At both marked sites there is an abrupt cutoff of contrast with little or no distal opacification beyond those points. Next,...
A
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Based on this image, are the findings normal or abnormal? A. Normal B. Abnormal
I examine the image for macroscopic features. I see a transverse section of a cardiac chamber with a conspicuous circumferential yellow layer at the outer surface consistent with fat. The myocardial wall beneath that yellow layer appears thinned in places and shows irregular, fatty-appearing streaks or pockets extendin...
B
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Which structure is indicated by the white arrow on this image? A. Anterior (bregmatic) fontanelle B. Posterior (occipital) fontanelle C. Sagittal suture D. Coronal suture
I examine the lateral skull radiograph and locate the white arrow. The white arrow points to a midline, superior-anterior area of the skull at the vertex where there is an apparent gap or radiolucent region between calvarial bones rather than a continuous suture line. Next, I relate these visual findings to the questi...
A
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Based on this image, which fascial structure is being grasped by the forceps? A. Vesicovaginal fascia B. Pubocervical fascia C. Rectovaginal fascia D. Uterosacral ligament
I examine the image for visible features. I see two fine, membranous fibrous sheets being held separately by two pairs of forceps; the layers are thin, glistening, and closely apposed, suggesting they are two leaves of a single fascial plane. Next, I relate these observations to the question, which asks which named fa...
A
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A patient has two hepatic nodules identified on prior cross-sectional imaging and is being considered for surgical resection. Which additional diagnostic test or imaging study is most appropriate to perform before resection? A. Percutaneous liver biopsy B. Gadoxetate-enhanced liver MRI C. Serum alpha-fetoprotein level...
I examine the image: an axial contrast-enhanced CT of the upper abdomen shows a well-circumscribed focal hepatic nodule at the liver periphery. The question states there are two hepatic nodules on prior cross-sectional imaging and asks what additional test or imaging is most appropriate before surgical resection. Next...
D
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Based on this CT image, which is the most likely diagnosis? A. Right-sided pleural effusion B. Left-sided pleural effusion C. Large pericardial effusion D. Right lower lobe consolidation E. Diaphragmatic hernia with bowel
I examine the axial CT image for the distribution and character of any thoracic abnormality. I see a large, homogeneous fluid-density collection filling most of one hemithorax and layering along the lateral chest wall, with a concave meniscus at its upper margin. Adjacent to this fluid collection there is compressed, d...
A
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Based on this image, are the findings normal or abnormal? A. Normal B. Abnormal
I examine the axial CT image focusing on the orbits and periorbital soft tissues. I see a large, well-demarcated abnormal soft-tissue density/collection over the orbit on one side, highlighted by an arrow. The image shows caliper measurements across this lesion (approximately 67 x 57 mm), confirming it is a sizable mas...
B
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Four weeks after a third intravitreal brolucizumab injection, a patient presents with new floaters. There is no anterior chamber inflammation on examination. Based on the imaging, what is the most appropriate next-step management? A. Conservative observation with close follow-up B. Topical corticosteroid therapy C. In...
I examine the image: the OCT B-scan shows multiple small, discrete hyperreflective round signals located in the vitreous cavity anterior to the retina (arrows), consistent with vitreous opacities corresponding to the patient’s new floaters. The retinal contour and retinal layers appear intact on this scan; there is no ...
A
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Which organ occupies the majority of the left side of this axial abdominal CT image? A. Liver B. Spleen C. Left kidney D. Stomach
I examine the axial CT image for the major soft-tissue structures on the viewer's left side. I see a large, homogeneous soft-tissue organ that spans most of the left half of the image from near midline to the lateral abdominal wall; it has a smooth rounded contour and occupies far more area on that side than any other ...
A
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Which label best describes the dominant gross appearance of the specimen? A. Large hemorrhagic necrotic cystic mass B. Solid homogeneous mass C. Well-circumscribed lipomatous lesion D. Purulent abscess
I examine the image for gross features of the specimen. The cut surface shows a large, irregular mass with striking heterogeneity: numerous dark red to black areas consistent with blood and tissue breakdown, interspersed with pale tan septa and rounder pale/yellowish cystic spaces. The surface appears disrupted and cav...
A
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Based on this image, are the findings normal or abnormal? A. Normal B. Abnormal
