answer_changed bool | correct_answer string | corrupted_answer string | corrupted_steps list | dataset string | dataset_type string | error_categories list | error_codes list | error_injection_reason string | error_step_code_map list | error_steps list | id string | modified_steps list | options list | original_steps list | question string | severity_level string | severity_score float64 | split string | vote_error_failed bool | vote_reasoning_adopt_count int64 | vote_reasoning_reject_count int64 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
true | Macrophage myofasciitis | Non-radiographic axial spondyloarthritis | [
"Thyroid-related myopathy was considered — “Endocrinology assessment suggested that this patients’ weakness was less likely related to thyroiditis.”",
"Hyperkalemic periodic paralysis was excluded — “Hyperkalemic paralysis was ruled out.”",
"Given the normal CK and EMG, major alternative endocrine etiologies ca... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-5"
] | I kept steps 1, 2, 4, 5, and 6 aligned with the original. I replaced the original endocrine-rule-out step with Variant 1’s shortcut statement to preserve the E-1 prerequisite omission at step 3. For step 7, I merged Variant 2’s premature closure on non-radiographic axial spondyloarthritis with Variant 3’s contradictory... | [
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
7
],
"error_type": "E-5",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
3,
7,
8
] | medprmbench_00001 | [
3,
7,
8
] | [] | [
"Thyroid-related myopathy was considered — “Endocrinology assessment suggested that this patients’ weakness was less likely related to thyroiditis.”",
"Hyperkalemic periodic paralysis was excluded — “Hyperkalemic paralysis was ruled out.”",
"Other endocrine causes (adrenal insufficiency, Cushing’s disease) were... | A 14-year-old girl presented with 2 months of progressive proximal muscle weakness. She initially noted difficulty combing her hair and rising from a chair; over weeks she became wheelchair-bound. She also reported morning stiffness of both small hand joints lasting about 30 minutes, dysphagia for solids and liquids, a... | Major | 0.5862 | test | null | null | null |
true | Lymphangioleiomyomatosis | Lymphoid interstitial pneumonia (LIP) | [
"COPD/emphysema considered because of recurrent pneumothorax and cysts — “Patients with chronic obstructive pulmonary disease (COPD) or emphysema may also present with recurrent pneumothorax and multiple pulmonary cysts on imaging, but they lack the presence of LAM cells in their alveoli, which needs to be confirme... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-4",
"S-2"
] | I kept steps 1–3 from the original. I merged Variant 2’s overconfident, stem-contradicting LIP claim into Step 4, and simultaneously incorporated Variant 1’s prerequisite-skipping move (declaring LIP unlikely and proceeding to LAM without the needed autoimmune/immune-status and corroborative imaging checks) into the sa... | [
{
"error_description": "Prerequisite Sensitivity: skips prerequisite evaluation for LIP (e.g., autoimmune/immune-status assessment and corroboration of interstitial infiltrates/effusions) and jumps directly to LAM-based reasoning.",
"error_step_indices": [
4
],
"error_type": "E-1",
"modifi... | [
4,
5
] | medprmbench_00002 | [
4,
5,
6,
7
] | [] | [
"COPD/emphysema considered because of recurrent pneumothorax and cysts — “Patients with chronic obstructive pulmonary disease (COPD) or emphysema may also present with recurrent pneumothorax and multiple pulmonary cysts on imaging, but they lack the presence of LAM cells in their alveoli, which needs to be confirme... | A 36-year-old woman presented with a 7-day history of right-sided chest pain and dyspnea without fever or cough. She reported two prior spontaneous pneumothoraces: one right-sided in 2018 managed medically, and one left-sided in 2019 treated surgically. She also noted occasional small-volume hemoptysis.
On admission,... | Major | 0.655 | test | null | null | null |
false | GiantCondylomaAcuminatum | Giant condyloma acuminatum (Buschke–Löwenstein tumor) | [
"The presence of long-standing, progressively enlarging, cauliflower-shaped perianal and scrotal lesions is most consistent with benign giant condyloma acuminatum (Buschke–Löwenstein tumor), so malignant etiologies do not need to be prioritized in the diagnosis.",
"Bowenoid papulosis is definitively confirmed her... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-1",
"R-4",
"R-5"
] | I used Variant 2's Step 1 as the composite Step 1 to simultaneously (a) skip histologic confirmation (E-1 prerequisite omission) and (b) prematurely narrow to benign giant condyloma while deprioritizing malignancy (E-5). I then inserted Variant 3's corrupted Step 2 to add the overconfident factual contradiction about H... | [
{
"error_description": "",
"error_step_indices": [
1,
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
1,
2
],
"error_type": "E-5",
"modified_steps": null
},
{
"error_description": "",
... | [
1,
2
] | medprmbench_00003 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Squamous cell carcinoma was considered but ruled out on histology because “no evidence of dysplasia or malignancy.”",
"Bowenoid papulosis was in the differential but excluded by the absence of dysplastic changes, as indicated by “no evidence of dysplasia or malignancy.”",
"Condyloma latum from syphilis was exc... | A 44-year-old single man presented with a 10-year history of progressively enlarging perianal and lower scrotal warts. He reported pruritus and a bloody, foul-smelling discharge over the past 4 years. He had a history of smoking, alcohol use, chronic hepatitis B infection, and multiple heterosexual partners.
On examin... | Critical | 0.875 | test | null | null | null |
true | Eosinophilic granulomatosis with polyangiitis | Occult aorto‑iliac occlusive disease causing ischemic peroneal neuropathy (acute ischemic foot drop) | [
"Lumbar disc herniation was considered because of the MRI finding, but was unlikely to explain her symptoms—MRI revealed a disc herniation at L5–S1, but there was no significant nerve root compression or cord compression.",
"The evolution to foot drop with a later absent peroneal evoked myogenic potential strongl... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-2",
"E-5",
"R-1",
"R-4",
"R-5"
] | I used Variant 1’s corrupted Step 2 (fabricated EPNS guideline/statistics) as the composite Step 2, and kept Variant 3’s inserted redundant imaging steps as composite Steps 3–4. For the vascular portion, I included Variant 2’s overconfident contradiction as composite Step 5 (root-cause R-4) while also retaining Variant... | [
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
4,
5,
6,
7
] | medprmbench_00004 | [
1,
2,
3,
4,
5,
6,
7
] | [] | [
"Lumbar disc herniation was considered because of the MRI finding, but was unlikely to explain her symptoms—“MRI revealed a disc herniation at L5–S1, but there was no significant nerve root compression or cord compression.”",
"Peroneal nerve palsy was on the differential given foot drop and conduction changes—“ne... | A 48‐year‐old woman with a history of asthma presented with a 2‐day history of right lower‐extremity numbness and pain that worsened despite conservative measures. She denied any low back pain. On examination, manual muscle testing of the right tibialis anterior and extensor hallucis longus was 3/5, and gastrocnemius a... | Critical | 0.91 | test | null | null | null |
true | Bardet‐Biedl syndrome | McKusick–Kaufman syndrome | [
"McKusick–Kaufman syndrome best explains this presentation because, in postpubertal/adult females, hydrometrocolpos with post-axial polydactyly most commonly reflects MKS due to distal vaginal obstruction, and this patient’s hematometrocolpos/vaginal obstruction with polydactyly fits that pattern.",
"Although Bar... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-3",
"S-2"
] | To integrate all variants, Step 1 was rewritten to retain the R-3 misapplied adult/postpubertal heuristic that hydrometrocolpos + polydactyly most commonly indicates MKS, while also implementing the E-1 omission by not performing an explicit initial MKS-vs-BBS differential before committing to MKS. Step 2 was then repl... | [
{
"error_description": "Prerequisite Sensitivity (E-1): the chain skips the prerequisite step of first explicitly considering and differentiating McKusick–Kaufman syndrome versus Bardet–Biedl syndrome before committing to a diagnosis; instead it moves directly into a committed choice without a proper initial di... | [
1,
2
] | medprmbench_00005 | [
1,
2
] | [] | [
"McKusick–Kaufman syndrome was initially considered because of hydrometrocolpos and polydactyly — “Initial clinical findings suggested MKS.”",
"MKS was excluded as the reproductive-tract anomalies were more extensive, aligning with BBS, since MKS primarily involves distal vaginal abnormalities while BBS includes ... | A 15-year-old girl with congenital intellectual disability and blindness presents with primary amenorrhea and a 2-year history of cyclical lower abdominal and pelvic pain lasting 5 days each month. The pain has worsened over the past 2 months and is partially relieved by oral analgesics. She exhibits irritability, redu... | Major | 0.77 | test | null | null | null |
false | autoimmune myelofibrosis | Systemic lupus erythematosus–associated autoimmune myelofibrosis | [
"Given the recurrent severe anemia with mildly elevated LDH, proceed under the assumption that hemolysis is not the primary driver and focus on an autoimmune marrow process.",
"Autoimmune myelofibrosis related to systemic lupus erythematosus was suspected because the overall picture is most consistent with an SLE... | medcasereasoning | A | [
"Sensitivity",
"Simplicity"
] | [
"E-1",
"S-2"
] | I used Variant 1’s Step 1 to preserve the prerequisite-skipping hemolysis assumption (E-1), replacing the original hemolysis-exclusion step. I then used Variant 2’s tautological Step 2 to preserve the circular justification (S-2). The steps were kept as a coherent two-step chain with both root-cause errors flagged at t... | [
{
"error_description": "Skips the prerequisite hemolysis exclusion workup/interpretation (DAT/Coombs, reticulocyte response, haptoglobin) and assumes hemolysis is not the driver before pursuing a non-hemolysis pathway.",
"error_step_indices": [
1
],
"error_type": "E-1",
"modified_steps": [... | [
1,
2
] | medprmbench_00006 | [
1,
2
] | [] | [
"Hemolytic anemia was excluded given a negative direct Coomb’s test and normal reticulocyte count and haptoglobin levels — “direct Coomb’s test was negative, while his reticulocyte counts and haptoglobin levels were within normal limits.”",
"Autoimmune myelofibrosis related to systemic lupus erythematosus was sus... | A 44-year-old African American man with a family history of systemic lupus erythematosus presented with progressive fatigue, severe anemia, and night sweats over several months. He also reported photosensitivity and nonspecific arthralgias. His vital signs were stable, and physical examination was unremarkable.
Labora... | Critical | 0.805 | test | null | null | null |
false | Mycobacterium marinum infection | Mycobacterium marinum infection | [
"Despite negative autoimmune serology and normal inflammatory markers, the chronic progressive swelling with firm extensor-surface nodules is still most consistent with seronegative rheumatoid arthritis, and escalation of immunosuppression is appropriate.",
"Because the initial hand swelling followed an acute lac... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-5",
"R-7"
] | I merged Variant 2’s safety/soundness error into Step 1 by reversing the original skepticism about RA and explicitly endorsing immunosuppression escalation despite not addressing occult infection. I then combined Variant 3’s timing/trajectory error (using chronicity and lack of response to short-course standard antibio... | [
{
"error_description": "Bypasses critical safety checks for occult infection and incorrectly frames escalation of immunosuppression as appropriate without ruling out serious infectious etiologies before/while using steroids and TNF inhibitors.",
"error_step_indices": [
1
],
"error_type": "R-5"... | [
1,
2
] | medprmbench_00007 | [
1,
2
] | [] | [
"The diagnosis of rheumatoid arthritis was questioned because “All autoimmune serology was negative, and inflammatory markers were normal.”",
"An atypical mycobacterial infection was suspected given his aquarium exposure and the nodular lymphatic distribution, noting that “M. marinum infections commonly present a... | A 67-year-old man presented in June 2013 with a swollen left hand after a laceration to his third finger sustained while working in soil. He also maintained three large hobby aquariums. He was treated with a 10-day course of cefprozil and clindamycin, with only marginal improvement. In October 2013, he returned with wo... | Critical | 1 | test | null | null | null |
true | Hydatid disease | Galactocele | [
"Common breast tumors (fibroadenoma or phyllodes) and malignancy were considered given the palpable mass — “it might mimic fibroadenoma, phyllodes tumor, chronic abscess, or even malignancies, and this should be included in the differential diagnoses of breast lumps, especially in endemic regions.”",
"Breast absc... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-3",
"R-5"
] | Both variants place their single root-cause error at Step 3 but with distinct angles: R-1 introduces incorrect ultrasound-pathology mapping (floating membranes/internal echoes attributed to galactocele and hydatid described as simple), while R-3 introduces context misapplication (treating a non-lactating patient as if ... | [
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "R-3",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
3,
5
] | medprmbench_00008 | [
3,
4,
5
] | [] | [
"Common breast tumors (fibroadenoma or phyllodes) and malignancy were considered given the palpable mass — “it might mimic fibroadenoma, phyllodes tumor, chronic abscess, or even malignancies, and this should be included in the differential diagnoses of breast lumps, especially in endemic regions.”",
"Breast absc... | A 31-year-old woman presented with a gradually progressive, painless lump in the left axillary tail of Spence of two years’ duration. There was no history of trauma, no nipple discharge, and no family history of breast cancer. On examination, the mass was firm, non-mobile, and measured 5 cm × 5 cm; the remainder of the... | Major | 0.765 | test | null | null | null |
false | Histoplasmosis | Disseminated histoplasmosis (Histoplasma capsulatum) causing lip ulcers and edema | [
"Herpes simplex virus infection is unlikely because HSV PCR taken from the base of the lip ulcer was negative.",
"Angioedema is unlikely because the complement C1 esterase inhibitor level was within normal limits.",
"Bacterial infection is less likely because Gram stain of lesion samples was negative.",
"Fung... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-3",
"S-1"
] | I kept the overall structure of the original chain but overlaid the three independent corruptions: (1) replaced the fungal-assessment step with the R-3 wording that inappropriately extrapolates test performance from immunocompetent hosts, (2) replaced the Histoplasma conclusion step with the E-1 version that asserts Hi... | [
{
"error_description": "Contextual applicability error: applies the near-rule-out value of negative fungal cultures/Histoplasma antigen testing as in immunocompetent hosts to an HIV patient with immune reconstitution, incorrectly deprioritizing fungal etiologies despite the clinical context.",
"error_step_i... | [
4,
6,
7,
8
] | medprmbench_00009 | [
1,
2,
3,
4,
5,
6,
7,
8,
9
] | [] | [
"Herpes simplex virus infection — “HSV polymerase chain reaction taken from the base of lip ulcer was negative.”",
"Angioedema — “Complement C1 esterase inhibitor level was negative.”",
"Bacterial infection — “Gram stain… were negative.”",
"Fungal infection (broad) — “fungal blood cultures, and urine and seru... | A 34‐year‐old African American man with hemophilia A, HIV‐1 infection, and hepatitis C virus infection presented with a 3‐month history of intermittent fever, unintentional weight loss, and progressive lip swelling with painful ulcerations. Six months earlier he had resumed antiretroviral therapy, with his CD4 count ri... | Critical | 0.805 | test | null | null | null |
false | Drug-induced lung injury | Sai-rei-to–induced diffuse alveolar hemorrhage (drug-induced lung injury) | [
"Drug-induced lung injury by Sai-rei-to was most likely — the tight temporal association (symptoms starting about 2 weeks after initiation) and lack of prior interstitial lung disease or collagen vascular disease history support Sai-rei-to–associated drug-induced interstitial lung disease.",
"Community-acquired p... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-3",
"R-5"
] | I kept Step 1 essentially aligned with the original/variants (drug-induced lung injury most likely). I merged Variant 1 and Variant 2 into a single composite Step 2 that simultaneously (a) excludes infection purely from negative bacteriology (E-1 prerequisite omission) and (b) asserts CAP is the only legitimate alterna... | [
{
"error_description": "Excluded infection solely based on negative bacteriological tests, skipping prerequisite evaluation/clinical reassessment to rule out atypical/viral/serologic causes before attributing findings to drug-induced DAH.",
"error_step_indices": [
2
],
"error_type": "E-1",
... | [
2,
3
] | medprmbench_00010 | [
1,
2,
3
] | [] | [
"Drug-induced lung injury by Sai-rei-to was most likely — “Drug-induced interstitial lung disease (ILD) caused by Sai-rei-to was the most likely diagnosis, because he had no history of interstitial pneumonia or collagen disease, and he had started taking Sai-rei-to a month earlier.”",
"Community-acquired pneumoni... | An 88-year-old man with hypertension and chronic kidney disease presented with progressive dry cough, dyspnea, fever, and chills. Twenty-five days earlier, he had started a herbal medicine, Sai-rei-to, and symptoms began two weeks after initiation. He was an ex-smoker, took no other medications, and had no history of p... | Critical | 1 | test | null | null | null |
true | GallbladderVolvulus | Acute calculous cholecystitis | [
"Ileosigmoid knot, pseudo-obstruction, severe constipation, and sigmoid diverticular disease were considered given acute abdominal pain but were excluded because the abdominal x‐ray on admission was normal.",
"Because she had a similar, self-limited episode 1 month earlier, the current presentation is most consis... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-2",
"R-7"
] | I kept Step 1 from the original. For Step 2, I merged Variant 3’s temporal misclassification and delayed-management framing with Variant 1’s prerequisite-skipping jump directly to volvulus, preserving both errors even though they create internal tension. For Step 3, I used Variant 2’s inconsistency (preserved flow/impa... | [
{
"error_description": "Prerequisite Sensitivity: skips first establishing/assessing acute (acalculous) cholecystitis as the immediate working diagnosis before using ischemic/malposition imaging findings to jump directly to gallbladder volvulus.",
"error_step_indices": [
2
],
"error_type": "E-... | [
2,
3
] | medprmbench_00011 | [
1,
2,
3
] | [] | [
"Ileosigmoid knot, pseudo-obstruction, severe constipation, and sigmoid diverticular disease were considered given acute abdominal pain but were excluded because “abdominal x‐ray on admission was normal.”",
"Acute cholecystitis was suspected based on gallbladder enlargement, wall thickening, and pericholecystic f... | A previously healthy 5‐year‐old girl presented with 9 hours of intermittent, moderate–severity epigastric pain radiating to the right lower quadrant. The pain was unchanged by position and was associated with multiple episodes of nonbloody vomiting. She was afebrile, had normal urination and bowel movements, and report... | Critical | 0.91 | test | null | null | null |
true | Metformin toxicity | Metformin-associated lactic acidosis | [
"Diabetic ketoacidosis is the most likely cause of the marked ketosis and severe high–anion gap metabolic acidosis, as the elevated β-hydroxybutyrate with profound acidemia is most consistent with DKA; the near-normal glucose can be attributed to poor intake or delayed presentation.",
"Type A lactic acidosis due ... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-3",
"R-5"
] | I used Variant 3’s Step 1 (DKA anchoring) to incorporate the R-5 safety error, kept its Step 2 for continuity, replaced Step 3 with Variant 2’s definitive-exclusion language to incorporate the E-3 error, and replaced Step 4 with Variant 1’s unverified MALA conclusion to incorporate the E-1 error. This preserves each va... | [
{
"error_description": "Safety Awareness error: anchors on diabetic ketoacidosis despite no diabetes history and low-normal glucose, omitting the critical life-threatening consideration of metformin-associated lactic acidosis in an end-stage kidney disease patient, creating a dangerous misdiagnosis trajectory."... | [
1,
3,
4
] | medprmbench_00012 | [
1,
2,
3,
4
] | [] | [
"Starvation ketoacidosis rather than diabetic ketoacidosis — “more likely secondary to starvation ketoacidosis than diabetic ketoacidosis given the patient’s low-normal glucose and no past history of diabetes.”",
"Type A lactic acidosis due to sepsis or shock was considered but infection was excluded — “clinicall... | A 60-year-old man with end-stage kidney disease secondary to presumed ischemic nephropathy treated with thrice-weekly hemodialysis was brought to the hospital for confusion, altered level of consciousness, and hypothermia. He had no history of diabetes mellitus. His medications included atorvastatin, amlodipine, pantop... | Critical | 1 | test | null | null | null |
false | cerebral venous thrombosis | Cerebral venous thrombosis (left transverse sinus thrombosis) | [
"Alzheimer’s disease was initially considered because of age and cognitive decline, but “the rapid progression, sudden‐onset symptoms, and lack of response to treatment were inconsistent with typical dementia.”",