I examine the image: it is an axial CT slice through the upper abdomen showing the vertebral body centrally and both kidneys laterally in the retroperitoneum. Next, I inspect the left retroperitoneal region. There is a well-defined soft-tissue mass on the left side next to the kidney hilum that is not mirrored on the ...
B
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Which region of the displayed image best localizes the primary finding? A. Upper left quadrant of image B. Upper right quadrant of image C. Central region of image D. Lower left quadrant of image E. Lower right quadrant of image
I examine the axial brain image for areas of abnormal signal intensity. I see multiple hyperintense (bright) foci clustered immediately around the lateral ventricles bilaterally; these bright areas are concentrated adjacent to the ventricular margins rather than confined to one lateral or inferior quadrant. Next, I re...
C
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Which of the following best describes the dominant imaging pattern? A. Subarachnoid/sulcal hyperdensity B. Acute subdural hematoma C. Intraparenchymal hemorrhage D. Epidural hematoma
I examine the image for visible findings. This is an axial noncontrast CT of the brain. I see linear/curvilinear hyperdense material that tracks along the cortical surface and within the sulci over the frontal convexities (small arrow at the top) and a focal curvilinear hyperdensity along the cerebellar folia in the po...
A
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Based on this image, which diagnosis is most likely? A. Cardiac fibroma B. Cardiac rhabdomyoma C. Cardiac myxoma D. Cardiac fibrosarcoma
I examine the image for histologic features. I see broad, densely eosinophilic (pink/red) interlacing bundles of collagen forming a fibrous matrix; interspersed within this collagen are pale, striated islands of cardiac muscle that appear entrapped by the collagen. The fibrous areas are relatively hypocellular with onl...
A
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A 66-year-old diabetic woman presents with abdominal pain. Contrast-enhanced CT was obtained (image shown). Based on the imaging, which surgical/operative management is most appropriate? A. Urgent nephrectomy B. Percutaneous drainage plus IV antibiotics C. IV antibiotics alone D. Percutaneous nephrostomy tube placemen...
I examine the CT image provided. There is a large, loculated fluid collection adjacent to the left kidney that contains pockets of gas (arrowed), consistent with a gas-forming perinephric/intrarenal abscess. The right kidney appears unremarkable by comparison. Next, I relate these imaging findings to the question, whi...
B
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Which region of the displayed image contains the finding? A. Upper right quadrant of the image B. Upper left quadrant of the image C. Central lower (midline) of the image D. Lower right quadrant of the image
I examine the image to establish orientation and what stands out. This is an axial CT through the paranasal sinuses; the bony structures and sinus air spaces are visible. Next, I look for any abnormality or focal density. I see a rounded area of increased density located along the midline near the posterior portion of...
C
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What does the red arrow in the image indicate? A. Right temporal lobe infarct B. Acute subdural hematoma C. Intracerebral hemorrhage D. Meningioma along the temporal convexity E. Normal cortical sulcus/CSF space
I examine the image for imaging modality, orientation, and the abnormality marked by the arrow. This is a coronal non-contrast head CT and the red arrow points to a focal region in the temporal lobe cortex on that side. The marked area is lower in attenuation (darker) than the surrounding brain and appears confluent wi...
A
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How many fenestrated renal stents are visible on this image? A. One B. Two C. Three D. Four
I examine the image for the structures the question asks about: fenestrated renal stents. On the rendered image I focus on the red-colored tubular structures because they are visually distinct from the green-colored aorta and branches. Next, I relate these observations to the question, which asks how many fenestrated ...
B
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A patient is undergoing an endoscopic extraperitoneal abdominal wall repair; the intraoperative view is shown. Based on the authors' described mesh-sizing practices and the approach depicted, which mesh dimension is most appropriate? A. 20 cm × 25 cm B. 30 cm × 30 cm C. 10 cm × 15 cm D. 40 cm × 50 cm
I examine the intraoperative image. I see an endoscopic extraperitoneal view with a large rectangular, macroporous mesh laid flat against the posterior abdominal wall. A laparoscopic instrument in the field gives a sense of scale: the mesh covers a substantial vertical length and extends well across the midline toward ...
A
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Based on this image, are the findings normal or abnormal? A. Normal B. Abnormal
I examine the axial CT image and focus on the region highlighted by the red arrow. There is a discrete, rounded soft-tissue density in the lower pelvis/left lower quadrant that is clearly distinguishable from adjacent bowel gas and surrounding fat. Next, I describe the lesion’s appearance: it is several centimeters in...
B