"Frontotemporal dementia was entertained, but “the sudden onset of symptoms reduced the likelihood of... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-1",
"S-1"
] | I used the S-1 variant’s inserted redundant steps as the composite chain’s steps 3–4. I kept the E-1 variant’s MRI-based wording for ruling out tumor and arterial stroke (steps 5–6). To integrate both E-1 and R-1 (which both corrupt the vascular-etiology step), I merged their competing, errorful claims into a single co... | [
{
"error_description": "Prerequisite Sensitivity: The chain jumps to diagnosing cerebral venous thrombosis without first establishing the intermediate vascular dementia/vascular localization hypothesis and without the targeted imaging reevaluation needed to justify CVT as the specific cause.",
"error_step_i... | [
7
] | medprmbench_00013 | [
3,
4,
5,
6,
7,
8
] | [] | [
"Alzheimer’s disease was initially considered because of age and cognitive decline, but “the rapid progression, sudden‐onset symptoms, and lack of response to treatment were inconsistent with typical dementia.”",
"Frontotemporal dementia was entertained, but “the sudden onset of symptoms reduced the likelihood of... | A 74-year-old right-handed woman was brought to the psychiatry clinic with a 5-month history of abrupt onset of disorganized speech, severe anxiety, and self-harm behaviors that began after a family trip. Her speech was rapid, fluent, and nonsensical—exemplified by the phrase “Our neighbor has gone to the cobbler to bu... | Critical | 0.8525 | test | null | null | null |
false | Urticarial vasculitis | Urticarial vasculitis | [
"Broad differential of annular urticarial lesions in childhood — importantly, recurrent annular plaques that recur in identical locations and resolve without residual injury are most characteristic of erythema multiforme (a targetoid hypersensitivity eruption that classically recurs at the same sites), making eryth... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-7"
] | I used Variant 2’s Step 1–2 wording to embed the R-1 evidence-based misstatements (EM recurring at identical sites and being the leading diagnosis). I then combined Variant 3’s Step 3–4 trajectory/timing argument (vasculitis considered too early/transient; defer vasculitis-directed evaluation and treat as acute urticar... | [
{
"error_description": "Incorrectly claims erythema multiforme characteristically recurs at identical sites and that the overall pattern is most characteristic of EM, inappropriately redirecting the leading diagnosis away from urticarial vasculitis.",
"error_step_indices": [
1
],
"error_type":... | [
1,
3
] | medprmbench_00014 | [
1,
2,
3,
4
] | [] | [
"Broad differential of annular urticarial lesions in childhood — “Annular urticarial lesions in a child must establish a differential diagnosis with urticaria multiforme, common urticaria, acute hemorrhagic edema of infancy, erythema marginatum, erythema annulare centrifugum, annular erythema in childhood, erythema... | A 6‐year‐old girl with no relevant medical history presented with intensely pruritic skin lesions on her anterior thighs. The lesions first appeared 2 weeks earlier in recurrent 3‐day outbreaks, always at the same locations, and resolved spontaneously without residual injury. She had no systemic symptoms, preceding inf... | Critical | 0.905 | test | null | null | null |
true | immune-related pneumonitis | Steroid-refractory immune checkpoint inhibitor–induced pneumonitis | [
"Connective tissue– or vasculitis-associated ILD was excluded based on negative autoantibodies in serological testing.",
"Hypersensitivity pneumonitis was ruled out due to the absence of any identifiable history of antigen exposure.",
"Bacterial pneumonia was considered and excluded when broad-spectrum antibiot... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-3",
"R-5"
] | I kept the original step structure but replaced Step 6 with the premature 'infection sufficiently unlikely to proceed without further infectious exclusion' logic and the ensuing jump to ICI pneumonitis, which simultaneously captures the E-1 prerequisite omission and the R-5 safety bypass (both rooted at Step 6). I then... | [
{
"error_description": "Skipped the prerequisite of confirming lower-respiratory infection exclusion via BAL/bronchoscopy culture results before concluding ICI-induced pneumonitis, effectively jumping ahead after biopsy/antibiotic nonresponse.",
"error_step_indices": [
6
],
"error_type": "E-1"... | [
6,
7
] | medprmbench_00015 | [
1,
2,
3,
4,
5,
6,
7,
8
] | [] | [
"Connective tissue– or vasculitis‐associated ILD was excluded — “Connective tissue disease‐associated interstitial lung disease (ILD) and vasculitis‐associated ILD were deemed unlikely based on the negative autoantibodies results in serological testing…”",
"Hypersensitivity pneumonitis was ruled out — “hypersensi... | An 82-year-old man with epithelioid pleural mesothelioma (cT1N0M0) was treated with ipilimumab and nivolumab. After eight courses, follow-up chest CT showed new bilateral infiltrative shadows. He reported fever and dyspnea. Laboratory tests revealed elevated C-reactive protein and surfactant protein D levels; Krebs von... | Critical | 1 | test | null | null | null |
true | Gemcitabine‐induced skin necrosis | Culture-negative bacterial cellulitis with skin necrosis and concomitant pseudogout (CPPD) of the right knee | [
"Simple bacterial cellulitis with secondary ulceration is the most likely explanation for the painful erythematous calf lesion; despite negative cultures/biopsy, culture-negative skin infection is common in older adults and should be prioritized over chemotherapy-related mimics.",
"Chemotherapy extravasation inju... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-1",
"R-5"
] | I used Variant 3 to replace Step 1 with the unsafe prioritization of bacterial cellulitis and retained its conclusion framework, while keeping Step 2 (extravasation) and Step 4 (DVT) consistent with all versions. I integrated Variant 2 by substituting Step 3 with the authoritative dismissal of vasculitis and the claim ... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
3,
5
] | medprmbench_00016 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Pseudocellulitis from gemcitabine — “Pseudocellulitis has been reported as an adverse reaction of gemcitabine … frequently misdiagnosed as an infection and inappropriately treated with antibiotics.”",
"Chemotherapy extravasation injury — “We did not find any reports of gemcitabine causing tissue necrosis due to ... | A 74‐year‐old man with a history of well-differentiated T3N1M0 pancreatic adenocarcinoma status post Whipple procedure completed six cycles of gemcitabine monotherapy (1000 mg/m2 on days 1, 8, 15 of a 28-day cycle). Two weeks after his final infusion, he noted a painful ulcer on the posterior aspect of his right calf a... | Critical | 0.965 | test | null | null | null |
true | AdenoidCysticCarcinoma | Recurrent chondroid syringoma | [
"A Bartholin gland cyst was initially considered but excluded because of the patient’s age and absence of pain or discomfort with activity — “The cyst was excluded, because it is more common in young women, and causes symptoms of pain during walking, sitting, and intercourse, which were absent in this case.”",
"B... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-1",
"R-4",
"R-5",
"R-6"
] | All three variants localized their root-cause error to Step 2, so the composite Step 2 explicitly merges: (1) anchoring on benign recurrent chondroid syringoma and dismissing malignancy (E-5), (2) the incorrect characterization of chondroid syringoma as infiltrative/hypervascular/rapidly recurrent to argue against it (... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2,
3,
4
],
"error_type": "E-5",
"modified_steps": null
},
{
"error_description": "",
... | [
2,
3,
4
] | medprmbench_00017 | [
2,
3,
4
] | [] | [
"A Bartholin gland cyst was initially considered but excluded because of the patient’s age and absence of pain or discomfort with activity — “The cyst was excluded, because it is more common in young women, and causes symptoms of pain during walking, sitting, and intercourse, which were absent in this case.”",
"C... | A 64-year-old woman presented with a slowly enlarging mass in the left labia majora over 10 years. Her vital signs were normal. On examination, the mass was firm, painless, immobile, and measured approximately 7 × 4 cm, extending toward the mons pubis. Routine laboratory tests were normal.
Surgical history:
– In 2000... | Critical | 0.7475 | test | null | null | null |
true | Spontaneous cerebrospinal fluid rhinorrhea | Chronic rhinosinusitis (isolated left sphenoid sinusitis) | [
"Consider spontaneous CSF rhinorrhea because of copious clear, predominantly unilateral rhinorrhea that worsens with bending/lifting/strain and is poorly responsive to rhinitis therapies; the headache/visual symptoms improving after onset of drainage suggests elevated intracranial pressure patterns with a spontaneo... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-7"
] | I kept Step 1 aligned with the shared framing across variants (CSF rhinorrhea considered). For Step 2, I merged Variant 1’s prerequisite-omission language (not needing to formally rule out allergic rhinitis) with Variant 2’s incorrect evidence claims about unilateral allergic rhinitis and treatment-refractory “local al... | [
{
"error_description": "Prerequisite Sensitivity: skips the prerequisite of actively excluding allergic rhinitis/benign rhinitis etiologies before committing forward in the reasoning, asserting they do not need to be formally ruled out.",
"error_step_indices": [
2
],
"error_type": "E-1",
"... | [
2,
3
] | medprmbench_00018 | [
1,
2,
3,
4,
5
] | [] | [
"Consideration of spontaneous CSF rhinorrhea because of the presentation of clear unilateral nasal discharge exacerbated by posture and menstrual cycle — “Copious clear unilateral rhinorrhea … poor response to antihistamines and ipratropium nasal spray; can be exacerbated by menstrual cycle.”",
"Allergic rhinitis... | A 44-year-old obese woman with chronic migraines, recurrent sinusitis, and allergic rhinitis presented for evaluation of a possible sinus infection. She reported a 2-month history of copious clear rhinorrhea, purulent postnasal drainage, and cough. She also experienced self-limiting episodes of clear nasal discharge at... | Critical | 0.94 | test | null | null | null |
false | Multisystem inflammatory syndrome in children | Multisystem inflammatory syndrome in children (MIS-C) | [
"Rheumatic fever was considered given cardiac dysfunction but excluded by a negative ASOT — “At this point, a diagnosis of rheumatic heart disease and rheumatic fever was entertained; an ASOT titer was obtained, being negative.”",
"The very high procalcitonin and shock physiology are sufficient to confirm bacteri... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-3",
"E-5",
"R-1",
"R-4",
"R-5"
] | I preserved Step 1 from the original (non-error). From Variant R-5, I replaced Step 2 with the premature 'confirmed septic shock' assertion that ignores sterile cultures (safety-check bypass). For Step 3, I used Variant E-3’s vasculitis-only framing that dismisses other valid alternatives as contraindicated based on ne... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-4",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3
] | medprmbench_00019 | [
2,
3,
5
] | [] | [
"Rheumatic fever was considered given cardiac dysfunction but excluded by a negative ASOT — “At this point, a diagnosis of rheumatic heart disease and rheumatic fever was entertained; an ASOT titer was obtained, being negative.”",
"Bacterial septic shock was considered due to hemodynamic collapse and high procalc... | An 18-year-old African male with no prior medical history presented first with a 2-day history of tonsillitis and a new macular rash on his chest that extended to his arms. Three days later he developed abdominal cramping and multiple episodes of non-bloody, watery diarrhea without nausea or vomiting, along with fevers... | Major | 0.86 | test | null | null | null |
null | Serous cystadenoma | Benign epithelial ovarian cystadenoma | [
"The markedly elevated total testosterone with normal DHEA/DHEA-S indicates an ovarian source of androgen excess, so an androgen-secreting ovarian tumor is the most likely diagnosis.",
"The absence of an adrenal mass on CT further supports a non-adrenal (ovarian) etiology.",
"Because the biochemical pattern is ... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-2",
"R-5"
] | I used Variant 1’s Step 1 to preserve the prerequisite-sensitivity omission (no assay confirmation before inferring ovarian source). I kept the original/Variant 1 Step 2 unchanged. I then inserted Variant 2’s contradictory Step 3 to create the step-consistency error (adrenal-pattern claim despite prior ovarian-pattern ... | [
{
"error_description": "Interprets the androgen panel as confirming an ovarian source without first confirming assay validity/true testosterone elevation with a high-specificity method (e.g., LC–MS/MS) or excluding spurious immunoassay elevation.",
"error_step_indices": [
1
],
"error_type": "E... | [
1,
3,
4
] | medprmbench_00020 | [
1,
2,
3,
4
] | [] | [
"Step 1: Evidence for ovarian rather than adrenal source — “High testosterone levels but normal DHEA and DHEAS levels indicate an ovarian origin for the increased androgens.”",
"Step 2: Adrenal tumor unlikely by imaging — “…no adrenal mass was noted….”",
"Step 3: Sex cord–stromal tumors as a possible androgen s... | A 60-year-old postmenopausal woman with a history of total abdominal hysterectomy 20 years earlier for fibroids presented with a 1-year history of clitoral enlargement, hirsutism, deepening of voice, decreased libido, and increasing abdominal girth. Baseline renal and hepatic chemistries, TSH, and lipid panel were unch... | Critical | 0.895 | test | null | 3 | 0 |
true | spinal epidural lipomatosis | Multiple sclerosis | [
"Steroid-induced epidural lipomatosis is unlikely because he denied steroid or other drug intake.",
"Endogenous hypercortisolism (Cushing syndrome) is unlikely given no clinical evidence of Cushing’s syndrome or endocrinopathy.",
"Obesity-associated epidural lipomatosis is unlikely because he is non-obese (BMI ... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-2"
] | Used Variant 2’s Step 4 to embed the differential-coverage error (E-5) and Variant 1’s Step 5 to embed the prerequisite-skip error (E-1), preserving the deferral of contrast imaging and premature closure on lipomatosis. Retained Variant 2’s Step 6 to keep the continued de-emphasis of infection. Then replaced the final ... | [
{
"error_description": "Prematurely narrows the differential by treating fat-signal MRI as essentially diagnostic of epidural lipomatosis and dismissing the need to pursue other important epidural mass etiologies (e.g., abscess, tumors) using a worst-first approach.",
"error_step_indices": [
4
],
... | [
4,
5,
7
] | medprmbench_00021 | [
1,
2,
3,
4,
5,
6,
7
] | [] | [
"Steroid-induced epidural lipomatosis — “denied history of ... drug intake like steroids”",
"Endogenous hypercortisolism (Cushing syndrome) — “without any evidence of Cushing’s syndrome or endocrinopathies”",
"Obesity-associated lipomatosis — “Non-obese patient [weight 65 kg ... BMI 23.30 kg/m2]”",
"Spinal an... | An 18-year-old man presented with 6 months of fluctuating lower-limb weakness. He awoke one morning unable to move his legs but recovered movement over 30 minutes, with residual unsteadiness. He remained asymptomatic for 4 months, then developed ascending spastic weakness of the lower limbs over 3 months until he was u... | Critical | 0.91 | test | null | null | null |
true | Bickerstaff brainstem encephalitis | Post-infectious acute disseminated encephalomyelitis (ADEM) | [
"Acute infectious herpetic encephalomyelitis is unlikely because the CSF is acellular with negative viral PCR and MRI of the brain and spinal cord is normal.",
"Tacrolimus neurotoxicity is unlikely because MRI is normal and the serum tacrolimus level is low.",
"Anti-GQ1b–associated Miller Fisher syndrome (MFS) ... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-1"
] | I kept steps 1–2 aligned with the original/variants (ruling out herpetic encephalomyelitis and tacrolimus toxicity). To integrate E-1 and E-5 simultaneously, I used Variant 2’s Step 3 wording that asserts anti-GQ1b positivity plus ophthalmoplegia/areflexia “essentially confirms” MFS and makes other differentials unnece... | [
{
"error_description": "Prerequisite Sensitivity: The chain anchors on anti-GQ1b positivity to assert an anti-GQ1b spectrum/GBS-variant diagnosis without first completing prerequisite supportive phenotype confirmation (e.g., appropriate interpretation of NCS/EMG timing or repeat studies) before using the antibo... | [
3,
4
] | medprmbench_00022 | [
1,
2,
3,
4
] | [] | [
"Acute infectious herpetic encephalomyelitis — “Acellular CSF with negative viral PCR and a normal MRI of the brain and spinal cord made this unlikely.”",
"Tacrolimus neurotoxicity — “its neurotoxic effects were ruled out by a normal MRI and by low serum levels.”",
"Acute inflammatory demyelinating polyneuropat... | A woman in her late 70s presented with a 2-week history of progressive bilateral leg weakness, unstable gait, and fluctuating drowsiness with moments of confusion. This followed a 4-week history of progressive bilateral lumbosacral herpes zoster infection that spread to her right groin and right leg. Her medical histor... | Critical | 0.835 | test | null | null | null |
true | Cerebral salt wasting syndrome | Syndrome of inappropriate antidiuretic hormone secretion (SIADH) | [
"SIADH is definitively favored because the patient is clearly euvolemic—there are no signs of dehydration or hypovolemic shock on presentation—and the combination of hypotonic hyponatremia with inappropriately high urine sodium after a recent intracerebral hemorrhage without diuretic use is classic for SIADH.",
"... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-4",
"S-1"
] | I used the R-4 variant’s first two steps to set the composite chain’s main diagnostic direction and its overconfident contradiction about euvolemia, and I preserved E-1 by keeping the reasoning anchored on urine sodium/osmolality-based differentiation without any explicit prerequisite step confirming true extracellular... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "R-4",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
3,
4
] | medprmbench_00023 | [
1,
2,
3,
4,
5
] | [] | [
"CSW was favored because of hypotonic hyponatremia in the setting of hypovolemic shock, renal sodium loss, no diuretics, and recent cerebral hemorrhage — “Given the Hypovolemic shock on admission, hypotonic hyponatremia as well as an increase in renal loss of Na+, without any notion of taking diuretics, and the not... | A 63-year-old man with a 5-year history of poorly controlled hypertension was admitted 10 days ago for a spontaneous intracerebral hemorrhage managed nonoperatively. He was discharged after 3 days on analgesics and an anticonvulsant. He re-presented with 2 days of profound asthenia and dyspnea that acutely worsened on ... | Critical | 0.805 | test | null | null | null |
true | embryonal rhabdomyosarcoma | Rhabdomyosarcoma with true lipogenic (liposarcomatous) divergent differentiation | [
"Glycogen vs lipid distinction is interpreted as therapy-related “lipogenic transdifferentiation” pointing away from rhabdomyosarcoma — although Oil Red O and adipophilin favor neutral lipid, the 2023 WHO–IASP Soft Tissue Tumor Update (endorsed consensus statement) and a multicenter series in Modern Pathology (Koba... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-2",
"R-1"
] | I used Variant 2’s corrupted Step 1 verbatim to incorporate the deception-based fabricated consensus/study (E-2). To simultaneously include the soundness error (R-1) and the prerequisite-omission error (E-1), I adopted Variant 3’s Step 2 claim that FNA commonly under-samples fragile lipid-rich cells, which asserts pree... | [
{
"error_description": "Adds authoritative-sounding but fabricated citations (WHO–IASP update and a Modern Pathology multicenter study) and incorrect statistical claims to argue that adipophilin+/Oil Red O+/S-100+ vacuolated cells after chemotherapy strongly predict missed DDIT3-rearranged myxoid liposarcoma, m... | [
1,
2
] | medprmbench_00024 | [
1,
2,
3
] | [] | [
"Glycogen vs lipid distinction favored lipid — “the histochemical and immunohistochemical features of the posttreatment excision support lipid accumulation rather than glycogen in the vacuolated cells.”",
"Preexisting lipogenic differentiation unsampled at biopsy considered but unlikely — “the biopsy contained no... | A 16-year-old boy noted a progressively enlarging lump at his posterior left knee over one year. MRI revealed a 13 cm mass in the left posteroinferior thigh, centered in the semitendinosus muscle and extending to the biceps femoris. Fine-needle aspiration showed a heterogeneous population of ovoid to tapered spindle ce... | Critical | 0.905 | test | null | null | null |
true | myxoinflammatory fibroblastic sarcoma | Nodular fasciitis | [
"Given the inflammatory background with Reed–Sternberg–like cells in a patient with prior Hodgkin lymphoma, recurrence is a key consideration and the pathologist appropriately recommends immunohistochemistry (IHC) to further classify the lesion.",
"As an additional precaution before interpreting lymphoma markers,... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-3",
"S-1"
] | I kept Variant 1’s omission of the key prerequisite step (no CD15/CD30 negativity shown before diagnosing myxoinflammatory fibroblastic sarcoma) by using its early MSF assertion as Step 3. I integrated Variant 3’s redundant additions as Step 2 (extra EBV/lymphoid panel) and Step 4 (PET/CT), marking both as simplicity e... | [
{
"error_description": "Prerequisite sensitivity error: concludes a specific soft-tissue neoplasm diagnosis (myxoinflammatory fibroblastic sarcoma) without first completing the prerequisite IHC exclusion of recurrent Hodgkin lymphoma (e.g., demonstrating CD15/CD30 negativity).",
"error_step_indices": [
... | [
2,
3,
4,
5
] | medprmbench_00025 | [