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Which pulmonary lobe is located in the posterior left hemithorax on this axial CT image? A. Left upper lobe B. Left lower lobe C. Right upper lobe D. Right lower lobe
I examine the axial CT for orientation and landmarks. I see the vertebral body and spinal canal posteriorly, the heart and mediastinal structures anteriorly and slightly to one side, and large lung/pleural spaces on both sides of the image. Next, I relate these observations to the question, which asks which pulmonary ...
B
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Based on this image, are the imaging findings normal or abnormal? A. Normal B. Abnormal
I examine the provided cardiac MRI image. I note a focal, rounded, well-circumscribed lesion at the region of the intraatrial septum, indicated by the red arrow. The lesion projects into the atrial cavity and is clearly distinct from the adjacent cardiac chambers and myocardium. Next, I relate these observations to th...
B
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Based on this image, are the imaging findings normal or abnormal? A. Normal B. Abnormal
I examine the axial CT image to identify the anatomy and any visible abnormalities. I locate a left-sided colonic loop (arrow) in the flank/descending colon region and inspect its wall and surrounding fat. Next, I note that the affected bowel segment demonstrates a visibly thickened, circumferential wall with a layere...
B
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Based on this image, is the most likely diagnosis an acute subdural hematoma? A. True B. False
I examine the image for the location, shape, and density of any abnormality and for mass effect. I see an extra-axial, crescent-shaped hyperdense collection along the cerebral convexity adjacent to the inner table of the skull. The adjacent cortical sulci are partially effaced and the ipsilateral lateral ventricle is c...
A
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Based on this image, are the endoscopic findings normal? A. Yes B. No
I examine the image for mucosal color, surface texture, and any focal lesions. The view shows concentric, smooth mucosal folds with a uniformly glistening surface and no obvious disruption of the lining. I do not see discrete ulcers, erosions, polypoid masses, adherent exudate, or active bleeding in the visualized fiel...
A
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Which label best describes the dominant spatial pattern in the image? A. Homogeneous distribution of ROIs B. Patchy clustered distribution with intermixed ROI types C. Single isolated cluster of minority ROIs D. Linear band-like distribution across the field
I examine the image for visible spatial patterns. The image shows a rectangular field over a limb covered by a dense grid of small ROIs colored yellow and blue. The colors are clearly visible and vary across the field rather than being uniform. Next, I relate what I see to the question, which asks for the dominant spa...
B
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Which of the following best describes the anatomical level shown on this axial neck CT? A. Level of the thyroid cartilage B. Superior border of the cricoid cartilage C. Inferior border of the cricoid cartilage D. Craniocervical junction (C1–C2)
I examine the axial neck CT image for salient landmarks. I see the midline airway anterior to the cervical vertebra and, directly anterior to the airway lumen, a well-defined, complete circular/ovoid cartilaginous ring. Lateral to that ring are expected neck soft tissues and vascular-appearing structures. Next, I rela...
B
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Based on this image, are the findings normal or abnormal? A. Normal B. Abnormal
I examine the radiograph for bone integrity and alignment. I see the right humerus (R marker present) with a clear cortical discontinuity in the distal third of the shaft: a fracture line is visible with a cortical step-off and the distal fragment is displaced and angulated relative to the proximal shaft. There is also...
B
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Based on this image, is a left-to-right midline shift present? A. Yes B. No
I examine the sagittal brain MRI for the position of midline structures that indicate laterality: the falx/ interhemispheric fissure region, the septum pellucidum/fornix area, and the third ventricle. I look for any obvious displacement of these structures away from the expected midline. Next, I relate what I see to t...
A
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Based on this image, which of the following best describes the predominant imaging finding? A. Acute posterior thoracic epidural hematoma B. Spinal epidural abscess C. Intradural extramedullary tumor D. Spinal subdural hematoma E. Large thoracic disc herniation
I examine the sagittal thoracic MRI image. I see a long-segment, crescentic collection located posterior to the thecal sac spanning the mid-to-lower thoracic levels (arrows), which is relatively hyperintense compared with surrounding soft tissues and tracks along the posterior canal. Next, I relate these observations ...
A
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Based on this image, is intussusception the most likely diagnosis? A. True B. False