1,
2,
3,
4,
5
] | [] | [
"Consideration of recurrent Hodgkin lymphoma — “the pathologist recommended immunohistochemistry (IHC) staining to rule out recurrence of Hodgkin lymphoma due to the presence of inflammatory background and Reed–Sternberg–like cells.”",
"Exclusion of Hodgkin lymphoma by negative classical markers — “CD15 and CD30 ... | A 25-year-old man with a history of Hodgkin lymphoma presented with a 2-month history of a gradually enlarging mass over the dorsum of his left hand. Six years earlier, he had been diagnosed with Hodgkin lymphoma on the basis of mediastinal lymphadenopathy and systemic symptoms, and he received 13 courses of chemothera... | Critical | 0.875 | test | null | null | null |
true | neuroendocrine carcinoma | Neuroendocrine carcinoma of the pineal region | [
"Consider pineal region tumors in the differential, including pineal parenchymal tumors such as pineoblastoma given the location, hydrocephalus, and aggressive primitive round-cell histology with rosette-like features.",
"Prioritize pineoblastoma over metastatic neuroendocrine carcinoma because cytokeratin (AE1/A... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-2"
] | I kept Step 1 close to the original. I merged Variant 2 (R-1) and Variant 3 (R-2) into a single Step 2 by preserving both the incorrect cytokeratin interpretation and the contradictory statement that the renal lesion was FDG-avid, even though these tensions make the step internally inconsistent. I then used Variant 1’s... | [
{
"error_description": "Introduces the incorrect medical claim that cytokeratin positivity is characteristic of pineoblastoma and generally not expected in metastatic neuroendocrine carcinoma, thereby mis-weighting the immunophenotype to favor pineoblastoma over neuroendocrine carcinoma.",
"error_step_indic... | [
2,
3
] | medprmbench_00026 | [
1,
2,
3,
4
] | [] | [
"Consideration of pineal parenchymal tumors — “The initial differential diagnosis included pineal parenchymal tumors, such as a pineoblastoma…”",
"Consideration of metastatic neuroendocrine carcinoma — “…as well as metastatic neuroendocrine carcinoma.”",
"Favoring neuroendocrine carcinoma based on dual marker e... | A 53-year-old man with hypertension presented with five days of intractable vomiting, generalized weakness, ataxia, and severe headaches. On examination, he was lethargic, retching frequently, and had bilateral papilledema with impaired upward and downward gaze; gait could not be assessed safely. CT and MRI of the brai... | Critical | 0.905 | test | null | null | null |
true | anisakiasis | Anisakiasis with spontaneous splenic rupture | [
"Hemorrhage from a perforated viscus was considered — “The differential diagnosis of shock in this patient with abdominal pain included hemorrhage, which can result from a perforated viscus…”",
"Ruptured abdominal aortic aneurysm was deprioritized because a rupture would be expected to cause a slower, more chroni... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-4",
"R-7"
] | I combined the distinct corrupted components from each single-error variant into one coherent chain. From R-7, I used the temporally incorrect deprioritization of ruptured AAA and carried its subacute framing forward by interpreting the CT-confirmed splenic rupture as evolving over 48 hours (reflected in steps 2, 7, an... | [
{
"error_description": "Trajectory (time-course) error: mischaracterizes ruptured AAA as typically slow/subacute and therefore less urgent in abrupt shock, then propagates this temporal framing by reinterpreting CT-proven splenic rupture as a subacute process developing over ~48 hours rather than an acute hemor... | [
2,
3,
8
] | medprmbench_00027 | [
2,
3,
4,
5,
6,
7,
8,
9
] | [] | [
"Hemorrhage from a perforated viscus was considered — “The differential diagnosis of shock in this patient with abdominal pain included hemorrhage, which can result from a perforated viscus…”",
"Ruptured abdominal aortic aneurysm was considered — “…hemorrhage … can result from a ruptured abdominal aortic aneurysm... | A 53-year-old woman presented to the emergency department with sudden, severe abdominal pain 60 minutes earlier, preceded by anchovy ingestion 48 hours before. She also reported weakness, diaphoresis, and hypotension. Her pain was rated 8/10 and was diffuse, with maximal tenderness in the periumbilical and epigastric a... | Critical | 0.8711 | test | null | null | null |
true | Massive ovarian edema | Krukenberg tumor (ovarian metastasis from signet-ring cell gastric adenocarcinoma) | [
"Treat the adnexal mass as a chronic, indolent process given the 1-month insidious pain and lifelong lymphedema; therefore, immediate operative staging is not time-sensitive, and the appropriate trajectory is short-term outpatient surveillance with repeat imaging in 6–8 weeks before committing to laparotomy for sus... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-1",
"R-4",
"R-5",
"R-6",
"R-7"
] | I used Variant 3’s Step 1 to embed the time/trajectory error (surveillance-first, delayed staging) and propagated its delayed-evaluation framing through later steps for coherence. I then replaced Step 2 with Variant 1’s safety-violating claim that normal markers rule out aggressive malignancy, while adding a brief link... | [
{
"error_description": "",
"error_step_indices": [
1,
2,
3,
4
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
4,
5
],
"error_type": "E-5",
"modified_steps": null
},
{
"error_d... | [
1,
2,
3,
4,
5
] | medprmbench_00028 | [
1,
2,
3,
4,
5
] | [] | [
"Consideration of a malignant ovarian tumor — “radiological findings were suggestive of an ovarian tumor; a staging laparotomy and surgical excision of the tumor and fibroid was planned with a provisional diagnosis of a malignant ovarian tumor with multiple fibroid and unilateral lymphedema.”",
"Exclusion of dysg... | A 25-year-old nulliparous woman presented with a 1-month history of insidious-onset right lower abdominal pain. She also had lifelong non-pitting edema of the left leg extending to the labia majora. She was otherwise healthy, with regular menses and no tobacco or alcohol use. On examination, she was afebrile, blood pre... | Critical | 0.895 | test | null | null | null |
true | Oculomotor mononeuropathy | Radiographically occult posterior communicating artery aneurysm causing compressive oculomotor nerve palsy | [
"Although noncontrast CT, brain MRI, and standard MR angiography were unremarkable, recent neuroradiology guidance (European Neurovascular Imaging Consensus Statement, Neuroradiology 2023) emphasizes that time-of-flight MRA can miss small posterior communicating artery (PCoA) aneurysms <3 mm, with reported sensitiv... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-2",
"R-1"
] | To integrate all single-error variants, I built a single composite chain that retains: (1) the fabricated consensus/guideline-style aneurysm argument from Variant 2 (E-2) and (2) the incorrect claim that pupil sparing plus normal MRI/MRA essentially rules out aneurysmal compression from Variant 3 (R-1). Because both er... | [
{
"error_description": "Skips the prerequisite step of first excluding compressive/structural etiologies (especially PCoA aneurysm) before concluding a post-vaccination immune-mediated oculomotor neuropathy.",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": [
2
... | [
1,
2
] | medprmbench_00029 | [
1,
2,
3,
4,
5,
6,
7
] | [] | [
"1. Compressive causes such as posterior communicating artery aneurysm were excluded by normal imaging — “Since all possible underlying structural causes of oculomotor nerve injury were ruled out by clinical, laboratorial, and imaging workup.”"
] | A 79-year-old white man presented with sudden onset of right-sided ophthalmoplegia, diplopia, and ptosis accompanied by nausea, vomiting, and headache. The symptoms began two days after receiving an inactivated seasonal influenza vaccine containing A/New Caledonia/20/99 (H1N1)-like, A/Wisconsin/67/2005 (H3N2)-like, and... | Critical | 0.94 | test | null | null | null |
false | DensInvaginatus | Dens invaginatus | [
"With no obvious restorations or cavitated lesions on clinical examination, caries can be set aside as the cause of the apical pathology.",
"Periodontal origin was considered but excluded — “Periodontally there were no pathological pockets, and oral hygiene was good.”",
"This presentation is without question ex... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-4",
"R-5"
] | I kept the overall four-step structure from the original/variants and integrated the corrupted steps from each single-error chain at their respective positions. Step 1 uses Variant 1’s premature exclusion of caries (omitting occult-caries workup) to preserve E-1. Step 3 replaces the original trauma-exclusion step with ... | [
{
"error_description": "Prerequisite Sensitivity: prematurely ruled out a carious etiology based only on absence of obvious restorations/cavitated lesions, skipping prerequisite checks for occult/non-cavitated caries (e.g., hidden proximal/fissure caries, cracks) before excluding caries.",
"error_step_indic... | [
1,
3,
4
] | medprmbench_00030 | [
1,
3,
4
] | [] | [
"Carious infection was considered but excluded — “Dentally the patient had an unrestored adult dentition with absent third molars and no detectable caries.”",
"Periodontal origin was considered but excluded — “Periodontally there were no pathological pockets, and oral hygiene was good.”",
"Traumatic injury was ... | A 25-year-old medically fit man presented to a dental emergency clinic with a 7-day history of constant aching pain localized to the left mandible. Extraoral and intraoral soft-tissue examinations were unremarkable. Periodontally, there were no pathological pockets, and oral hygiene was good. Dentally, he had an unrest... | Critical | 0.8075 | test | null | null | null |
false | mucous extravasation phenomenon | Submandibular mucous extravasation pseudocyst (ranula) | [
"Infection was unlikely because there were no inflammatory signs and intraoral findings were normal.",
"Tumor of salivary origin was less likely because in pediatric patients, salivary neoplasms are uncommon and most recurrent facial swellings are developmental or inflammatory rather than neoplastic; therefore, a... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-3",
"S-2"
] | Kept Step 1 from the original. Replaced Step 2 with Variant 2’s contextually inapplicable pediatric-epidemiology rationale to embed R-3. Used Variant 1’s Step 3 phrasing to preserve the combined aspirate-based exclusion of vascular malformation while maintaining coherence with the shortened chain. Collapsed the downstr... | [
{
"error_description": "Applies pediatric epidemiology (salivary tumors are rarer in children) to an adult patient to deprioritize salivary neoplasm, despite the patient being 25 years old.",
"error_step_indices": [
2
],
"error_type": "R-3",
"modified_steps": [
2
]
},
{
"... | [
2,
4
] | medprmbench_00031 | [
1,
2,
3,
4
] | [] | [
"Infection was unlikely — “Absence of inflammatory signs and normal intraoral findings excluded chances of infection.”",
"Tumor of salivary origin was less likely — “The recurrent nature of the swelling … nullified the tumerous etiology.”",
"Vascular malformation was excluded by aspirate — “The clinical picture... | A 25-year-old man presented with an asymptomatic, diffuse swelling on the right side of his face and neck. He reported similar, smaller swellings over the past 3–4 years that would spontaneously regress. He could not relate episodes to trauma, meals, dental pain, or systemic symptoms.
On examination, a 7 × 3 cm firm, ... | Critical | 0.805 | test | null | null | null |
true | Acute appendicitis | Pelvic inflammatory disease (PID) | [
"Ectopic pregnancy was initially suspected given early pregnancy with an empty uterus on ultrasound, β-hCG below the discriminatory zone, and a small left adnexal structure with free fluid, so diagnostic laparoscopy was offered to evaluate for ectopic pregnancy.",
"Since the laparoscopy did not show hemoperitoneu... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-5"
] | I kept Step 1 consistent with all variants (initial ectopic concern leading to laparoscopy). I merged Variant 1’s Step 2 corruption (dismissing adnexal findings after negative laparoscopy, and omitting confirmation of the fluid/pus source) with Variant 3’s Step 2 anchoring on a ruptured corpus luteum to create a single... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "E-5",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
4
] | medprmbench_00032 | [
1,
2,
3,
4
] | [] | [
"Ectopic pregnancy was initially suspected given the imaging and lab findings — “Given the short duration of amenorrhea, absence of vaginal bleeding, b-hCG level below discriminatory zone, and empty uterus on scan, a diagnostic laparoscopy was offered for the possibility of an ectopic pregnancy.”",
"Intraoperativ... | A 34-year-old woman, gravida 2 para 1 (previous cesarean section), presented at 4 weeks 5 days of amenorrhea with a 1-day history of epigastric pain radiating to the lower abdomen. She denied fever, nausea, vomiting, or vaginal bleeding. On examination, she was afebrile, hemodynamically stable, and had epigastric tende... | Critical | 0.965 | test | null | null | null |
true | chemotherapy induced sclerosing cholangitis | Primary sclerosing cholangitis | [
"The bile duct biopsy clearly and definitively confirms eosinophilic cholangitis, demonstrating prominent eosinophilic infiltration of the bile duct wall, which without question explains the strictures and dilatations seen on cholangiography.",
"Cholangiocarcinoma was excluded because there were no malignant cell... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-4",
"R-5"
] | I formed a single coherent chain by combining the distinct corrupted elements from each variant at their corresponding logical positions. Step 1 uses Variant 2’s overconfident, fact-contradicting eosinophilic-cholangitis confirmation (R-4) and Step 4 references this as ‘biopsy-proven’ to keep the narrative consistent. ... | [
{
"error_description": "Confidence Invariance: asserted with high certainty that biopsy showed prominent eosinophilic infiltration confirming eosinophilic cholangitis, contradicting the stem (modest neutrophils, no eosinophils), and carried this ‘biopsy-proven’ claim forward for coherence.",
"error_step_ind... | [
1,
3,
5
] | medprmbench_00033 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Eosinophilic cholangitis was excluded because “there [was] a lack of eosinophilic infiltration in the bile duct biopsy.”",
"Cholangiocarcinoma was excluded because “there [were] no malignant cells in the bile duct biopsy, and cytology of bile … revealed no features of malignancies.”",
"IgG4-related cholangitis... | A 61-year-old woman with cervical cancer metastatic to paraaortic and left supraclavicular lymph nodes was treated with systemic chemotherapy: paclitaxel and bevacizumab administered for 63 and 36 days before presentation, respectively, each followed the next day by cisplatin. On day 0, she was admitted for marked elev... | Critical | 0.895 | test | null | null | null |
true | Bartonella neuroretinitis | Demyelinating optic neuritis | [
"Demyelinating optic neuritis was initially considered given unilateral disc swelling, RAPD, and a centrocecal scotoma. The combination of unilateral optic disc swelling followed by development of a macular star supports a diagnosis of neuroretinitis, so demyelinating optic neuritis is excluded. Contrary to the tra... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-2",
"R-1"
] | I merged the Step 1 corruptions from Variant 1 (premature exclusion of demyelinating optic neuritis based on macular star without establishing it as present at that moment) and Variant 2 (fabricated 2023 consensus/STAR-ON cohort statistics claiming the partial macular star supports MS-associated demyelinating optic neu... | [
{
"error_description": "Excludes demyelinating optic neuritis (and asserts neuroretinitis) without first establishing the prerequisite that a macular star is already present at the time of exclusion.",
"error_step_indices": [
1
],
"error_type": "E-1",
"modified_steps": [
1
]
},... | [
1,
2
] | medprmbench_00034 | [
1,
2,
3,
4
] | [] | [
"Demyelinating optic neuritis was considered given the isolated disc swelling, but was excluded because “The appearance of a macular star generally precludes the possibility of a demyelinating aetiology.”",
"Malignant hypertension was considered because it can present with a macular star, but was unlikely since i... | A 23-year-old Malay man was referred for sudden-onset, painless, central blurring of vision in the right eye without floaters, photopsia, or eye-movement pain. Two days before visual symptoms, he had headache, low-grade fever (37.7 °C), and painful cervical lymphadenopathy treated with amoxicillin/clavulanic acid. He h... | Critical | 0.94 | test | null | null | null |
true | Cysticercosis | Disseminated cutaneous hydatidosis (echinococcosis) | [
"Lipoma was considered because of firm, mobile subcutaneous nodules. It was excluded after histopathology revealed a parasitic cyst rather than mature adipose tissue.",
"Sebaceous cyst was considered due to subcutaneous nodules with normal overlying skin. It was excluded when biopsy showed a larval cyst instead o... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-1"
] | I used Variant 2 as the backbone because it introduces the differential-narrowing error and changes downstream interpretation/need for imaging. I then replaced the lymphoma step with Variant 1’s prerequisite-skipping exclusion (keeping the rest of Variant 2’s flow), and incorporated Variant 3’s evidence error by overwr... | [
{
"error_description": "Prematurely narrows the differential to benign lipomatosis and deprioritizes/omits high-risk treatable causes (e.g., disseminated cysticercosis/neurocysticercosis and malignancy), propagating the narrowing by dismissing the need for further evaluation and reinterpreting biopsy/imaging cl... | [
3,
6,
10
] | medprmbench_00035 | [
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11
] | [] | [
"Lipoma was considered because of firm, mobile subcutaneous nodules — “Important differential diagnoses that need to be considered are lipoma, sebaceous cysts, deep mycoses, neurofibroma, lymphomas, cutaneous metastasis, and reactive generalized lymphadenopathy.” It was excluded after histopathology revealed a para... | A 55-year-old man presented with multiple asymptomatic, skin-colored nodules over his neck, trunk, and upper limbs for 1 year. The lesions had slowly increased in size and number. He reported no systemic complaints, including no fever, weight loss, or neurologic symptoms. He ate beef but denied consumption of pork and ... | Critical | 0.94 | test | null | null | null |
false | Retinal neovascularization | Retinal neovascularization secondary to chronic central serous chorioretinopathy | [
"Given the longstanding chronic CSCR with widespread RPE alterations and the presence of a vascular complex with hemorrhage, the most likely explanation is choroidal neovascularization (CNV) secondary to chronic CSCR, which can account for new floaters from vitreous hemorrhage.",
"Given the vitreous hemorrhage wi... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-3"
] | I used Variant 2’s Step 1 to introduce the premature anchoring/narrow differential (E-5) and retained its downstream narrowing and direct anti-VEGF management step to preserve that error’s trajectory. I then replaced Step 2 with Variant 3’s PDR-prevalence-based conclusion to embed the contextual inapplicability error (... | [
{
"error_description": "Prematurely anchors on CSCR-related CNV and effectively stops constructing a worst-first differential for vitreous hemorrhage/preretinal neovascularization (e.g., retinal tear/detachment, ocular ischemic syndrome, vasculitides), proceeding toward anti-VEGF without adequate exclusion of o... | [
1,
2,
4
] | medprmbench_00036 | [
1,
2,
3,
4,
6
] | [] | [
"Consideration of choroidal neovascularization — “At first sight, a choroidal neovascularization was suspected which is a common complication in chronic CSCR which could have penetrated the retina and into the vitreous. Surprisingly, however, the origin of the neovascularization was found to be retinal and its loca... | A 48-year-old man with a longstanding history of central serous chorioretinopathy presented with a sudden onset of tiny floaters in the field of view of his left eye. He had episodic blurred vision in both eyes. His past medical history was notable for ethanol-related liver cirrhosis with decompensation and hepatorenal... | Critical | 0.7467 | test | null | null | null |
true | congenital unilateral hypoplasia of depressor anguli oris | Congenital facial nerve palsy of the marginal mandibular branch due to birth-related compression/trauma | [
"The presentation is most consistent with congenital hypoplasia/agenesis of the depressor anguli oris muscle (asymmetric crying facies), so conclude this diagnosis.",
"The birth history clearly confirms significant obstetric trauma with complicated delivery, definitively supporting a compression-related facial ne... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-4",
"R-6"
] | I used Variant 1’s Step 1 to preserve the prerequisite-omission error (skipping the CN VII functional confirmation before concluding depressor anguli oris hypoplasia). For Step 2, I combined Variants 2 and 3 to simultaneously (a) contradict the earlier direction by making birth trauma/facial nerve palsy a leading possi... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2,
3
] | medprmbench_00037 | [
1,
2,
3
] | [] | [
"Facial nerve paralysis considered; excluded because other facial functions were intact — “Facial nerve lesions may cause weakness of facial expressions; however, congenital hypoplasia of depressor anguli oris afflicts lower lip while other functions of facial nerves are preserved.”",
"Obstetric-related compressi... | A ten-month-old Hispanic girl presented for evaluation of facial asymmetry noted since birth. The mother reported that when the child smiles or cries, the right lower lip deviates inward, whereas the rest of facial movement is symmetric. Pregnancy was uncomplicated, and the patient was born full term. Developmental mil... | Critical | 0.805 | test | null | null | null |
true | Wunderlich syndrome | Congenital perirenal (retroperitoneal) lymphangioma | [
"Prioritize congenital perirenal lymphatic malformation (retroperitoneal lymphangioma) rather than urinoma/hematoma: a 2023 European Society of Fetal Urology (ESFU) consensus statement (Prenatal Diagnosis, 2023) reports that internal septations/light bands within a perirenal fluid collection have a specificity of 9... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-2",
"E-4",
"E-5",
"R-1",
"R-4",
"R-5"
] | I used Variant 1 as the backbone to preserve the fabricated ESFU consensus/statistics and the resulting lymphangioma-directed trajectory (E-2), which necessarily alters downstream framing and conclusion. I then merged Variant 3’s overconfident factual contradiction into Step 2 (normal amniotic fluid and normal bladder)... | [
{
"error_description": "",
"error_step_indices": [
1,
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error... | [
1,
2,
3,
4
] | medprmbench_00038 | [
1,
2,
3,
4
] | [] | [
"Consideration of urinoma—“Multiple slightly strong echoes, septations, and flocculent echoes were more likely to be seen in ultrasonography of hematoma.”",
"Inclusion of lymphangioma and mesenteric cyst—“The differential diagnosis of cystic masses located between the kidney and spine includes urinoma, lymphangio... | A 27-year-old gravida 2 para 0 woman with an uncomplicated spontaneous pregnancy was referred at 36 weeks’ gestation for suspected fetal renal anomalies. Prenatal ultrasound showed:
• Bilateral renal enlargement and hydronephrosis
• A markedly dilated fetal bladder
• A left perirenal fluid collection measuring 64 ×... | Critical | 0.875 | test | null | null | null |
true | urachal cyst | Infected urachal cyst (urachal abscess) | [
"A midline hyperdense mass above the bladder in a child with fever and acute abdomen is most consistent with an infected urachal remnant (urachal cyst/abscess).",
"Appendicitis was entertained due to acute abdominal pain, and a midline hypogastric inflammatory mass above the bladder can commonly represent a pelvi... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-1",
"R-6",
"S-1"
] | I used Variant 1’s Step 1 to embed the prerequisite-skip (E-1) by directly diagnosing an infected urachal remnant from imaging alone. I then adopted Variant 2’s appendicitis reinterpretation as Step 2 to incorporate the evidence-soundness error (R-1), and kept its downstream framing of granulomatous considerations in S... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2,
3,
4
] | medprmbench_00039 | [
1,
2,
3,
4
] | [] | [
"Vitelline duct anomalies were considered given midline masses in children — “In the differential diagnosis, vitelline duct anomalies…should be kept in mind.”",
"Appendicitis was entertained due to acute abdominal pain, but the imaging showed a hypogastric mass rather than right-lower-quadrant inflammation — “Abd... | A 5-year-old Caucasian girl presented with an 18-hour history of generalized abdominal pain, fever (39 °C), vomiting, and constipation. Her past medical history was unremarkable. On examination, she was febrile, with a rigid abdomen and diffuse severe tenderness. Digital rectal examination revealed soft stool without b... | Critical | 0.835 | test | null | null | null |
true | cutaneous leishmaniasis | Cutaneous squamous cell carcinoma | [
"Fungal infection was excluded — “Special stains and cultures for fungi … were negative.”",
"Mycobacterial infection (tuberculosis) can be set aside based on the negative PPD and lack of response to empiric antituberculous therapy, so no further TB-related safety considerations are needed in the differential.",
... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"E-5",
"R-3",
"R-5",
"S-1"
] | I kept the original question unchanged. To merge variants, I used Variant 2’s Step 2 to embed the TB safety-bypass error (R-5). For Step 5, I combined Variant 2’s unsafe reinterpretation of SCC as reactive (R-5) with Variant 1’s premature closure on SCC and dismissal of alternative infectious etiologies (E-5) into a si... | [
{
"error_description": "",
"error_step_indices": [
2,
6,
7
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-3",
"modified_steps": null
},
{
"error_description": "",
... | [
2,
5,
6,
7,
8,
9
] | medprmbench_00040 | [
2,
5,
6,
7,
8,
9
] | [] | [
"Fungal infection was excluded — “Special stains and cultures for fungi … were negative.”",
"Mycobacterial infection (tuberculosis) was excluded — “PPD was negative” and “anti-tuberculous therapy … was not effective.”",
"Noninfectious granulomatous disorders were considered — “patient had received … systemic co... | An 87-year-old man from Isfahan presented with asymptomatic, progressive facial lesions of 3 years’ duration. He noted onset after an overnight outdoor camping trip; his son concurrently developed a leishmanial nodule on his leg. Lesions gradually extended over the nose, cheeks, upper lip, and periorbital areas, with c... | Major | 0.8833 | test | null | null | null |
true | Dyke-Davidoff-Masson syndrome | Rasmussen encephalitis | [
"The combination of early-onset, medically refractory focal seizures with progressive unilateral (left-sided) upper-motor-neuron weakness strongly points to Rasmussen encephalitis as the unifying diagnosis; in adults with chronic focal epilepsy and progressive hemiparesis, Rasmussen can show unilateral cerebral atr... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"E-5",
"R-1",
"R-4",
"R-5",
"S-2"
] | I used Variant 1 as the backbone because it implements the E-5 premature narrowing across the chain (Rasmussen as the unifying diagnosis, skull findings dismissed, and management redirected). I then merged Variant 2’s R-3 contextual misapplication directly into the composite Step 1 by adding the adult-based claim that ... | [
{
"error_description": "",
"error_step_indices": [
1,
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
1,
3
],
"error_type": "E-5",
"modified_steps": null
},
{
"error_description": "",
... | [
1,
2,
3
] | medprmbench_00041 | [
1,
2,
3
] | [] | [
"Rasmussen encephalitis was considered because of the progressive hemiparesis and seizures, but “it lacks the compensatory cranial changes seen in DDMS.”",
"Sturge–Weber syndrome was considered due to similar neurological symptoms, but it is “distinguished by the presence of leptomeningeal angiomatosis and port-w... | An 8-year-old girl was evaluated for recurrent seizures, left-sided weakness, and developmental delays. Seizures began at age 3 months, initially infrequent but progressively more frequent despite antiepileptic therapy. The parents also noted delayed motor and cognitive milestones and gradual behavioral changes, includ... | Critical | 0.805 | test | null | null | null |
false | Primary testicular lymphoma | Primary testicular diffuse large B‑cell lymphoma | [
"Non-seminomatous germ cell malignancies were a possible differential on ultrasound alone but were unlikely in an older patient — “other non-seminomatous germ cell testicular malignancies; but given our patient’s age these would be unlikely.”",
"Given the imaging pattern of a testicular mass with contiguous exten... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-6",
"S-2"
] | I used Variant 1’s Step 2 to enforce the E-1 omission (skipping the prerequisite distinction between primary testicular lymphoma and secondary testicular involvement). To integrate R-6 and S-2 without reintroducing the omitted prerequisite step, I kept the chain at three steps and merged Variants 2 and 3 into a single ... | [
{
"error_description": "Prerequisite Sensitivity error: omits the necessary step of considering/assessing whether the testicular lesion could represent secondary involvement from systemic lymphoma (and the need to distinguish that from PTL) before concluding PTL based on the spread pattern.",
"error_step_in... | [
2,
3
] | medprmbench_00042 | [
2,
3
] | [] | [
"Non-seminomatous germ cell malignancies were a possible differential on ultrasound alone but were unlikely in an older patient — “other non-seminomatous germ cell testicular malignancies; but given our patient’s age these would be unlikely.”",
"Secondary involvement of the testis by systemic lymphoma could not b... | A 70-year-old man was referred with a 6-week history of a left-sided scrotal swelling that was not painful but had increased in size. His medical history included hypertension, eczema, and a right orchidectomy with chemotherapy for seminoma 25 years earlier. On examination, he had a large left hemi-scrotal swelling wit... | Major | 0.7583 | test | null | null | null |
true | Intraosseous schwannoma | Simple bone cyst of the calcaneus | [
"Simple bone cyst was considered due to a well-defined lytic lesion with sclerotic rim — “it is difficult to differentiate from other benign bone lesions such as bone cyst…”.",
"Aneurysmal bone cyst was considered given overlapping cystic imaging features — “… aneurysmal bone cyst…”.",
"Benign chondroblastoma w... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-3",
"R-5",
"R-6"
] | I kept steps 1–5 from the original chain. I replaced step 6 with the hallucinated aspiration/cytology content from Variant 3 (R-6). I then replaced step 7 with Variant 2’s safety-bypassing malignancy assessment (R-5). For step 8, I used Variant 1’s prerequisite-skipping schwannoma assertion (E-1) while also aligning wi... | [
{
"error_description": "",
"error_step_indices": [
8
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
7
],
"error_type": "R-5",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
6,
7,
8
] | medprmbench_00043 | [
6,
7,
8,
9,
10
] | [] | [
"Simple bone cyst was considered due to a well-defined lytic lesion with sclerotic rim — “it is difficult to differentiate from other benign bone lesions such as bone cyst…”.",
"Aneurysmal bone cyst was considered given overlapping cystic imaging features — “… aneurysmal bone cyst…”.",
"Benign chondroblastoma w... | A 35-year-old woman presented with an eight-month history of right heel pain that had gradually increased over the past two months. The pain commonly occurred at night, was unrelated to activity, and was felt at rest. There was no history of trauma. She smoked 20 cigarettes per day for 10 years and had no other medical... | Major | 0.79 | test | null | null | null |
true | Posterior scleritis | Central serous chorioretinopathy (CSC) | [
"Rheumatic diseases were considered and excluded because the systemic workup was negative for rheumatic markers (ESR, CRP, ANA, c-ANCA, and p-ANCA).",
"With rheumatic causes unlikely, proceed to diagnosis based on the ocular imaging pattern (serous macular detachment on OCT, pinpoint subretinal leakages on fluore... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"E-5",
"R-1",
"S-2"
] | I used Variant 1’s structure to omit a dedicated infectious-exclusion step and move directly from rheumatic exclusion to imaging-based reasoning (creating the E-1 omission at Step 2). To also include Variant 3’s S-2 error despite the omitted infectious step, I embedded its tautological infectious-rule-out phrasing with... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "S-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
4
] | medprmbench_00044 | [
1,
2,
3,
4
] | [] | [
"Rheumatic diseases were considered and excluded — “The systemic workup was negative for rheumatic markers (ESR, CRP, ANA, c-ANCA, and p-ANCA).”",
"Infectious etiologies were considered and excluded — “The systemic workup was negative for … infectious etiologies (PPD skin test, toxoplasma IgG and IgM).”",
"Behç... | A 16-year-old girl with genetically confirmed familial Mediterranean fever since age 3, on colchicine 1.5 mg daily, presents after 1 week of painful blurry vision in the left eye following high perceived stress.
Visual acuity is 20/100 in the left eye; mild ciliary injection; serous macular detachment with cloudy sub... | Critical | 0.805 | test | null | null | null |
true | Angiolymphoid hyperplasia with eosinophilia | Atypical hemangioma | [
"The MRI signal characteristics and vivid enhancement suggest a vascular lesion, making an atypical hemangioma a leading consideration.",
"Given overlapping imaging appearances among vascular tumors and proliferations (e.g., hemangioma spectrum, epithelioid hemangioendothelioma, angiosarcoma, Kimura disease), the... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-6",
"S-1"
] | I used Variant 1’s chain as the backbone to preserve the prerequisite-sensitivity error (declaring a definitive diagnosis of atypical hemangioma without histopathologic confirmation). Then I inserted Variant 2’s redundant pre-excision workup steps (extra vascular imaging and inflammatory screening) after the differenti... | [
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
5,
6
],
"error_type": "S-1",
"modified_steps": null
},
{
"error_description": "",
"error... | [
3,
5,
6
] | medprmbench_00045 | [
1,
2,
3,
4,
5,
6,
7
] | [] | [
"Imaging pattern suggesting a vascular lesion — “Based on these MRI findings, an atypical hemangioma was considered as a probable diagnosis.”",
"Other benign vascular proliferations such as Kimura disease, epithelioid hemangioendothelioma, and angiosarcoma were considered due to overlapping clinical and imaging f... | A 27-year-old man noted a progressively enlarging lesion on his right cheek over two months. He had no pain, pruritus, bleeding, weight loss, appetite changes, trauma, or relevant family history. On examination, there was a dome-shaped, firm, nodular subcutaneous lesion measuring about 2×2 cm on the right cheek; it was... | Critical | 0.805 | test | null | null | null |
true | isolated unilateral temporalis muscle hypertrophy | Hypothyroid-related temporalis muscle pseudohypertrophy (myxedematous infiltration) | [
"Inflammatory or infectious myositis considered but excluded — “No signs indicative of inflammatory changes, such as pain, fever, warmth, tenderness, or erythema, were observed.”",
"Neoplasm is treated as both excludable and urgently concerning: temporalis muscle tumors typically appear as diffuse, homogeneous en... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-7"
] | I kept Step 1 from the original. I merged Variant 2 (R-1) and Variant 3 (R-7) into a single Step 2 by including both the incorrect claim about tumor MRI appearance (supporting benign infiltrative interpretation) and the contradictory trajectory-based urgency/rapid malignancy framing with immediate biopsy, preserving bo... | [
{
"error_description": "Skips the prerequisite exclusion of trauma/TMJ pathology as a dedicated step and prematurely concludes idiopathic unilateral temporalis muscle hypertrophy based mainly on a normal exam, rather than completing a full prerequisite check before concluding.",
"error_step_indices": [
... | [
2,
6
] | medprmbench_00046 | [
2,
3,
4,
5,
6,
7,
8
] | [] | [
"Inflammatory or infectious myositis considered but excluded — “No signs indicative of inflammatory changes, such as pain, fever, warmth, tenderness, or erythema, were observed.”",
"Neoplasm considered but excluded — “Contrast-enhanced MRI revealed an asymmetrically homogenous hypertrophy of the left temporalis m... | A 39-year-old woman presented with a one-month history of painless swelling over her left temporal region. Her past medical history was notable only for hypothyroidism treated for 10 years. She denied head trauma, dietary changes, bruxism, headaches, or recent surgery. She had received botulinum toxin A injections into... | Critical | 0.7912 | test | null | null | null |
false | Histoplasmosis | Disseminated histoplasmosis (Histoplasma capsulatum) involving the oral and colonic mucosa | [
"CMV reactivation remains the most likely diagnosis in an immunosuppressed transplant recipient with fever, diarrhea, and oral ulcers; negative early cytology/serology can occur, and lack of response after 7 days does not exclude CMV, so the working diagnosis should stay CMV disease.",
"HSV infection is less like... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-2",
"R-5"
] | I used Variant 3’s Step 1 to embed the safety-awareness anchoring error (R-5) and kept its Step 2 framing to maintain the CMV-prioritization narrative. For Step 3, I adopted Variant 1’s biopsy-free conclusion of disseminated histoplasmosis to preserve the prerequisite-omission error (E-1), and I appended Variant 2’s co... | [
{
"error_description": "Bypasses critical safety awareness by anchoring on CMV as the leading diagnosis despite negative testing and nonresponse, deprioritizing alternative opportunistic infections and risking a dangerous missed diagnosis.",
"error_step_indices": [
1
],
"error_type": "R-5",
... | [
1,
3
] | medprmbench_00047 | [
1,
2,
3
] | [] | [
"CMV reactivation was initially considered due to immunosuppression and compatible symptoms — “presented fever, diarrhea, cutaneous rash, and oral lesions—features that are consistent with the diagnosis of CMV infection.” It was deemed less likely when “exfoliative cytology and the anti-CMV IgG tests were negative,... | A 36-year-old woman presented with a 3-day history of fever, chills, night sweats, diarrhea, and painful oral lesions. She underwent liver transplantation 8 years earlier for biliary cirrhosis and has been maintained on prednisone 5 mg/day and mycophenolate sodium 360 mg/day. Three months after transplantation she had ... | Critical | 0.895 | test | null | null | null |
true | BrownTumor | Bone metastasis from an occult primary malignancy | [
"Infection ruled out — we initially ruled out a gastrointestinal or lung infection, or any cardiac cause for the patient's symptoms.",
"Pulmonary abscess or tuberculosis considered late/subacutely and prioritized — because the symptoms have been present for 15 days, this represents a chronic process rather than a... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-2",
"R-3"
] | I merged the single-error variants by keeping Step 1 intact and combining the two distinct root-cause corruptions into the same composite chain: Step 2 incorporates both R-1's incorrect TB imaging premise and R-7's timing/trajectory misclassification. Step 3 adopts E-1's premature metastatic working diagnosis (skipping... | [
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
4
] | medprmbench_00048 | [
1,
2,
3,
4,
5,
6,
7
] | [] | [
"Infection ruled out — “we initially ruled out a gastrointestinal or lung infection, or any cardiac cause for the patient's symptoms.”",
"Pulmonary abscess or tuberculosis considered — “These findings were initially interpreted as a pulmonary infection, probably a lung abscess, an abscedated nodule or pulmonary t... | A 60-year-old man was transferred from the hemodialysis unit to the emergency department with 15 days of malaise, subjective fevers, shortness of breath, dry cough, abdominal pain, diarrhea, and mild non-radiating anterior chest pain. His history was notable for type 2 diabetes mellitus (with retinopathy), chronic kidn... | Critical | 0.905 | test | null | null | null |
true | tumoral calcinosis | Synovial osteochondromatosis | [
"Secondary metastatic peri-articular calcification due to metabolic disorders (e.g., renal insufficiency, hyperparathyroidism, hypervitaminosis D, milk-alkali syndrome) was considered but is unlikely given normal renal function and normal calcium/phosphate-related laboratory values.",
"Given the characteristic ap... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-1",
"R-6"
] | I kept Step 1 from the variants/original (non-error). For E-1, I used Variant 1’s Step 2 that concludes primary tumoral calcinosis based on imaging without the prerequisite phosphate/familial assessment. For Step 3, I merged Variant 2’s premature narrowing to post-traumatic myositis ossificans and dismissal of serious ... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "E-5",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
4
] | medprmbench_00049 | [
1,
2,
3,
4
] | [] | [
"Secondary metastatic peri-articular calcification due to metabolic disorders was considered — “secondary metastatic peri-articular calcification occurring in conditions such as renal insufficiency, hyperparathyroidism, hypervitaminosis D and milk-alkali syndrome.” It was excluded given that “laboratory test result... | A 31-year-old right-hand-dominant woman of Indian origin, 30 weeks pregnant, presented with a three-month history of a gradually enlarging, painful swelling at the volar tip of her right middle finger. She had sustained a superficial laceration at that site from a kitchen knife, treated with a dry dressing. Two weeks b... | Critical | 0.94 | test | null | 3 | 0 |
true | acute non-rheumatic perimyocarditis | Acute pericarditis following streptococcal pharyngitis | [
"Consideration of acute ST-elevation myocardial infarction — the patient underwent coronary angiography, which revealed normal coronary arteries, making obstructive STEMI unlikely.",
"With normal coronaries and a recent infectious prodrome plus myocardial injury biomarkers, this presentation can be treated as MIN... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-3",
"R-5"
] | I retained the original 8-step structure but replaced Step 2 with Variant 1’s MINOCA-without-mechanism prerequisite omission (E-1), replaced Step 3 with Variant 2’s pediatric-pattern-overapplication (R-3), and replaced Steps 7–8 with Variant 3’s pericarditis-downgrade and altered final diagnosis (R-5). Non-error steps ... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "R-3",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
7,
8
] | medprmbench_00050 | [
1,
2,
3,
4,
5,
6,
7,
8
] | [] | [
"Consideration of acute ST-elevation myocardial infarction — “the patient immediately underwent coronary angiography … which revealed normal coronary arteries.”",
"Consideration of MINOCA — “for the diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) no specific cause of the patient... | A 48-year-old man presented with acute chest pain. Two weeks earlier he had an upper respiratory tract infection with sore throat; family members had acute tonsillitis. On admission he was febrile and appeared ill. Vital signs were stable; cardiac and pulmonary exams were unremarkable; no skin rash or edema.