I examine the axial CT image of the lower abdomen/pelvis for bowel morphology and any focal lesions. I observe a rounded, layered soft-tissue structure in the right lower quadrant that shows multiple concentric rings on cross-section — a target-like appearance — consistent with bowel telescoping (a bowel-within-bowel c...
A
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A 64-year-old man presented with five weeks of right upper quadrant pain, nausea, jaundice, and 5 kg weight loss. Liver function tests indicated biliary obstruction and serum CA 19-9 was markedly elevated; ERCP relieved the obstruction with biliary stenting. Based on the clinical presentation and the accompanying CT im...
I examine the provided axial CT image at the level of the pancreas. I see a relatively large, well‑circumscribed, homogeneous soft‑tissue mass centered in the region of the pancreatic head. A biliary stent is visible within the expected course of the common bile duct, consistent with the history of ERCP and relieved ob...
B
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Based on this image, what is the most likely diagnosis? A. Plica neuropathica (plica polonica) B. Tinea capitis C. Pediculosis capitis D. Seborrheic dermatitis
I examine the image closely. The photograph shows the occipital/posterior scalp of a young child with a dense, compact mass of tightly matted and tangled hair. Small patches of scalp are visible through the mass and appear intact — I do not see obvious erythema, crusting, or large areas of hair loss. I also do not see ...
A
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True or False: The cervical spinal cord demonstrates normal signal on this T2-weighted sagittal image. A. True B. False
I examine the provided image: a sagittal T2-weighted MRI of the cervical spine. I note the bright cerebrospinal fluid (CSF) signal surrounding the cord and the spinal cord running centrally from the foramen magnum through the lower cervical levels. Next, I inspect the spinal cord itself for focal or diffuse signal abn...
A
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Based on this image, which anatomic space contains the finding? A. Pericardial (pericardial cavity) B. Left pleural cavity C. Posterior mediastinum D. Peritoneal cavity
I examine the axial CT image for anatomic landmarks. I see the cardiac silhouette centrally located in the chest with bilateral lungs as large dark (air) spaces on either side. The arrows on the image point to a thin, relatively uniform low-attenuation rim that closely follows and partially surrounds the heart. Next, ...
A
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Based on this image, which of the following best describes the dominant imaging finding? A. Prominent anterior cervical osteophytes B. Posterior cervical disc herniation with cord compression C. Retropharyngeal abscess D. Atlantoaxial subluxation E. Cervical vertebral metastasis
I examine the sagittal MRI of the cervical spine and note the vertebral bodies, intervertebral disc spaces, the spinal canal with the cord, and the prevertebral/retropharyngeal soft tissues. Next, I look for abnormal findings. Along the anterior margins of multiple cervical vertebral bodies there are prominent bony pr...
A
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Based on this image, are the imaging findings normal or abnormal? A. Normal B. Abnormal
I examine the two MRI views provided: one axial view through the posterior fossa and one midline sagittal view. I focus on the posterior fossa anatomy—specifically the midline region where the cerebellar vermis and the cerebellar peduncles should be visualized. Next, I note specific abnormalities on the images. On the...
B
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Which region of the displayed image contains the primary finding? A. Upper left quadrant of the image B. Upper right quadrant of the image C. Lower left quadrant of the image D. Lower right quadrant of the image
I examine the axial CT image for areas of abnormality. I see a large, well-circumscribed, lobulated soft-tissue mass that occupies the lateral portion of the image near the level of the mandible; it is clearly visible and denser than surrounding fat but less dense than bone. Next, I relate these visual findings to the...
A
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A patient with blunt thoracic trauma underwent CT angiographic 3D reconstruction to assess potential vascular injury. Initial neurovascular examination was normal. Based on the imaging, which safety measure is most appropriate? A. Observe in critical care ≥36 hours B. Discharge home with follow-up C. Start therapeutic...
I examine the provided 3D CT angiographic reconstruction. The image shows the upper ribs with a clearly displaced fracture of the first rib (sharp, displaced fragment) and a contrast-filled vessel (subclavian artery) running immediately adjacent to that fracture fragment. I do not see imaging signs of active contrast e...
A
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Which of the following best describes the primary content of the image? A. Intraoperative photograph with polyethylene pusher B. Arthroscopic joint endoscopic view C. Fluoroscopic intraoperative radiograph D. Preoperative clinical skin photograph
I examine the image for visible features. I see an open surgical field with exposed soft tissue, metal retractors, and a gloved hand holding a textured metal instrument. A white, puck-shaped device is pressed against tissue beneath the metal instrument and is prominent in the field. The scene is clearly intraoperative ...