ECG showe... | Critical | 1 | test | null | null | null |
true | Paracoccidioidomycosis | Disseminated blastomycosis (Blastomyces dermatitidis infection) | [
"Acute cholangitis was initially considered based on fever, jaundice, abdominal pain, and elevated inflammatory markers.",
"Given the combination of hepatosplenomegaly, coalescent periportal/retroperitoneal lymphadenopathy, mediastinal adenopathy, and pulmonary micronodules in a patient from Minas Gerais, the mos... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-1",
"R-2",
"R-6",
"S-1"
] | I used Variant 1’s Step 2 to preserve the prerequisite-skipping jump to paracoccidioidomycosis (E-1). I then inserted Variant 3’s redundant PET-CT/bone marrow biopsy and repeat hepatobiliary imaging steps as Steps 3–4 (S-1), keeping the flow from the imaging-based lymphoma concern. I retained the serology exclusion ste... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3,
4
],
"error_type": "S-1",
"modified_steps": null
},
{
"error_description": "",
"error... | [
2,
3,
4,
6
] | medprmbench_00051 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Acute cholangitis was initially considered — “with the presumptive diagnosis of cholangitis.”",
"Lymphoproliferative disease was entertained based on imaging — “diagnostic hypothesis of lymphoproliferative disease was suggested.”",
"Viral and other systemic infections were excluded by serology — “Serological t... | A 19-year-old man from urban Minas Gerais, Brazil, presented with a 10-day history of low back pain that evolved over two days into severe epigastric pain. Upper endoscopy revealed two 1.5 cm duodenal ulcers on the anterior wall and bulb transition; Helicobacter pylori culture was negative, and no biopsy was taken. Ome... | Critical | 0.91 | test | null | null | null |
true | Faecaloma | Aortoenteric (aorto-colonic) fistula | [
"Colonic tumour suspected — Given the palpable abdominal mass, a large colonic tumour is suspected as the cause of massive fresh PR bleeding.",
"Diverticular disease considered less likely — Diverticular bleeding is less likely given the prominent palpable mass and profound haemorrhage.",
"Proceed directly on t... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-4",
"R-1"
] | I used Variant 1’s structure as the backbone because it removes the IBD step and introduces the prerequisite-skipping move straight to presumed aortoenteric fistula (E-1) at step 3, which forces later CT findings to be interpreted as confirming a fistula. I then inserted Variant 3’s incorrect, strongly worded pathophys... | [
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
6,
8
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error... | [
3,
6,
7,
8
] | medprmbench_00052 | [
1,
2,
3,
4,
5,
6,
7,
8
] | [] | [
"Step 1: Colonic tumour suspected — “Given the palpable abdominal mass, a large colonic tumour was suspected…”",
"Step 2: Diverticular disease considered less likely — “…other possible aetiologies such as diverticular disease… were believed to be less likely.”",
"Step 3: Inflammatory bowel disease considered le... | A 66-year-old man residing in a nursing home was brought to the emergency department after an episode of profuse per-rectum bleeding, estimated at 1 L. He had advanced Parkinson’s disease and schizophrenia, with very limited communication and mobility, and was fed via a percutaneous gastrostomy tube. Nursing-home staff... | Critical | 0.94 | test | null | 3 | 0 |
false | Arteriovenous malformation | Arteriovenous malformation (AVM) | [
"Consideration of a salivary gland tumour — the lesion is most consistent with a parotid neoplasm because the CT also demonstrated a subtly enlarged left parotid tail with a 1.8 cm enhancing nodule and small intraparotid lymph nodes, suggesting a pleomorphic adenoma as the primary process rather than a primary mand... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-6",
"S-1"
] | I kept the question unchanged (no variants modified it). I used Variant 2’s fabricated parotid CT details and salivary-tumour framing in steps 1–3 to preserve the R-6 grounding error. I then inserted Variant 3’s additional MRI and metabolic lab workup as steps 4–5 to preserve the S-1 redundancy error while maintaining ... | [
{
"error_description": "Fabricates CT findings (parotid tail enhancing nodule and intraparotid lymph nodes) not present in the stem and uses them to steer the reasoning toward a salivary-gland origin (pleomorphic adenoma) and away from the true intraosseous process.",
"error_step_indices": [
1
],
... | [
1,
4,
5,
6
] | medprmbench_00053 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Consideration of a salivary gland tumour — “a lesion of the parotid salivary gland was amongst the more likely potential explanations.”",
"Confusion with cystic lesions or tumours on imaging — “radiological features variable possibly resulting in confusion with cystic lesions or tumours.”",
"Overlap with bone ... | A 47-year-old Caucasian woman presented with a non-painful swelling of the left cheek/preauricular region that developed over several weeks. She denied trauma, discharge, redness, or warmth. Her medical and family history were unremarkable. On examination, there was a firm mass causing facial asymmetry; intraoral inspe... | Critical | 0.91 | test | null | null | null |
false | Actinomycosis | Abdominal wall actinomycosis | [
"Crohn disease was considered because imaging findings can mimic chronic inflammatory bowel disease: “However, these features are also seen in other diagnoses such as Crohn disease, abdominal tuberculosis, and malignant tumors, making diagnosis challenging.”",
"Abdominal tuberculosis was considered because CT fin... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-4",
"R-2"
] | I merged the single-error variants by (1) replacing the original malignancy step with the R-2 contradictory reframing at composite step 3, (2) replacing the original Aspergillus consideration step with the E-4 CRP unit-conversion error at composite step 6 and keeping its downstream effect on interpretation at step 7, a... | [
{
"error_description": "Step-consistency error: malignancy is prematurely reframed as less likely and the same infiltrative, firm mass is reinterpreted as predominantly inflammatory/infectious, contradicting the earlier malignancy-suspicion state from the original chain.",
"error_step_indices": [
3
... | [
3,
6,
8
] | medprmbench_00054 | [
3,
6,
7,
8,
10
] | [] | [
"Crohn disease was considered because imaging findings can mimic chronic inflammatory bowel disease: “However, these features are also seen in other diagnoses such as Crohn disease, abdominal tuberculosis, and malignant tumors, making diagnosis challenging.”",
"Abdominal tuberculosis was considered because CT fin... | A 47-year-old man with no prior medical or surgical history and no tobacco, alcohol, or drug use presented with a 4-month history of a slowly enlarging abdominal mass in the epigastrium. He denied weight loss, fever, night sweats, changes in bowel habits, anorexia, or vomiting. He appeared well; vital signs were within... | Major | 0.63 | test | null | null | null |
false | neuroglial choristoma | Neuroglial choristoma of the middle ear/mastoid | [
"Schwannoma was considered but excluded because the preoperative MRI reportedly showed no internal auditory canal or cerebellopontine angle extension and the lesion demonstrated a low ADC value suggestive of a non-neoplastic, reactive process; therefore a true spindle-cell schwannoma was less likely despite its vas... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-2",
"R-6"
] | I kept the original question unchanged because none of the variants modified it. I merged Variant 3’s fabricated MRI/ADC rationale into Step 1 (hallucinated, ungrounded data) while retaining the low-cellularity exclusion language. I then constructed Step 2 to simultaneously (a) contradict Step 1 by claiming adequate sp... | [
{
"error_description": "Introduces fabricated information (preoperative MRI diffusion/ADC findings and IAC/CPA extension status) not present in the stem and uses it to argue against schwannoma.",
"error_step_indices": [
1
],
"error_type": "R-6",
"modified_steps": [
1
]
},
{
... | [
1,
2
] | medprmbench_00055 | [
1,
2,
3
] | [] | [
"Schwannoma was considered but excluded because “the stromal cellularity is very low and insufficient to identify a spindle-cell lesion, the presence of a schwannoma was less likely.”",
"Inflammatory lesion with fibrous stroma was included in the frozen‐section differential because “a subsequent frozen section re... | A 63‐year‐old woman presented with right‐sided hearing loss that had been present since early childhood. She had no history of congenital anomalies, trauma, or ear surgery. Otoscopic examination showed a moderate‐sized tympanic membrane perforation of the right ear and a small perforation of the left ear. Pure‐tone aud... | Critical | 0.805 | test | null | null | null |
false | Cytomegalovirus colitis | Cytomegalovirus (CMV) colitis | [
"C. difficile colitis was considered because of the initial presentation of diarrhea and fever in a hospitalized patient — “C. difficile infection is usually suspected when hospitalized patients develop diarrhea and fever.”",
"Bacterial enteropathogens were excluded given negative stool cultures for common pathog... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-3",
"R-1",
"R-6"
] | I kept steps 1–3 identical to the original because none of the variants altered them. All three single-error variants root their corruption at step 4, so I merged their distinct erroneous assertions into a single step 4 that simultaneously (a) prematurely concludes CMV as most likely without a diagnostic confirmation p... | [
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "E-3",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
4,
5
] | medprmbench_00056 | [
4,
5
] | [] | [
"C. difficile colitis was considered because of the initial presentation of diarrhea and fever in a hospitalized patient — “C. difficile infection is usually suspected when hospitalized patients develop diarrhea and fever.”",
"Bacterial enteropathogens were excluded given negative stool cultures for common pathog... | An 80-year-old woman was referred for infectious-disease consultation because of diarrhea, abdominal discomfort, and fever of 1 week’s duration during rehabilitation after spinal stenosis surgery. Three weeks earlier, she had undergone spinal stenosis surgery and then received methylprednisolone (250 mg daily for 1 wee... | Major | 0.695 | test | null | null | null |
true | Baxter neuropathy | Symptomatic partial Achilles tendon tear | [
"Plantar fasciitis was considered — “Plantar fasciitis (PF) remains the most well-known cause of non-traumatic heel pain,” and MRI showed “mildly thickened and hyperintense plantar fascia (~5 mm) adjacent to the calcaneal spur.”",
"Plantar heel fat pad atrophy was excluded — imaging revealed “significant heel fat... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-4",
"R-7"
] | Kept steps 1–2 from the original. Replaced step 3 with Variant 1’s premature Baxter diagnosis (E-1), removing the prerequisite MRI denervation correlation. For step 4, combined Variant 2’s overconfident contradiction (Achilles MRI “completely normal”) with Variant 3’s temporal misreasoning (treat Achilles tear as emerg... | [
{
"error_description": "Prerequisite sensitivity error: skips the prerequisite MRI correlation (selective ADM denervation) before concluding Baxter’s neuropathy, jumping from symptom pattern directly to diagnosis.",
"error_step_indices": [
3
],
"error_type": "E-1",
"modified_steps": [
... | [
3,
4
] | medprmbench_00057 | [
3,
4,
5
] | [] | [
"Plantar fasciitis was considered — “Plantar fasciitis (PF) remains the most well-known cause of non-traumatic heel pain,” and MRI showed “mildly thickened and hyperintense plantar fascia (~5 mm) adjacent to the calcaneal spur.”",
"Plantar heel fat pad atrophy was excluded — imaging revealed “significant heel fat... | A 57-year-old woman presented with a 1-year history of sharp, burning right heel pain that radiated laterally, worsened with walking, and improved with rest. There was no relevant medical or family history. She had undergone shoe and activity modification, stretching, physiotherapy, and NSAIDs without relief. On examin... | Major | 0.665 | test | null | null | null |
true | bilateral brachial artery occlusion | Septic shock from presumed urinary tract infection | [
"Septic shock — “The patient was triaged as having possible septic shock secondary to a urinary tract infection (UTI).”",
"Urinary tract infection — “Despite a negative urinalysis, the urinary symptoms and leukocytosis are sufficient to presume a UTI as the primary source.”",
"Persistent septic shock — “Failure... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-3",
"R-6",
"R-7"
] | I used Variant 2’s sepsis-anchored Step 2 and downstream framing (Steps 3, 4, and the final diagnosis step) to preserve the safety-awareness failure of not prioritizing catastrophic vascular causes. I then incorporated Variant 3’s hallucinated ECG/telemetry confirmation into Step 11 and its downstream embolic reasoning... | [
{
"error_description": "",
"error_step_indices": [
11
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
11
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error_step_i... | [
2,
4,
11
] | medprmbench_00058 | [
2,
3,
4,
11,
12,
13
] | [] | [
"Septic shock — “The patient was triaged as having possible septic shock secondary to a urinary tract infection (UTI).”",
"Urinary tract infection — “The urinalysis did not show a urinary tract infection.”",
"Cardiogenic shock (pump failure) — “If the low blood pressure was from septic shock or pump failure, th... | A 60-year-old man presented with a 1-week history of left flank pain, urinary frequency, urgency, dribbling, incomplete bladder emptying, and two to three episodes of vomiting daily. His history included hypertension (on amlodipine) and a 40-pack-year smoking history. On arrival, radial pulses and blood pressure were u... | Major | 0.8115 | test | null | null | null |
true | PrimaryDermalMelanoma | Clear cell sarcoma (malignant melanoma of soft parts) | [
"A long-standing, firm subcutaneous thigh nodule without overlying skin changes initially raises benign soft-tissue tumors (e.g., lipoma) or soft-tissue sarcoma in the differential.",
"Given the clinical course and imaging plus the pathology report indicating melanoma markers (SOX10 and Melan-A positivity), proce... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-1",
"R-5",
"S-1"
] | I kept the overall structure of the original chain while combining the specific corrupted components from each variant. From Variant 1, Step 2 was replaced to explicitly accept melanoma on immunostains without first excluding key mimics, preserving the omitted prerequisite (E-1). From Variant 2, Step 4 was replaced wit... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "S-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
4,
6
] | medprmbench_00059 | [
1,
2,
3,
4,
5,
6,
7
] | [] | [
"Initial suspicion of a benign soft-tissue neoplasm — “The differential diagnosis at that time included lipoma or sarcoma.”",
"Exclusion of benign masses by biopsy confirming melanoma — “the histopathological report concluded malignant melanoma … SOX10: positive, Melan-A: positive … P40: negative.”",
"Considera... | A 73-year-old woman presented with a subcutaneous nodule on the right thigh that had been present for about one year and was occasionally irritating. There was no overlying skin lesion. Her medical history included hypertension, atrial fibrillation, prior cerebrovascular accident, aortic valve replacement, total knee r... | Critical | 0.905 | test | null | null | null |
true | ResistanceToThyroidHormone | TSH-secreting pituitary adenoma (TSHoma) | [
"Multinodular toxic goiter — the initial suppressed TSH with elevated FT3/FT4 and increased radionuclide uptake is consistent with toxic multinodular goiter, and after near-total thyroidectomy the pituitary–thyroid axis should normalize quickly (within days to a couple of weeks). Therefore, persistent elevation of ... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-7"
] | I kept a single 3-step chain for coherence, using Variant 3’s temporal framing in Step 1 (postoperative/levothyroxine stabilization explanation). For Step 2, I merged Variant 3’s deferral/provisional exclusion of pituitary evaluation (creating the prerequisite-omission context from Variant 1) with Variant 2’s incorrect... | [
{
"error_description": "Trajectory/temporal error: attributes persistent inappropriately elevated TSH with elevated FT3/FT4 to short-term postoperative/levothyroxine pharmacokinetic stabilization and recommends deferring evaluation for chronic etiologies.",
"error_step_indices": [
1
],
"error_... | [
1,
2
] | medprmbench_00060 | [
1,
2,
3
] | [] | [
"Multinodular toxic goiter — initially diagnosed based on goiter and hyperthyroxinemia, but it was reconsidered because “high levels of FT3 and FT4 did not suppress TSH, as expected; on the contrary, TSH was found to be a little elevated.”",
"TSH-secreting pituitary adenoma — included in the differential for inap... | A 58-year-old man was referred for frequent episodes of sinus tachycardia. He had no personal or family history of thyroid disease. On examination, his thyroid gland was enlarged and multinodular. Initial laboratory studies showed a suppressed TSH level with elevated free T3 and free T4; antithyroglobulin and antithyro... | Critical | 0.905 | test | null | null | null |
true | Plaque-like cutaneous mucinosis | Tumid lupus erythematosus | [
"Herpes zoster was initially suspected given the painful back rash but was ruled out when it did not improve despite treatment with acyclovir.",
"Since malignancy and tuberculosis were reportedly excluded elsewhere, these causes can be set aside and the evaluation can proceed directly to distinguishing among infl... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-2",
"R-2",
"R-6"
] | I kept Step 1 aligned with all variants. I replaced Step 2 with Variant 1’s prerequisite-skipping formulation to embed E-1. I replaced Step 3 (and its downstream framing in Step 4) with Variant 3’s altered biopsy interpretation favoring morphea, preserving the internal contradiction with later mention of mucin (R-2). F... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "R-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
5
] | medprmbench_00061 | [
1,
2,
3,
4,
5
] | [] | [
"Herpes zoster was initially suspected given the painful back rash but was ruled out when “treated with acyclovir due to the suspected diagnosis of herpes zoster, without any improvement.”",
"Malignancy and tuberculosis were reportedly excluded during earlier evaluation elsewhere; however, the details of that wor... | A 26-year-old woman presented with a 1-year history of hyperpigmented plaques along her spine, associated with pruritus, a burning sensation, and pain that worsened when leaning against a hard chair back. She was initially treated with acyclovir for presumed herpes zoster, without improvement, and over time new lesions... | Critical | 0.805 | test | null | 2 | 1 |
true | eosinophilic granulomatosis polyangiitis | Eosinophilic pneumonia with eosinophilic pericarditis causing cardiac tamponade | [
"The large pericardial effusion with tamponade physiology and elevated NT-proBNP indicates decompensated congestive heart failure as the primary diagnosis.",
"Pulmonary embolism is less likely because CT pulmonary angiography did not show emboli and the dominant finding is pericardial effusion.",
"Marked periph... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-1",
"S-2"
] | I merged the full Step 1 from Variant 1 (prematurely concluding CHF without using echocardiographic LV assessment) with the full Step 3 from Variant 2 (incorrect evidence claim that eosinophilic pneumonia commonly causes eosinophilic pericarditis/tamponade and thus is the unifying diagnosis) and the full Step 4 from Va... | [
{
"error_description": "Concludes decompensated congestive heart failure from the effusion/tamponade physiology and NT-proBNP without first completing (and using) the prerequisite echocardiographic assessment of LV systolic function/structure to support CHF as the primary diagnosis.",
"error_step_indices": ... | [
1,
3,
4
] | medprmbench_00062 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Considered congestive heart failure — “differentials included congestive heart failure” but echocardiogram demonstrated normal left ventricular cavity size, wall thickness and systolic function with estimated ejection fraction greater than 55%.",
"Considered pulmonary embolism — “differentials included congestiv... | A 52-year-old woman presented with one month of progressive dyspnea, orthopnea, chest pain, and dry cough. She also noted numbness and tingling in her right hand. Vital signs showed blood pressure 124/79 mmHg, heart rate 119 beats/min, respiratory rate 16 breaths/min, oxygen saturation 89% on room air, and afebrile tem... | Critical | 0.94 | test | null | null | null |
false | Postinfectious inflammatory response syndrome | Postinfectious inflammatory response syndrome (PIIRS) following cryptococcal meningitis | [
"Cryptococcal meningitis recurrence — Given the return of fever, headache, altered mental status, and worsening meningeal enhancement with new parenchymal lesions on MRI, the most likely explanation is relapse/progression of cryptococcal infection, even if cultures are negative and antigen/cell counts are lower (wh... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-3",
"R-5"
] | I kept a 4-step structure aligned to the original. Step 1 was replaced with the R-5 relapse-assumption framing (ignoring the key safety check of considering immune-mediated PIRS despite improving CSF/microbiology). Step 2 was replaced with the E-3 claim that only primary tumor explains the lesions while dismissing PIRS... | [
{
"error_description": "Bypasses the safety-critical consideration of immune-mediated PIRS/PIIRS when worsening occurs despite improving microbiologic/CSF markers, and instead assumes cryptococcal relapse primarily from symptoms/imaging (downplaying negative cultures and falling antigen/cell counts).",
"err... | [
1,
2,
3
] | medprmbench_00063 | [
1,
2,
3,
4
] | [] | [
"Cryptococcal meningitis recurrence — “Considering the course of the disease, CM recurrence was suspected.”; excluded because “the decrease in cryptococcal antigen titers and CSF cell counts compared with the initial data, along with negative blood and CSF cultures, suggests that the second event was not caused by ... | A 72-year-old previously healthy woman presented with dysarthria and severe limb weakness, rendering her unable to walk independently. On examination, her temperature was 38.3°C, blood pressure 125/73 mmHg, and heart rate 93 bpm. Neurologic examination revealed moderate dysarthria, neck stiffness, and a positive Kernig... | Critical | 1 | test | null | null | null |
true | Follicular dendritic cell sarcoma | Inflammatory myofibroblastic tumor (ALK-negative variant) | [
"A lymphoproliferative malignancy was considered but excluded — “no evidence of … lymphoproliferative disorder … or acute leukemia.”",
"Given the necrotic mesenteric mass composed of spindle cells in a storiform/fascicular pattern with vimentin and CD68 positivity, this is most consistent with an inflammatory myo... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-6"
] | All three variants localize their root-cause corruption to the differential/immunophenotype interpretation step. I merged them by constructing a single Step 2 that (a) prematurely commits to IMT and downplays other malignant entities (E-5), (b) relies on an incorrect evidence claim about CD21 positivity in IMT and its ... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2
] | medprmbench_00064 | [
1,
2,
3
] | [] | [
"Step 1: A lymphoproliferative malignancy was considered but excluded — “no evidence of … lymphoproliferative disorder … or acute leukemia.”",
"Step 2: An inflammatory myofibroblastic tumor was considered in the differential but was less likely given the strong CD21 positivity, which is characteristic of follicul... | A 39-year-old man with a 20–pack-year smoking history presented with a several-day history of painful oral ulcers that did not respond to fluconazole or valacyclovir. He denied fever, chills, night sweats, anorexia, or weight loss. Ten days later, he developed diffuse bullous and erosive skin lesions on the chest, abdo... | Major | 0.7883 | test | null | 2 | 1 |
true | BurkittLymphoma | Vogt–Koyanagi–Harada syndrome | [
"Inflammatory (Vogt-Koyanagi-Harada syndrome) was initially considered — “the initial differential included Vogt-Koyanagi-Harada syndrome, however, extensive workup was undertaken to look for an alternative underlying etiology given the patients additional symptoms.”",
"The positive interferon-γ release assay sup... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-1",
"R-2",
"R-3",
"R-7"
] | I kept Step 1 from the original. I replaced Step 2 with Variant 1’s unsupported attribution of the positive interferon-γ release assay to ocular/active TB (E-1). I then inserted Variant 3’s contradictory hematology reinterpretation at Step 3 (R-2), and retained its downstream myeloid-favoring statement at Step 4 for co... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "R-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
5,
7
] | medprmbench_00065 | [
2,
3,
4,
5,
6,
7
] | [] | [
"Inflammatory (Vogt-Koyanagi-Harada syndrome) was initially considered — “the initial differential included Vogt-Koyanagi-Harada syndrome, however, extensive workup was undertaken to look for an alternative underlying etiology given the patients additional symptoms.”",
"Active tuberculosis was considered due to a... | A 38-year-old man with no significant medical history presented with one week of subjective fever, myalgias, profuse sweating, generalized body pain, decreased appetite, weight loss, inguinal lymphadenopathy, and blurred vision in both eyes. He denied cough, hemoptysis, diarrhea, urinary symptoms, or rash.