A
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Based on this image, which of the following is the most likely diagnosis? A. Ventriculitis B. Subdural empyema C. Intraventricular hemorrhage D. Cerebral (parenchymal) abscess E. Diffuse leptomeningitis
I examine the images: an axial and a sagittal CT of the head. Both show hyperdense material filling and layering within the ventricular system (notably within the lateral ventricles), and there is a thin, irregular hyperdense line along the ependymal surface of the ventricles. The abnormality is intraventricular rather...
A
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Which description best classifies the dominant imaging appearance? A. Normal densely packed cone mosaic B. Disrupted cone mosaic with reduced density C. Extensive geographic atrophy D. Retinal pigment epithelium mosaic
I examine the image for descriptive features. The image shows a dense field of small, discrete bright punctate signals distributed across the frame, with a central irregular darker zone where those bright puncta are fewer and less distinct. Overall the spacing and brightness of the spots are non-uniform: some regions a...
B
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Based on this image, which ocular structure is most likely involved? A. Retina B. Vitreous body C. Lens D. Optic nerve
I examine the image for the abnormality. This axial orbital image shows both globes; the yellow arrow points to the left globe, which contains a clearly visible curvilinear, membranous structure with adjacent layering of material inside the posterior chamber of the eye. Next, I relate those findings to the question, w...
A
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Which structure is indicated by the arrow? A. Left vestibular fold (false vocal cord) B. Left true vocal fold (vocal cord) C. Epiglottic pedicle D. Anterior commissure
I examine the axial CT image to identify gross landmarks: there is a central air column (the laryngeal airway) and surrounding soft tissue. Posteriorly I can see the bony/osseous structure of the cervical spine; anterior and lateral to the airway are paired soft-tissue folds. Next, I relate what I see to the question,...
A
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Based on this image, which cardiac chamber is primarily involved? A. Left atrium B. Right atrium C. Left ventricle D. Right ventricle
I examine the provided axial cardiac CT image. I see a large, well-defined rounded soft-tissue mass outlined in yellow and indicated by a yellow arrow that occupies the posterior-superior cardiac chamber in this slice. Next, I relate this observation to the question, which asks which cardiac chamber is primarily invol...
A
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Based on this image, which description best fits the observed intra-abdominal finding? A. Intraperitoneal composite mesh secured with tackers B. Large seroma overlying abdominal wall C. Suture-only fascial repair without mesh D. Bowel wall with ischemic necrosis
I examine the image for obvious intra-abdominal structures. I see a large, porous/prosthetic-looking sheet with a regular perforated pattern lying against the inner abdominal surface; several small metallic fixation devices (tackers) are visible along its margin. There is no obvious fluid collection or bulging fluid po...
A
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Based on this image, which of the following best describes the dominant finding? A. Bilateral adrenal masses B. Large hepatic mass C. Left renal mass D. Pancreatic head mass
I examine the axial CT image to identify organs and any abnormal soft-tissue densities. I note two rounded soft-tissue masses located in the adrenal regions: one adjacent to the superior-medial aspect of the right kidney and another adjacent to the superior-medial aspect of the left kidney. These lesions lie where the ...
A
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Based on this sagittal pelvic MRI, which structure occupies the midline pelvic cavity anterior to the rectum? A. Urinary bladder B. Uterus C. Rectum D. Sigmoid colon
I examine the midline sagittal pelvic image to identify the relative positions of pelvic structures. I locate the posterior bony sacrum and the tubular structure immediately anterior to it that corresponds to the rectum (seen more posteriorly in the pelvis). Next, I look anterior to that rectal structure in the midlin...
A
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Based on this image, what is the most likely diagnosis? A. Pulmonary metastases B. Primary bronchogenic carcinoma C. Septic pulmonary emboli D. Miliary tuberculosis E. Multiple pulmonary hamartomas
I examine the CT image carefully for lesion pattern and distribution. I see multiple discrete, well-defined round nodules scattered in both lungs on this axial lung-window image; the nodules vary in size and are present bilaterally rather than forming a single large mass or innumerable tiny diffuse speckling. Next, I ...
A
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On this radiograph, which bone is the most distal bone of the great toe (hallux)? A. Distal phalanx of the hallux B. Proximal phalanx of the hallux C. First metatarsal D. Medial cuneiform
I examine the radiograph and locate the great toe (hallux) at the medial/most anterior aspect of the foot. On the image I can visually follow the bones of the hallux from the tip inward: a small terminal bone at the tip of the toe and a larger bone immediately behind it. Next, I relate these visible bones to the answ...
A
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The horizontal double-headed arrow labeled "Excursion" in the M-mode image indicates which structure? A. Diaphragm B. Liver C. Lung artifact D. Rib shadow
I examine the image for visible markers and labels. The M‑mode strip shows a rhythmic, wavy reflector that shifts up and down over time; a horizontal double‑headed arrow labeled "Excursion" spans the distance of that cyclic displacement. On the right side of the image there is a vertical label list that includes (from ...
A
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Based on this image, is segmental testicular infarction the most appropriate descriptive label? A. Yes B. No
I examine the image for salient findings. This is a power-Doppler scrotal ultrasound showing a well-demarcated triangular/wedge-shaped area (indicated by arrows) within the testicular parenchyma that is visually different in echotexture from the surrounding tissue. Next, I look specifically at vascularity: there is no...
A
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Based on this image, are the findings normal or abnormal? A. Normal B. Abnormal
I examine the image for anatomic landmarks and any obvious abnormalities. This is a midline sagittal brain MRI through the sellar region. Next, I inspect the sellar region: there is a large, rounded soft-tissue mass occupying and markedly expanding the sella turcica. The mass extends superiorly into the suprasellar re...
B
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Which pulmonary lobes are primarily involved on this axial thoracic CT image? A. Right upper lobe B. Right middle lobe C. Right upper and middle lobes D. Right lower lobe
I examine the axial thoracic CT image and identify a focal area of increased soft-tissue attenuation/consolidation in the anterior and anterolateral portion of the right hemithorax at this level. Next, I relate that location to pulmonary lobe anatomy on axial sections: the right upper lobe occupies the anterior-superi...
C
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On the displayed image, in which quadrant of the image is the primary finding located? A. Upper left of the image B. Upper right of the image C. Lower left of the image D. Lower right of the image
I examine the axial abdominal CT image and note the marked abnormality: several white arrows and arrowheads point to branching low-attenuation structures located on the viewer's left side of the image, in the upper half of the visible liver region. Next, I relate what I see to the question, which asks specifically whi...
A
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What does the blue arrow indicate? A. Enlargement of cerebrospinal fluid spaces B. Acute subarachnoid hemorrhage C. Acute intracerebral hemorrhage D. Acute ischemic infarct
I examine the image: an axial non-contrast head CT. I focus on the region indicated by the blue arrow and note the local appearance and density compared with adjacent brain tissue. Next, I relate what I see to the question, which asks what the blue arrow indicates. The area under the blue arrow appears darker (lower a...
A
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Based on this image, which diagnosis is most likely? A. Left ventricular outflow tract obstruction B. Unobstructed left ventricular outflow tract C. Severe aortic valve stenosis D. Left ventricular pseudoaneurysm
I examine the image for anatomic details and contrast flow. This is a lateral fluoroscopic/angiographic view with the left ventricular cavity opacified by contrast; the region of the left ventricular outflow tract (LVOT) and the path towards the aortic root are visible. Next, I relate what I see to the question, which...
B
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Based on this image, are the imaging findings normal or abnormal? A. Normal B. Abnormal
I examine the image for overall anatomic appearance: this is a sagittal MRI of the thoracolumbar spine showing vertebral bodies, the spinal canal/thecal sac, and spinal cord/CSF column. Next, I look for focal abnormalities. There is a well-defined, crescent/oval-shaped extra‑thecal collection located posterior to the ...
B
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Based on this image, are the findings normal or abnormal? A. Normal B. Abnormal
I examine the radiograph: there is a contrast-filled bladder in the pelvis and a single, clearly opacified tubular structure tracking cephalad from the bladder on one side. The opacified tube is markedly dilated and shows pronounced tortuosity, with contrast extending well beyond the expected distal ureter and collecti...
B
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In this micrograph, which cellular structure is most likely shown? A. Filopodia B. Lamellipodia C. Microvilli D. Cilia
I examine the image for morphological details. This is a scanning electron micrograph (scale bar 5 µm) showing a cell surface with several thin, elongated, finger-like projections extending away from the cell body; a small cluster of these parallel, tapering protrusions is visible in the boxed region. Next, I relate w...
A
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End of preview. Expand in Data Studio