On examina... | Critical | 0.86 | test | null | null | null |
false | Mondor disease | Mondor’s disease (superficial thrombophlebitis of the breast) | [
"Superficial thrombophlebitis (Mondor’s disease) was suspected given the acute appearance of linear creases after vaccination and sonographic evidence of thrombosed superficial veins — “Given the initial presentation of acute development of linear creases in the breast shortly after a vaccination event, the most li... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-1",
"R-7",
"S-1"
] | I kept the original Mondor’s disease anchoring (step 1) and final conclusion (step 8). I merged Variant 1’s prerequisite-skipping malignancy dismissal into step 2 while simultaneously incorporating Variant 2’s temporal claim that imaging at one week is too early to exclude malignancy, preserving both errors in a single... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2,
3,
4,
7
],
"error_type": "R-7",
"modified_steps": null
},
{
"error_descriptio... | [
2,
3,
4,
5,
6,
7
] | medprmbench_00066 | [
2,
3,
4,
5,
6,
7,
8
] | [] | [
"Superficial thrombophlebitis (Mondor’s disease) was suspected given the acute appearance of linear creases after vaccination and sonographic evidence of thrombosed superficial veins — “Given the initial presentation of acute development of linear creases in the breast shortly after a vaccination event, the most li... | A 43-year-old woman presented to the breast clinic with at least three new linear creases in her left breast that developed one week after receiving the first dose of the Pfizer-BioNTech COVID-19 vaccine in her left arm. Her medical history was notable only for hypertension managed with nifedipine. She had no history o... | Critical | 0.8662 | test | null | null | null |
true | Gastric adenocarcinoma | Cutaneous lymphoma | [
"The rash was initially treated as cellulitis, and the lack of improvement with antibiotics plus development of thick, indurated, leathery borders raises suspicion for a noninfectious infiltrative process rather than a simple skin/soft tissue infection (eg, carcinoma en cuirasse-like involvement).",
"To further e... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-1",
"R-2",
"R-7",
"S-1"
] | I created a single composite chain by (1) retaining the infection-versus-infiltrative framing from the original/variants, (2) merging Variant 1’s prerequisite-skip jump to metastatic upper GI into the early workup step while omitting the original explicit imaging-based lymphoma/inflammatory differential, (3) inserting ... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "R-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
4,
8
] | medprmbench_00067 | [
1,
2,
3,
4,
5,
6,
7,
8
] | [] | [
"Consideration of skin and soft tissue infection — “initially prescribed oral antibiotics for a presumed skin and soft tissue infection; however, after treatment, his rash had worsened.”",
"Consideration of lymphoma on imaging — “the initial differential included lymphoma vs an inflammatory process.”",
"Exclusi... | A 48-year-old man with a history of isolated left parotid gland enlargement presented with a several-month history of a rash on his face, anterior neck, and upper chest. He first noted a single lesion on his anterior neck that gradually expanded superiorly to the face and inferiorly to the chest wall. He was treated em... | Critical | 0.875 | test | null | null | null |
true | Leporacarus gibbus | Feline demodicosis (Demodex infestation) | [
"Hypersensitivity dermatitis is considered because of nonseasonal pruritus and the clinical patterns, but the young age at onset, origin, limited antiparasitic history, and self-induced alopecia pattern keep parasitic disease high on the differential (flea bite hypersensitivity, food allergy, atopic dermatitis).",
... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-4",
"S-1"
] | I kept the overall structure and wording close to the original while combining the altered parts from each variant. From Variant 1, Step 2 was replaced to prematurely rule out food allergy without the prerequisite proper elimination trial (E-1). From Variant 3, I inserted the redundant repeat-scraping and biopsy consid... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
7
],
"error_type": "R-4",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
5,
6,
7
] | medprmbench_00068 | [
1,
2,
3,
4,
5,
6,
7,
8,
9
] | [] | [
"Step 1: Final Diagnosis - Leporacarus gibbus. Initial logic and parameters are validated.",
"Step 2: Standard processing applied.",
"Step 3: Standard processing applied.",
"Step 4: Standard processing applied.",
"Step 5: Standard processing applied.",
"Step 6: Standard processing applied.",
"Step 7: Ly... | A 14-month-old spayed female Ragdoll cat, kept strictly indoors and adopted online a year earlier, was evaluated for a 12-month history of pruritus. Within days of acquisition, the owner noted generalized scratching, alopecia of the tail and face, and dark cerumen in both ears. A primary veterinarian diagnosed otodecti... | Major | 0.7 | test | null | 3 | 0 |
true | Methotrexate neurotoxicity | Guillain–Barré syndrome (acute demyelinating polyradiculoneuropathy) | [
"Infective or leukemic infiltration should be considered in the differential, but the normal CSF cell count/protein/glucose and lack of MRI abnormalities make these less likely.",
"Immune-mediated neuropathy (e.g., checkpoint inhibitors) — “in contrast to immune‐mediated mechanism observed in monoclonal antibody‐... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-4",
"R-1",
"R-5"
] | I kept the 6-step structure of the original chain. For E-1, I replaced Step 1 with Variant 1’s version that mentions infection/infiltration but omits the prerequisite CSF flow cytometry and viral PCR exclusion, marking it as the root-cause error. For E-4, I replaced Step 4 with Variant 2’s neurolinfomatosis step includ... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "E-4",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
4,
6
] | medprmbench_00069 | [
1,
4,
6
] | [] | [
"Infective or leukemic infiltration — “In all cases, CSF‐flow cytometry and quantitative polymerase chain reaction (PCR) of virus have to be considered to rule out infective or infiltrative aetiologies.”",
"Immune-mediated neuropathy (e.g., checkpoint inhibitors) — “in contrast to immune‐mediated mechanism observ... | A 58-year-old man with high-grade B-cell lymphoma underwent systemic chemotherapy with cyclophosphamide and rituximab and CNS prophylaxis consisting of intrathecal methotrexate, cytarabine, and dexamethasone (three doses of intrathecal methotrexate, total 36 mg, given on nonconsecutive days). Ten days after the last lu... | Major | 0.72 | test | null | null | null |
false | Myointimoma | Myointimoma (intravascular myofibroblastic tumor) of the glans penis | [
"Consideration of plexiform fibrohistiocytic tumor — “Unlike myointimoma, it contains a mixture of two components: a differentiated spindle fibroblastic/myofibroblastic cells and a round histiocytic cell component containing multinucleated giant cells (osteoclast-like giant cells).”",
"Exclusion of neural tumors ... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-2",
"R-4"
] | I kept Steps 1–3 and 6–7 aligned with the original. I merged Variant 2 (E-5) and Variant 3 (R-3) by combining both corrupted ideas into a single Step 4: it uses adult-context weighting to favor myopericytoma while also prematurely dismissing the need to consider malignant vascular tumors/sarcoma. I additionally incorpo... | [
{
"error_description": "",
"error_step_indices": [
4,
8
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
4,
5,
8
],
"error_type": "R-4",
"modified_steps": null
},
{
"error_descriptio... | [
4,
5,
8
] | medprmbench_00070 | [
4,
5,
8
] | [] | [
"Consideration of plexiform fibrohistiocytic tumor — “Unlike myointimoma, it contains a mixture of two components: a differentiated spindle fibroblastic/myofibroblastic cells and a round histiocytic cell component containing multinucleated giant cells (osteoclast-like giant cells).”",
"Exclusion of neural tumors ... | A 15-year-old boy presented with a 6-month history of a slowly enlarging, firm nodule within the glans penis. He was asymptomatic and voided normally. There was no history of trauma or systemic disease. On examination, there was a well-circumscribed, firm, whitish, painless mass approximately 1 cm in diameter in the gl... | Major | 0.6912 | test | null | null | null |
true | RetiformHemangioendothelioma | Primary pleural angiosarcoma | [
"In adults, a large heterogeneously enhancing pleural-based paracardiac mass that compresses/encases mediastinal structures (pulmonary trunk and SVC) fits the typical imaging heuristic for pleural angiosarcoma, which is more common among adult pleural vascular tumors than RH; therefore the CT appearance alone is mo... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-3",
"R-7"
] | I kept a 4-step structure matching the original. Step 1 was replaced with a merged version that simultaneously (a) makes an imaging-only diagnostic leap (E-1) and (b) applies adult imaging/epidemiologic heuristics to prioritize angiosarcoma over RH despite downstream pathology (R-3). Steps 3 and 4 were taken from the R... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "R-3",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
3,
4
] | medprmbench_00071 | [
1,
2,
3,
4
] | [] | [
"Angiosarcoma was considered in the differential due to the imaging findings of a heterogeneously enhancing pleural mass with invasion of adjacent structures; however, definitive differentiation requires histopathologic evaluation.",
"Consideration of Kaposi sarcoma — “the diagnosis of other vascular tumors like ... | A 50-year-old woman presented with an 8-month history of nonproductive cough and progressive dyspnea. She also reported fatigue and unquantified weight loss. She had no history of chemical exposures, bleeding diatheses, or immunodeficiency, and she was HIV negative.
On examination, vital signs were within normal limit... | Critical | 0.805 | test | null | 3 | 0 |
false | Hemophagocytic lymphohistiocytosis | EBV-driven secondary hemophagocytic lymphohistiocytosis (HLH) triggered during COVID-19 | [
"COVID-19 with sepsis/dehydration and CNI toxicity — The initial picture is consistent with COVID-19 plus mild graft dysfunction due to dehydration/sepsis and tacrolimus toxicity.",
"CMV/EBV viraemia — Opportunistic viral reactivation (CMV/EBV) remains a key alternative explanation in an immunosuppressed transpla... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-5"
] | I combined the corrupted steps from each single-error variant into one coherent chain while keeping all other steps close to the original. From R-5, I replaced the CNS-infection step with the unsafe dismissal based on absent meningism/focal deficits (step 4). From R-1, I used the altered PTLD reasoning that incorrectly... | [
{
"error_description": "Bypasses a critical safety check by prematurely dismissing/setting aside urgent evaluation and treatment of possible CNS infection in an immunosuppressed encephalopathic transplant patient based on lack of neck stiffness/focal deficits.",
"error_step_indices": [
4
],
"e... | [
4,
5,
7
] | medprmbench_00072 | [
1,
2,
3,
4,
5,
6,
7,
8
] | [] | [
"COVID-19 with sepsis/dehydration and CNI toxicity — “Our initial working diagnosis was COVID-19 with a mild kidney graft dysfunction most likely secondary to sepsis/dehydration and calcineurin inhibitor (CNI) toxicity.”",
"CMV/EBV viraemia — “Other differentials included CMV/EBV viraemia or bacterial sepsis such... | A 33-year-old man with end-stage renal failure secondary to Dent’s disease underwent his second renal transplant in 2011 and had stable allograft function on tacrolimus, mycophenolic acid and low-dose prednisolone. In March 2020, he presented with 6 days of intermittent fever, diffuse myalgia, arthralgia, nonproductive... | Critical | 1 | test | null | null | null |
false | HemophiliaB | Hemophilia B (Factor IX deficiency) | [
"Platelet disorders and von Willebrand Disease were considered because they cause mucosal bleeding but were excluded by a normal bleeding time — “Routine blood investigations were performed, which were in the normal range, including the hemoglobin, bleeding time (BT), and clotting time.”",
"Vitamin K deficiency w... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-4"
] | I used Variant 1’s Step 3 to inject the prerequisite-skipping jump from isolated prolonged APTT directly to hemophilia B (E-1). I then replaced the original Step 4 with Variant 2’s narrowed hemophilia A-only claim and carried forward its Step 5 to preserve the premature truncation of the differential (E-5). Finally, I ... | [
{
"error_description": "Prerequisite Sensitivity: jumps from an isolated prolonged APTT directly to hemophilia B without first completing prerequisite intrinsic-pathway differentiation (e.g., normal-PT/other-parameter check, mixing study, and/or specific factor assays to distinguish deficiency vs inhibitor and ... | [
3,
4,
6
] | medprmbench_00073 | [
1,
2,
3,
4,
5,
6,
7
] | [] | [
"Hemophilia B. Initial logic and parameters are validated.",
"Standard processing applied.",
"Standard processing applied.",
"Hemophilia A and hemophilia C were considered because they present with a prolonged APTT but were excluded when specific assays demonstrated a different factor deficiency.",
"Standar... | A 34-year-old man presented with a 5- to 6-month history of bleeding and swollen gums in the upper and lower front teeth. He was in fair general health, denied any personal or family history of systemic illness, abnormal bleeding, surgeries, or drug allergies, and had stopped a 10-year tobacco-chewing habit 3 months ea... | Critical | 0.81 | test | null | 3 | 0 |
true | pseudotumor | Periosteal osteosarcoma | [
"The periosteal erosion with an adjacent soft-tissue mass on imaging makes a periosteal osteosarcoma the leading consideration.",
"Metastatic disease was excluded because the negative evaluation indicated there was no metastatic disease, and the absence of metastatic disease is supported by the negative metastati... | medcasereasoning | A | [
"Sensitivity",
"Simplicity"
] | [
"E-1",
"S-2"
] | I constructed a single coherent chain by combining Variant 1’s malignancy-assumption without biopsy (E-1) with Variant 3’s tautological metastatic exclusion phrasing (S-2) inside the same Step 2, since both target Step 2 and can coexist as a composite corrupted step. I then replaced the infection step with Variant 2’s ... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "S-2",
"modified_steps": null
}
] | [
1,
2
] | medprmbench_00074 | [
1,
2,
3,
4
] | [] | [
"Final Diagnosis: pseudotumor. Initial logic and parameters are validated.",
"Standard processing applied.",
"Standard processing applied.",
"The patient's clear surgical history, insidious clinical presentation, characteristic pseudotumor findings on imaging, and aseptic inflammatory reaction suggest ALVAL /... | A 68-year-old woman presented six years after implantation of a cemented endoprosthetic hinge total knee arthroplasty for conversion of a long-standing knee fusion. For the past five months she noted mild distal thigh and knee pain while walking. On examination, the knee was cool, stable, with a range of motion of 0–80... | Critical | 0.805 | test | null | 3 | 0 |
true | Thymic carcinoma | Thymic carcinoma with cutaneous metastases | [
"The skin metastasis is CK7+/CK20–, which supports a broad differential including lung, breast, thyroid, mesothelioma, endocrine, thymic, and germ cell primaries.",
"TTF-1 negativity makes a primary thyroid tumor unlikely in this context.",
"P40 negativity argues against squamous cell carcinoma of the lung.",
... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-1",
"R-6",
"S-1"
] | I used the S-1 variant’s inserted redundant steps (additional immunopanels and PET-CT) as new steps 4–5, keeping the original early diagnostic exclusions (TTF-1, P40) intact as steps 2–3. I retained the CD5 low-sensitivity caveat as step 6. To integrate E-1, I omitted the original CD117 subtype-interpretation step and ... | [
{
"error_description": "",
"error_step_indices": [
7
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
8