This data is the Open-PMC derived data part that we discuss in the paper

Medical VQA with Reasoning Traces (Anonymous)

A multiple-choice medical visual question answering benchmark with chain-of-thought reasoning traces. Each example consists of a medical image (radiology, pathology, clinical photograph, etc.), a multiple-choice question with labeled options, a reasoning trace, and the correct answer letter.

This dataset is released anonymously in support of a peer-reviewed submission.

Columns

Column Type Populated on Description
image Image train, test The medical image relevant to the question (JPEG, embedded).
question string train, test Question text followed by labeled answer options (e.g. "A. ...").
reasoning string train, test Chain-of-thought reasoning trace that supports the correct answer.
answer string train, test Single uppercase letter giving the correct option (e.g. "A").
Perception string test only JSON list of observation-axis unit-questions (what the image actually shows).
Medical knowledge string test only JSON list of knowledge-axis unit-questions (relevant clinical/medical facts).
Rationale string test only JSON list of inference-axis unit-questions (reasoning-from-observations claims).

Perception / Medical knowledge / Rationale are evaluation aids: each is a JSON-encoded list of {topic, claim, presence_question, correctness_question, source_quote, importance} items derived from the reference reasoning trace. They are populated for the test split only and held as "[]" strings on the train split for schema parity (so the dataset viewer works on both splits).

Loading

from datasets import load_dataset
import json

ds = load_dataset("researcher2026/OpenMedReason")
print(ds)
print(ds["train"][0])

# Eval-time helpers (test split):
ex = ds["test"][0]
perception = json.loads(ex["Perception"])
knowledge  = json.loads(ex["Medical knowledge"])
rationale  = json.loads(ex["Rationale"])
print(f"perception items: {len(perception)}")

Anonymity

The dataset is hosted from an anonymous account and the dataset card omits any identifying information about the authors, institution, or project.

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