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
4,
5,
7,
8
] | medprmbench_00075 | [
1,
2,
3,
4,
5,
6,
7,
8
] | [] | [
"Broad CK7+/CK20– differential including lung, breast, thyroid, mesothelioma, endocrine, thymus, and germ cell primaries — “the IHC result from the skin biopsy sample was positive for CK7 and negative for CK20, which included the differential diagnoses of primary tumor from the lung, breast, thyroid, mesothelioma, ... | A 57-year-old man presented with multiple painful tumors on the chest, right shoulder, and neck. Eleven months earlier, he noted right-sided cervical lymphadenopathy; one month later, multiple marble-sized skin tumors developed over these nodes. Over the next two months, the tumors spread to the chest and neck, accompa... | Major | 0.805 | test | null | null | null |
true | Rothmund–Thomson syndrome | Baller–Gerold syndrome | [
"The repeated fractures with delayed union and focal cortical thickening in a patient with Rothmund–Thomson syndrome are most consistent with insufficiency/stress fractures from RTS-associated osteopenia; malignancy is unlikely given a negative biopsy and MRI.",
"Therefore, the unifying diagnosis is RTS-related m... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-1"
] | I used Variant 2 as the backbone because it restructures the chain around prematurely closing the differential (E-5), then integrated Variant 1’s specific prerequisite-omission into the same root-cause Step 2 by retaining the jump to “osteopenia/insufficiency fractures” without any BMD/metabolic confirmation (E-1). I t... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-5",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
4,
5
] | medprmbench_00076 | [
1,
2,
3,
4,
5
] | [] | [
"Consideration of osteosarcoma due to unusual fracture appearance — “more osteolysis than expected along the fracture line given the reported age of the fracture. Therefore, a bone biopsy of the fracture was performed, which was negative for neoplasm and infection.”",
"Recognition of stress and insufficiency frac... | An 18-year-old man with a history of Rothmund–Thomson syndrome diagnosed at age two presented with acute right mid-leg pain after cutting to kick a soccer ball. Four years earlier, he had sustained a right tibial fracture during play; radiographs then showed mild tibial deformity from the healed fracture and a mildly d... | Critical | 0.91 | test | null | null | null |
true | congenital lobar overinflation | Vascular ring causing extrinsic bronchial compression with congenital lobar overinflation (air trapping) | [
"The persistent tachypnea with unilateral hyperinflation and mediastinal shift on radiograph suggests a structural pulmonary cause rather than an infectious etiology.",
"Right lung hypoplasia with compensatory left hyperinflation was considered based on the chest radiograph showing left-sided hyperinflation and m... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-2",
"R-5"
] | I used Variant 1’s opening to create the E-1 omission: the chain starts by favoring a structural cause without first documenting sepsis exclusion, and I kept subsequent imaging-based steps consistent with that premature pivot. I then inserted Variant 3’s deprioritization of vascular ring as a non-urgent step to preserv... | [
{
"error_description": "Prerequisite Sensitivity error: the chain jumps to a structural pulmonary etiology from imaging/clinical pattern without first completing the prerequisite step of excluding sepsis/non-structural causes via documented lack of response and infection workup, making the later conclusion unre... | [
1,
3,
5
] | medprmbench_00077 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Early-onset neonatal sepsis was considered — “She was admitted with a working diagnosis of EONS.”",
"Sepsis was excluded after lack of improvement — “She failed to improve despite being put on IV antibiotics and intranasal oxygen.”",
"Right lung hypoplasia with compensatory left hyperinflation was considered —... | A 28-day-old female neonate, born at 39 weeks 4 days by cesarean delivery, presented with progressive tachypnea since 6 hours of age. On examination, her respiratory rate was 65 breaths per minute, with subcostal and intercostal retractions and mild chest indrawing; chest auscultation was otherwise unremarkable. Initia... | Critical | 0.965 | test | null | null | null |
true | Hepatic steatosis | Hepatitis B reactivation (chemotherapy-associated hepatitis) | [
"Liver metastases were considered — abdominal imaging showed no evidence of metastatic disease, making metastatic infiltration unlikely as the cause of the liver test abnormalities.",
"Viral hepatitis remained a leading possibility because the hepatitis serologies suggested prior hepatitis B exposure (with concer... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-2",
"R-4",
"R-6",
"S-2"
] | I kept the shared Step 1 from the variants. I merged Variant 1 and Variant 2 by combining their corrupted Step 2 into a single step that both (a) skips broader prerequisite evaluation before attributing to capecitabine (E-1) and (b) contradicts the provided negative hepatitis serologies by asserting prior HBV exposure/... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
4
] | medprmbench_00078 | [
1,
2,
3,
4
] | [] | [
"Liver metastases were considered — “imaging investigations were arranged to rule out the possibility of hepatic dysfunction due to liver metastases… There was no evidence of metastatic disease.”",
"Viral hepatitis was excluded — “Other causes of liver disease such as viral hepatitis were considered and ruled out... | A 74-year-old Armenian woman with Stage III colon cancer began adjuvant capecitabine (1000 mg/m2 twice daily for 14 days every 3 weeks). Her history included type II diabetes mellitus, hypertension, and gastroesophageal reflux disease managed with glyburide, metformin, telmisartan, atenolol, and lansoprazole. She had n... | Critical | 0.875 | test | null | null | null |
false | Septic arthritis of the pubic symphysis | Septic arthritis of the pubic symphysis | [
"Symphyseal diastasis — “Persistent postpartum pubic pain is common and can be caused by diastasis of the pubic symphysis.”",
"Noninfective pubic osteitis — “Noninfective pubic osteitis can occur postpartum, and when postpartum pubic pain with low-grade systemic features is present, this presentation is consisten... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-5",
"S-2"
] | I preserved the S-2 tautology by using Variant 3’s corrupted Step 2. I incorporated Variant 2’s R-5 premature-closure/safety error by replacing the original Step 4 with the endometritis/retained-products closure statement and aligning Step 3 with Variant 2’s ultrasound-focused endometritis phrasing for coherence. To al... | [
{
"error_description": "Introduces tautological/circular logic by justifying noninfective pubic osteitis only by restating that postpartum pubic pain with mild fever-like features is consistent with noninfective pubic osteitis, without adding distinguishing evidence or mechanism.",
"error_step_indices": [
... | [
2,
4,
5
] | medprmbench_00079 | [
1,
2,
3,
4,
5
] | [] | [
"Final Diagnosis: Septic arthritis of the pubic symphysis. Initial logic and parameters are validated.",
"Step 2: Noninfective pubic osteitis — High fever, inability to ambulate, markedly elevated inflammatory markers, and MRSA bacteremia makes septic arthritis much more likely.",
"Standard processing applied."... | A 36-year-old woman, gravida 5 para 5, at 41 weeks of gestation underwent an uncomplicated spontaneous vaginal delivery of a 3720 g infant. Six hours postpartum, she developed increasing pelvic pain over the pubic symphysis radiating to the groin, which was attributed to pelvic girdle strain. She was discharged 24 hour... | Critical | 0.93 | test | null | 3 | 0 |
true | MycosisFungoides | Primary cutaneous aggressive epidermotropic CD8+ T-cell lymphoma (cutaneous T-cell lymphoma) | [
"Psoriasis was initially diagnosed based on scaly plaques and treated with apremilast, guselkumab, and secukinumab but was deemed unlikely after the plaques continued to increase in number, become scalier, and develop fissures despite targeted therapy.",
"Dermatophyte infection is still the most likely diagnosis ... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-2",
"R-5"
] | I kept Step 1 from the original. I replaced Step 2 with Variant 3 to incorporate the safety error (escalating corticosteroids and maintaining dermatophyte as most likely, while not prioritizing CTCL). For Step 3, I merged Variant 2’s contradictory biopsy interpretation and alternate CTCL diagnosis with Variant 1’s prem... | [
{
"error_description": "Bypasses a critical safety check by endorsing escalation of systemic/topical corticosteroids despite possible infectious or malignant etiology, deprioritizing CTCL evaluation and risking delayed diagnosis/progression.",
"error_step_indices": [
2
],
"error_type": "R-5",
... | [
2,
3
] | medprmbench_00080 | [
1,
2,
3
] | [] | [
"Psoriasis was initially diagnosed based on scaly plaques and treated with apremilast, guselkumab, and secukinumab but was deemed unlikely after “the plaques continued to increase in number, become scalier, and develop fissures” despite targeted therapy.",
"Dermatophyte infection was suspected when a Wood’s lamp ... | A 45-year-old African-American man presented with a 3-year history of well-circumscribed, scaly plaques on his back, abdomen, groin, and axillae. The lesions began in the right groin, spread to his back within 2 weeks, and gradually increased in size and number. He reported only pruritus and denied systemic symptoms.
... | Critical | 0.895 | test | null | null | null |
true | Disseminated intravascular coagulation | Streptococcus pneumoniae–associated hemolytic uremic syndrome (pneumococcal HUS) | [
"TTP was considered but ruled out because ADAMTS13 activity was above the typical threshold: “ADAMTS13 activity is typically <10% in TTP, in contrast to the unchanged or moderately decreased ADAMTS13 activity in HUS.”",
"S. pneumoniae–associated HUS was considered likely because pneumococcal-associated HUS is cla... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-3",
"R-6",
"S-1"
] | I combined Variant 2’s corrupted Step 2 (R-3) into the composite chain, then incorporated Variant 3’s added Steps 5–6 as new Steps 4–5 to preserve the S-1 redundancy. To satisfy Variant 1 (E-1), I removed the original immune-complex glomerulonephritis exclusion step entirely and proceeded to the final conclusion withou... | [
{
"error_description": "",
"error_step_indices": [
6
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-3",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
4,
5,
6
] | medprmbench_00081 | [
2,
4,
5,
6
] | [] | [
"TTP was considered but ruled out because ADAMTS13 activity was above the typical threshold: “ADAMTS13 activity is typically <10% in TTP, in contrast to the unchanged or moderately decreased ADAMTS13 activity in HUS.”",
"S. pneumoniae–associated HUS was unlikely given coagulopathy and Coombs negativity: “In HUS, ... | A 43-year-old woman presented to the emergency department with fever up to 41°C, vomiting, diarrhea, and severe pain in the distal parts of her fingers and toes. She had undergone splenectomy at age 18 for immune thrombocytopenic purpura; pneumococcal vaccination had lapsed more than 5 years earlier. On examination, te... | Major | 0.7933 | test | null | null | null |
false | Hepatic angiosarcoma | Primary hepatic angiosarcoma | [
"Exclusion of hepatocellular carcinoma — The multiphase imaging pattern lacks the classic arterial hyperenhancement with portal/delayed washout typical of hepatocellular carcinoma, making HCC unlikely.",
"Consideration of intrahepatic cholangiocarcinoma — Despite being less typical overall, the peripheral (rim) a... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-2",
"R-4",
"R-6"
] | I built a single composite chain by combining the corrupted Step 2 from the R-2 variant (cholangiocarcinoma reintroduced as leading despite exclusion), the corrupted Step 3 from the R-4 variant (overconfident false claim that tumor markers are elevated, 'confirming' metastases), and the E-1 omission pattern by using Va... | [
{
"error_description": "",
"error_step_indices": [
5
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
5
] | medprmbench_00082 | [
1,
2,
3,
4,
5,
6,
7
] | [] | [
"Step 1: Exclusion of hepatocellular carcinoma — “These images did not demonstrate features of commonly identified hepatic malignancies, such as hepatocellular carcinoma and intrahepatic cholangiocarcinoma.”",
"Step 2: Exclusion of intrahepatic cholangiocarcinoma — “These images did not demonstrate features of co... | A 44-year-old Hispanic man presented with a 2-month history of worsening abdominal pain and jaundice. He had no significant past medical, family, or social history and denied exposure to vinyl chloride, arsenic, or thorium dioxide. On examination, he appeared icteric and had a distended, diffusely tender abdomen; there... | Critical | 0.91 | test | null | 3 | 0 |
false | diffuse large B-cell lymphoma | Diffuse large B-cell lymphoma (DLBCL) | [
"Squamous cell carcinoma — considered because of the ulcer’s irregular margins, but histology demonstrated lymphoid rather than epithelial cells “revealed a proliferation of large lymphoid cells with a high nucleus:cytoplasm ratio, coarse chromatin, and inconspicuous nucleoli with abnormal mitotic figures.”",
"Or... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-7"
] | I kept Step 1 from the original as a non-error anchor. I then inserted the R-7 timing-based metastasis logic into Step 2 (root cause at step 2). Next, I applied the R-1 immunophenotype misattribution in Step 3, keeping its claim that CD20/CD79a/Bcl-2/Bcl-6 can fit minor salivary lymphoepithelial carcinoma (root cause a... | [
{
"error_description": "Prerequisite Sensitivity: Concludes DLBCL from morphology alone while skipping the prerequisite immunohistochemical confirmation of B-cell phenotype/subtype needed before making that specific lymphoma diagnosis.",
"error_step_indices": [
4
],
"error_type": "E-1",
"m... | [
2,
3,
4
] | medprmbench_00083 | [
1,
2,
3,
4
] | [] | [
"Final Result: Diffuse large B-cell lymphoma",
"Step 1: Initial logic and parameters are validated.",
"Step 2-3: Standard processing applied.",
"Step 4: Diffuse large B-cell lymphoma — The morphology (proliferation of large lymphoid cells with high nucleus:cytoplasm ratio, coarse chromatin, and abnormal mitot... | An 85-year-old woman was referred for evaluation of a painful palatal lesion present for two weeks. Her medical history was notable for hypertension, diastolic heart dysfunction, and episodes of dizziness. Intraoral examination revealed a 30-mm ulcer with raised, irregular edges and a yellowish-white membrane on the le... | Critical | 0.8175 | test | null | 2 | 1 |
false | foreign body neuralgia | Foreign body neuralgia | [
"Trigeminal neuralgia was excluded because the pain was continuous rather than paroxysmal and no typical lesion was found — “the features were atypical of trigeminal neuralgic pain and no lesion was evident except for the scar…”",
"Traumatic neuroma was considered due to the prior mental nerve avulsion but was ru... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-6"
] | I kept Steps 1–2 aligned with the original. I then imported Variant 2’s hallucinated imaging-based pivot in Step 3 (R-6). For Step 4, I used Variant 1’s omission-based conclusion (E-1) by asserting foreign body neuralgia without citing/confirming radiopaque material at the mental foramen, while lightly adapting wording... | [
{
"error_description": "Fabricates radiographic findings (panoramic radiograph showing a retained root fragment, periapical radiolucency, and mandibular canal widening) not provided in the stem and uses them to re-rank the differential.",
"error_step_indices": [
3
],
"error_type": "R-6",
"... | [
3,
4
] | medprmbench_00084 | [
1,
2,
3,
4
] | [] | [
"Final Result: foreign body neuralgia. Initial logic and parameters are validated.",
"Standard processing applied.",
"Standard processing applied.",
"Foreign body neuralgia would be confirmed if imaging reveals entrapped radiopaque material at the mental foramen, correlating with the clinical symptoms."
] | A 54-year-old woman presented with a 6–9-month history of continuous dull aching pain in the right lower back tooth region. The pain worsened with chewing and talking and was only slightly relieved by medication. Four years earlier, she had sharp, intermittent pain in the same area; she underwent extraction of all righ... | Major | 0.63 | test | null | 3 | 0 |
false | Extrarenal Wilms tumor | Extrarenal Wilms tumor (intramedullary spinal cord nephroblastoma) | [
"Primary spinal cord tumors — Considering the patient’s history of myelomeningocele and an intramedullary lumbosacral mass, the most likely etiology is a primary spinal cord tumor arising in a dysraphic region rather than a secondary lesion.",
"Myxopapillary ependymoma as the unifying diagnosis — A well-circumscr... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-6"
] | I kept Variant 2’s premature narrowing to myxopapillary ependymoma as the Step 2 root-cause error (E-5) and maintained its framing in Step 1. I then inserted Variant 3’s hallucinated abdominal CT/tumor-marker-based teratoma explanation as Step 3 (R-6), creating a coherent but contradictory pivot away from Step 2 while ... | [
{
"error_description": "Prematurely narrows the differential to myxopapillary ependymoma based on imaging/location and asserts that broader evaluation for metastatic disease or extrarenal embryonal tumors is unnecessary, dismissing important alternatives without worst-first/systematic coverage or confirmation."... | [
2,
3,
4
] | medprmbench_00085 | [
1,
2,
3,
4,
5
] | [] | [
"Primary spinal cord tumors — “Considering the patient’s history of myelomeningocele, the differential diagnosis included primary spinal cord tumors and secondary lesions.”",
"Metastatic Wilms tumor from the kidney — “First, it is essential to rule out a primary intrarenal tumor with secondary extrarenal metastas... | A 22-year-old woman was admitted with six months of worsening lower back pain and progressive lower limb weakness, culminating in paraparesis and loss of bladder and bowel control. She had no prior history of neurological deficits after surgical repair of a congenital lipo-myelomeningocele in infancy. On examination, v... | Critical | 0.805 | test | null | null | null |
true | lichen amyloidosis | Severe chronic atopic dermatitis | [
"Atopic dermatitis was diagnosed because of diffuse erythema, lichenification, and scaling in classic flexural areas — “lesions typical of chronic eczema... were the most suggestive for a diagnosis of AD.”",
"Contact dermatitis was excluded as a cause of the flexural lesions since “patch tests returned negative r... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-2"
] | I kept Step 1 consistent with the original AD recognition. I merged Variant 3’s contradiction into Step 2 by combining the original exclusion language with the later claim that ACD cannot be excluded, making Step 2 the R-2 root-cause error. For Step 3, I integrated Variant 2’s premature unification of the lower-leg pap... | [
{
"error_description": "Introduces internal inconsistency by first stating contact dermatitis is excluded based on negative patch testing, then immediately asserting it cannot be excluded and subsequently letting that possibility steer later interpretation and management.",
"error_step_indices": [
2
... | [
2,
3
] | medprmbench_00086 | [
2,
3,
4,
5
] | [] | [
"Atopic dermatitis was diagnosed because of diffuse erythema, lichenification, and scaling in classic flexural areas — “lesions typical of chronic eczema... were the most suggestive for a diagnosis of AD.”",
"Contact dermatitis was excluded as a cause of the flexural lesions since “patch tests returned negative r... | A 52-year-old woman presented with severe, long-standing pruritus and multiple papular and eczematous skin lesions. She first noted brownish, itchy papules coalescing into patches on her lower legs approximately 27 years ago. These lesions gradually increased in number and pruritus over decades. More recently, she deve... | Critical | 0.735 | test | null | null | null |
false | Intrahepatic portosystemic venous shunt | Congenital intrahepatic portosystemic venous shunt (IPSVS) with aneurysmal portohepatic venous communications | [
"An acquired shunt due to portal hypertension was considered because adults usually develop IPSVS in cirrhosis; “The intrahepatic portal venous shunt in adults is most commonly due to portal venous communication to a systemic vein secondary to portal hypertension.”",
"A congenital origin was favored because of la... | medcasereasoning | A | [
"Sensitivity",
"Simplicity"
] | [
"E-1",
"S-1",
"S-2"
] | I used Variant 1’s structure to preserve the E-1 omission by removing the trauma/biopsy acquired-cause consideration and moving directly from portal-hypertension consideration to favoring congenital origin (composite Step 2). I then inserted Variant 2’s redundant portal-hypertension workup step after excluding minute c... | [
{
"error_description": "Prerequisite Sensitivity: the chain skips the prerequisite consideration of acquired causes from trauma/biopsy (and related history exclusion) before concluding the shunt is congenital, then proceeds to the final diagnosis based on that unsupported assumption.",
"error_step_indices":... | [
2,
4,
7
] | medprmbench_00087 | [
2,
3,
4,
7,
8
] | [] | [
"An acquired shunt due to portal hypertension was considered because adults usually develop IPSVS in cirrhosis; “The intrahepatic portal venous shunt in adults is most commonly due to portal venous communication to a systemic vein secondary to portal hypertension.”",
"An acquired shunt from trauma or biopsy was c... | A 45-year-old woman presented with several months of progressively worsening right upper quadrant abdominal pain and swelling, accompanied by confusion and an altered level of consciousness. She reported no fever, nausea, vomiting, or changes in bowel habits. Her medical history was unremarkable for hepatic, renal, or ... | Major | 0.595 | test | null | null | null |
false | granulomatous cheilitis | Orofacial granulomatosis (granulomatous cheilitis/Miescher cheilitis) | [
"Angioedema is definitively confirmed because the patient clearly reports dyspnea with throat obstruction and associated urticaria, which is the classic triad for acute angioedema.",
"Contact cheilitis becomes unlikely, but allergy testing is not required here because the airway symptoms and urticaria without que... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-4"
] | I used the R-4 variant’s Step 1 to introduce the factual-contradiction angioedema “confirmation,” which also necessitates keeping its downstream angioedema-framed Steps 2–6 for coherent flow. I then replaced Step 4 with the E-5 variant’s premature-narrowing statement to preserve the explicit dismissal of malignant/syst... | [
{
"error_description": "Confidence-invariance contradiction: asserts with overconfident language that dyspnea, throat obstruction, and urticaria are present (confirming angioedema), directly contradicting the stem’s explicit denial and steering subsequent reasoning around angioedema.",
"error_step_indices":... | [
1,
4,
7
] | medprmbench_00088 | [
1,
2,
3,
4,
5,
6,
7
] | [] | [
"Angioedema considered and excluded — “He did not experience shortness of breath, throat obstruction, or urticaria.”",
"Contact cheilitis considered and excluded by allergy testing — “Skin prick tests for airborne and food allergies were negative, as were epidermal prick tests.”",
"Infectious granulomatous dise... | A 58-year-old man presented with severe swelling of both the upper and lower lips. Six months earlier, he had a one-week episode of lip swelling that resolved spontaneously; three weeks later, swelling recurred and progressively increased over six months. He denied prior surgical, dental, or cosmetic procedures, and re... | Critical | 0.91 | test | null | null | null |
true | Cerebral venous sinus thrombosis | Idiopathic intracranial hypertension (IIH) | [
"Given the imaging signs of intracranial hypertension and no mass lesion or hydrocephalus, the most likely diagnosis is idiopathic intracranial hypertension (IIH).",
"Intracranial space‐occupying lesions such as tumors or hemorrhage were considered as causes of papilledema but were excluded by imaging — “The caus... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-4",
"R-5"
] | I used Variant 1’s Step 1 to preserve the prerequisite-omission error (declaring IIH without first excluding CVST via MRV/CTV). I kept Steps 2–3 aligned with the original/variants as non-error differentials. I then substituted Variant 2’s Step 4 to inject the incorrect microvascular-ischemia unifying claim (R-1). Next,... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
4,
5,
6
] | medprmbench_00089 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Step 1: Idiopathic intracranial hypertension was initially suspected.",
"Step 2: Intracranial space‐occupying lesions such as tumors or hemorrhage were considered as causes of papilledema but were excluded by imaging — “The causes of optic disc swelling include intracranial space‐occupying lesions, such as brain... | A 54‐year‐old woman was referred for binocular diplopia that began 2 weeks earlier. She denied headache, vomiting, recent trauma, pregnancy, childbirth, vaccination, or personal/family history of thrombosis. Her blood pressure was 120/85 mm Hg; other vital signs were normal. On examination, visual acuity was 20/20 in b... | Major | 0.8233 | test | null | 3 | 0 |
true | Chromoblastomycosis | Mucoid (myxoid) cyst | [
"Considered a callus because of the firm, dome-shaped appearance on an acral site.",
"Considered a glomangioma or glomus tumor given the lesion’s tenderness on the finger.",
"Given the distal finger location and long-standing, stable, smooth dome-shaped papule, consider a mucoid (myxoid) cyst as the leading and... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-3"
] | All three variants shared the same root-cause location (step 3), so the composite chain fuses their Step-3 distortions into a single coherent pivot: it (i) commits to mucoid cyst primarily from location/morphology (E-1), (ii) prematurely dismisses infectious/malignant causes despite exposure history (E-5), and (iii) in... | [
{
"error_description": "Skips the prerequisite step of incorporating/confirming biopsy histopathology results before making the final diagnosis, instead moving from clinical location/morphology to a mucoid cyst diagnosis.",
"error_step_indices": [
3
],
"error_type": "E-1",
"modified_steps"... | [
3
] | medprmbench_00090 | [
1,
2,
3,
4,
5
] | [] | [
"Considered a callus because of the firm, dome-shaped appearance on an acral site — “The differential diagnosis included a callus…”",
"Considered a glomangioma or glomus tumor given the lesion’s tenderness on the finger — “…glomangioma or glomus…”",
"Considered a mucoid cyst based on the location at the distal ... | A 52-year-old man with type 2 diabetes presented with an 8-year history of a lesion on the tip of his right index finger. The lesion had reached its current size several years earlier and then remained unchanged. He denied any history of local trauma or systemic symptoms but reported mild tenderness. He was born in the... | Critical | 0.805 | test | null | null | null |
true | Midgut malrotation | Midgut malrotation with volvulus | [
"Intrinsic duodenal obstruction was considered but excluded — “esophageal-gastro-duodenoscopy showed normal mucosa … however, no obvious obstruction seen.”",
"Cecal volvulus was considered as a cause of obstruction — “Other differentials include cecal volvulus ….”",
"Mesenteric ischemia was considered given pai... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-6",
"S-2"
] | I kept the original step structure but replaced Step 4 with Variant 1’s premature IBS assumption (E-1), replaced Step 5 with Variant 2’s hallucinated appendectomy/radiograph details that prioritize adhesions (R-6), and replaced Step 8 with Variant 3’s circular justification for malrotation-with-volvulus (S-2). I did no... | [
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
5
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
4,
5,
8
] | medprmbench_00091 | [
4,
5,
8
] | [] | [
"Intrinsic duodenal obstruction was considered but excluded — “esophageal-gastro-duodenoscopy showed normal mucosa … however, no obvious obstruction seen.”",
"Cecal volvulus was considered as a cause of obstruction — “Other differentials include cecal volvulus ….”",
"Mesenteric ischemia was considered given pai... | A 19-year-old man presented with a 2-day history of non-projectile, greenish vomiting (2–3 times daily) and periumbilical pain. He also reported long-standing (since age 6) intermittent constipation, generalized weakness, and significant weight loss, with partial relief on a liquid diet. He denied abdominal distension ... | Major | 0.6912 | test | null | null | null |
true | Leiomyosarcoma | Acute malignant portal vein tumour thrombus from pancreatic adenocarcinoma | [
"Bland thrombus vs tumour thrombus — enlargement of the portal vein and feeding vessels within the lesion indicate tumour thrombus rather than bland thrombus.",
"Pancreatic adenocarcinoma with tumour thrombus — the lack of concurrent dilated common bile and pancreatic ducts makes this diagnosis less likely.",
"... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-7",
"S-1"
] | I used the expanded step structure from the S-1 variant (inserting the extra work-up steps) and retained the original early differential steps. To integrate E-1, I replaced the intraluminal-confirmation step with the E-1 shortcut that jumps directly to portal-vein leiomyosarcoma, thereby omitting the rim-of-contrast/be... | [
{
"error_description": "Added unnecessary, tangential diagnostic work-up steps (tumour markers, liver MRI, EUS-FNA) that do not contribute to the decision and duplicate already-available CT/biopsy information.",
"error_step_indices": [
3,
4
],
"error_type": "S-1",
"modified_steps": [... | [
3,
4,
6,
7
] | medprmbench_00092 | [
1,
2,
3,
4,
5,
6,
7,
8
] | [] | [
"Bland thrombus vs tumour thrombus — “enlargement of the PV and demonstration of feeding vessels within the thrombus indicate the presence of tumour thrombus rather than bland thrombus.”",
"Pancreatic adenocarcinoma with tumour thrombus — “the lack of concurrent dilated common bile and pancreatic ducts should mak... | A 67-year-old man underwent contrast-enhanced multidetector CT of the abdomen after an incidental mass was noted in the upper abdomen. He was asymptomatic; physical examination and routine laboratory tests, including liver biochemistry, were unremarkable.
Initial CT (September 2014) showed a 4.2×3.9 cm mass near the h... | Critical | 0.875 | test | null | null | null |
true | extramedullary plasmacytoma | Solitary plasmacytoma of the sphenoid bone | [
"Extramedullary plasmacytoma confirmed — “Plasmacytoma was confirmed by histological analysis of multiple biopsy specimens of sphenoid sinus mass.”",
"Reactive plasma cell lesion excluded — “The differential diagnoses of extramedullary plasmacytoma include reactive lesions with an abundance of plasma cells…”; “Im... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-2",
"R-6"
] | I used the longer step structure from the S-1 variant to preserve the injected redundant testing steps (steps 3–4). To integrate E-1, I replaced the original systemic-exclusion step for multiple myeloma with the E-1 variant’s premature diagnostic conclusion (now step 6), thereby skipping the prerequisite systemic evalu... | [
{
"error_description": "",
"error_step_indices": [
6
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
7
],
"error_type": "R-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
5,
6,
7
] | medprmbench_00093 | [
1,
3,
4,
5,
6,
7
] | [] | [
"Extramedullary plasmacytoma confirmed — plasmacytoma was confirmed by histological analysis of multiple biopsy specimens of sphenoid sinus mass.",
"Reactive plasma cell lesion excluded — “The differential diagnoses of extramedullary plasmacytoma include reactive lesions with an abundance of plasma cells…”; “Immu... | A 62-year-old woman was referred to otolaryngology with a 3-month history of right-sided ptosis and headache. On examination, she had complete immobilization and decreased visual acuity of the right eye. She denied weight loss, nasal discharge, infectious symptoms, or bone pain. She appeared well, with no lymphadenopat... | Major | 0.725 | test | null | 3 | 0 |
false | IgG4-related disease | IgG4-related disease (IgG4-related spinal epidural inflammatory pseudotumor) | [
"Malignancy, including metastatic disease, was considered unlikely — “Whole body positron emission tomography (PET) scan showed no evidence of malignancy with no abnormality demonstrated in the spleen, liver, pancreas, salivary or adrenal glands.”",
"With malignancy unlikely, proceed directly to interpreting the ... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-6",
"S-1"
] | I used Variant 1’s shortened sequence that omits the lymphoma-exclusion step and jumps straight from malignancy being unlikely to storiform fibrosis/IgG4 ratio interpretation, preserving the prerequisite-skipping error (E-1). Into that shortened chain, I inserted Variant 2’s infection-ruling step containing fabricated ... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3
] | medprmbench_00094 | [
2,
3,
4
] | [] | [
"Malignancy, including metastatic disease, was considered unlikely — “Whole body positron emission tomography (PET) scan showed no evidence of malignancy with no abnormality demonstrated in the spleen, liver, pancreas, salivary or adrenal glands.”",
"Lymphoma was excluded by immunophenotyping — “Flow cytometry sh... | A 60-year-old woman with obstructive sleep apnea, seasonal allergies, and osteoarthritis presented with 4 weeks of weakness and numbness in all four extremities. She initially noted burning pain at the tips of her fingers and toes that progressed to paresthesia, accompanied by low-grade fever, bowel and bladder inconti... | Major | 0.63 | test | null | null | null |
false | Siliconoma | Calcitriol-mediated hypercalcemia from silicone-induced foreign body granulomas (siliconomas) due to ruptured breast implant | [
"Consideration and exclusion of antacid overuse — She denied any antacid use.",
"Primary hyperparathyroidism excluded by suppressed PTH — Parathyroid hormone was low (13 pg/mL).",
"PTHrP-mediated malignancy excluded by normal PTHrP — Parathyroid hormone-related peptide was normal (<2 pmol/L).",
"Malignancy be... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-2"
] | I kept steps 1–3 and 5 aligned with the original. I replaced step 4 with the R-2 corrupted imaging interpretation (malignancy now prioritized). To integrate both E-1 and R-1, I rewrote step 6 to (a) omit the prerequisite granulomatous-physiology establishment and jump to siliconomas (E-1) while simultaneously (b) asser... | [
{
"error_description": "Skipped the prerequisite step of first establishing granulomatous disease physiology via elevated calcitriol/ACE before attributing hypercalcemia to silicone-induced granulomas, jumping directly from implant history/soft tissue calcifications to siliconoma-based diagnosis.",
"error_s... | [
4,
6
] | medprmbench_00095 | [
1,
2,
3,
4,
5,
6,
7
] | [] | [
"Consideration and exclusion of antacid overuse — “She denied any antacid use.”",
"Primary hyperparathyroidism excluded by suppressed PTH — “Parathyroid hormone was low, 13 pg/mL (normal 15–65 pg/mL);”",
"PTHrP-mediated malignancy excluded by normal PTHrP — “Parathyroid hormone-related peptide … was normal, <2 ... | A 67-year-old woman presented with two months of burning epigastric pain that was intermittent, nonradiating, and associated with nausea and vomiting. She reported unintentional weight loss of approximately 30 pounds over three months but denied diarrhea, hematemesis, or melena. Her medical history was notable for bila... | Critical | 0.94 | test | null | null | null |
true | sclerochoroidal calcification | Choroidal osteoma | [
"Retained intraocular foreign body was the initial leading consideration because of the hyperdense appearance on CT — “as intraocular foreign bodies are usually hyper dense and located in the posterior segment of the globe in most cases, it would be prudent to include retained intraocular foreign body as the top of... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-2",
"R-6"
] | I kept the original step 1 and step 3 intact. I merged Variant 1’s E-1 omission into step 2 by having the reasoning pivot away from the initial IOFB concern without first confirming or excluding it. Into that same step 2, I integrated Variant 3’s R-6 hallucinated melanoma history and staging CT findings to support meta... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
4,
5
] | medprmbench_00096 | [
2,
4,
5
] | [] | [
"Retained intraocular foreign body was the initial leading consideration because of the hyperdense appearance on CT — “as intraocular foreign bodies are usually hyper dense and located in the posterior segment of the globe in most cases, it would be prudent to include retained intraocular foreign body as the top of... | A 41-year-old New Zealand European man was admitted after a car-versus-bicycle collision in which he was ejected from his bicycle. He sustained multiple injuries, including a right tripod facial fracture; a CT scan of the face performed at initial trauma evaluation showed a hyperdense lesion within the posterior segmen... | Major | 0.695 | test | null | null | null |
true | giant hydronephrosis | Giant megacystis (massively distended urinary bladder) with intraperitoneal bladder rupture causing urinary ascites | [
"Massive ascites was initially considered due to abdominal distension; however, absence of shifting dullness argued against free intraperitoneal fluid.",
"Cystic abdominal tumors and other masses (ovarian cysts, retroperitoneal hematoma, hepatobiliary cysts, mesenteric cysts, pseudomyxoma, renal tumor, retroperit... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-6"
] | I kept Step 1 aligned with the original. I merged Variant 1’s premature leap from urine aspiration to giant hydronephrosis into Step 2/3 to preserve the missing-prerequisite error (E-1). I simultaneously incorporated Variant 3’s fabricated aspirate chemistries and CT cystography expectation into Step 2 and Step 4, pres... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2,
3,
4
] | medprmbench_00097 | [
1,
2,
3,
4
] | [] | [
"giant hydronephrosis. Initial logic and parameters are validated.",
"Standard processing applied.",
"Standard processing applied.",
"Giant hydronephrosis should be considered; advanced imaging (e.g., CT urography) may help confirm the diagnosis."
] | A 42-year-old man presented with an 18-month history of progressive abdominal distension and mild, diffuse, dull aching pain. He denied fever, jaundice, vomiting, weight loss, or appetite change, and had no urinary or bowel complaints. On examination, there was massive, symmetric abdominal distension without palpable m... | Critical | 0.835 | test | null | 3 | 0 |
false | thoracic disc herniation | Thoracic disc herniation causing Th11 radiculopathy with abdominal wall pseudohernia | [
"Abdominal wall hernia was the main consideration for a sudden abdominal wall bulge, but the CT abdomen showed no evidence of an abdominal wall defect or herniation, making this unlikely.",
"Thoracic diabetic radiculopathy is less likely given no history of diabetes, intact sensation, and the focal Th11 radicular... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-1"
] | I kept the overall 6-step structure and merged the corrupted content where errors occurred. From Variant 1, I used the zoster exclusion based solely on absent rash (step 3) to preserve the missing prerequisite check (E-1). From Variants 2 and 3, I combined their malignancy-related distortions into a single coherent ste... | [
{
"error_description": "Skipped the prerequisite diagnostic check for herpes zoster (including prodromal zoster/zoster sine herpete) and excluded it solely based on absence of rash, then proceeded toward thoracic disc herniation.",
"error_step_indices": [
3
],
"error_type": "E-1",
"modifie... | [
3,
4
] | medprmbench_00098 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Abdominal wall hernia — “abdominal wall hernia … were considered and excluded via a paraspinal EMG and a CT scan.”",
"Thoracic diabetic radiculopathy — “thoracic diabetic radiculopathy … were considered and excluded via a paraspinal EMG and a CT scan.”",
"Herpes zoster infection — “herpes zoster infection … we... | An 81-year-old man presented with sudden onset of right-sided abdominal wall bulging and sharp pain radiating in the Th11 dermatome. He denied leg pain, back pain, bladder or bowel dysfunction, or gait disturbances. Sensation was intact throughout, and there were no skin lesions. His medical history included a left mid... | Critical | 0.835 | test | null | null | null |
false | pneumothorax | Pneumothorax | [
"Endotracheal tube migration was excluded because “breath sounds were equal bilaterally without wheezing at the apices anteriorly.”",
"Neuromuscular weakness was excluded after “residual neuromuscular blockade was reversed.”",
"Fluid overload was deemed unlikely given “urine output was 3475cc with an EBL of 100... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-3",
"R-7"
] | I kept steps 1–2 aligned with the original. I imported Variant 2’s multi-solution collapse at step 3 (pulmonary edema as the only plausible process) and its downstream dismissal of alternatives and avoidance of imaging into steps 4 and 6. To integrate Variant 1 and Variant 3, I rewrote step 5 to simultaneously (a) depr... | [
{
"error_description": "Incorrectly collapses multiple valid diagnostic possibilities into a single 'only plausible' option (pulmonary edema), dismissing alternatives with fabricated rationale and implying imaging is unnecessary.",
"error_step_indices": [
3
],
"error_type": "E-3",
"modifie... | [
3,
5
] | medprmbench_00099 | [
3,
4,
5,
6
] | [] | [
"Endotracheal tube migration was excluded because “breath sounds were equal bilaterally without wheezing at the apices anteriorly.”",
"Neuromuscular weakness was excluded after “residual neuromuscular blockade was reversed.”",
"Fluid overload was deemed unlikely given “urine output was 3475cc with an EBL of 100... | A 15-year-old previously healthy 68-kg girl with idiopathic thoracolumbar scoliosis underwent posterior fusion and instrumentation (T3–L4) in the prone position. Anesthesia was induced with lidocaine, propofol, fentanyl, and succinylcholine; she was intubated with a 7.0-mm cuffed endotracheal tube without difficulty. M... | Major | 0.7933 | test | null | null | null |
false | adrenal hemangioma | Adrenal hemangioma | [
"Considered benign adrenal tumors (adenoma, myelolipoma, angiomyolipoma, teratoma) as initial differentials for a large adrenal-region mass.",
"With no symptoms of adrenal hormone excess, focused on imaging characteristics to narrow the diagnosis, and did not first ensure a proper biochemical exclusion of pheochr... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-1",
"R-7",
"S-2"
] | I combined Variant 1’s prerequisite-omission by replacing the original biochemical-rule-out step with an imaging-first narrowing step (Step 2), while separately incorporating Variant 2’s trajectory error as a subsequent step that incorrectly insists on weeks of repeat metanephrines and drives delayed management/interva... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
6
] | medprmbench_00100 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Considered benign adrenal tumors (adenoma, myelolipoma, angiomyolipoma, teratoma) — “The differential diagnoses for AH include benign adrenal, adenomas, myelolipomas, angiomyolipomas, or rare teratomas.”",
"Considered pheochromocytoma but excluded by normal biochemical testing — “Biochemical tests, like the 24-h... | A 59-year-old morbidly obese woman with a 10-year history of essential hypertension and known hypothyroidism was referred to urology after an incidental finding on imaging. She reported no abdominal pain, weight loss, palpitations, flushing, or other symptoms suggestive of adrenal overactivity. Physical examination was... | Critical | 0.91 | test | null | null | null |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.