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

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101	aug-10-2017	An 8-year-old girl with atopic dermatitis presented with a 3-day history of diffuse eruption of pruritic, umbilicated, erythematous vesicles with erosion and crusting on the flexor surfaces of the legs and arms. What is the diagnosis?	yes	19%	56%	4%	2%	20%	104878	0.054	e31b058554eee81a962648760ef7e6a4	[ "A: Impetigo", "B: Eczema herpeticum", "C: Contact dermatitis", "D: Drug eruption", "E: Dermatitis herpetiformis" ]	B: Eczema herpeticum
102	aug-10-2023	A 3-year-old girl presented to the emergency department with a 1-day history of dark urine and jaundice after the development of an upper respiratory tract infection 1 week earlier. The physical examination was notable for pharyngeal erythema and exudates, conjunctival pallor, and scleral icterus. There was no hepatosp...	yes	44%	10%	17%	10%	20%	36693	0.08	e7a04d81db7f73488f38809e70fb4ce1	[ "A: Cold agglutinin syndrome", "B: G6PD Deficiency", "C: Hemolytic uremic syndrome", "D: Hereditary spherocytosis", "E: Warm autoimmune hemolytic anemia" ]	A: Cold agglutinin syndrome
103	aug-11-2011	What is the diagnosis?	no	4%	17%	12%	5%	62%	94634	0.038	1a551fe3af8f4aa05609462a34e659f8	[ "A: Calciphylaxis", "B: Epidermoid cysts", "C: Hidradenitis suppurativa", "D: Onchocerciasis", "E: Scrotal calcinosis" ]	E: Scrotal calcinosis
104	aug-11-2016	A 36-year-old woman presented with uncontrolled hypertension after an emergency cesarean section and was found to have bilateral renal artery stenosis and this imaging finding. What is the most likely diagnosis?	yes	54%	15%	14%	10%	7%	78509	0.054	cca64b63e391dd6b7f400f58998171e2	[ "A: Takayasu’s arteritis", "B: Aortic dissection", "C: Classical polyarteritis nodosa", "D: Abdominal aortic aneurysm", "E: Microscopic polyangiitis" ]	A: Takayasu’s arteritis
105	aug-11-2022	An 86-year-old woman presented with 1 day of nausea, vomiting, and right-sided abdominal pain. Computed tomography of the abdomen and pelvis revealed a distended gallbladder with a thickened wall outside the gallbladder fossa. There was also swirling of the cystic artery and duct but no dilatation of the common bile du...	yes	13%	11%	6%	12%	59%	25053	0.043	cb94e603949b810597086131c5bf3981	[ "A: Acalculous cholecystitis", "B: Cholangiocarcinoma", "C: Cholangitis", "D: Ectopic gallbladder", "E: Gallbladder volvulus" ]	E: Gallbladder volvulus
106	aug-12-2010	What is the diagnosis?	no	53%	17%	5%	4%	21%	85343	0.06	56d53fcaab5a5b998914e95001e4f016	[ "A: Bladder diverticula", "B: Orthotopic neobladder", "C: Schistosomiasis", "D: Transitional-cell carcinoma", "E: Vesicolithiasis" ]	A: Bladder diverticula
107	aug-12-2021	A 26-year-old woman with the Peutz–Jeghers syndrome presented to the emergency department with abdominal pain and nonbilious vomiting. A tender mass was palpable in the upper abdomen. What is the most likely diagnosis?	yes	10%	7%	18%	49%	15%	56268	0.066	ff699608f459e8c3183b11a628058713	[ "A: Acute necrotizing pancreatitis", "B: Cholangiocarcinoma", "C: Gastric leiomyosarcoma", "D: Gastrogastric intussusception", "E: Pancreatic adenocarcinoma with gastric invasion" ]	D: Gastrogastric intussusception
108	aug-13-2009	What is the diagnosis?	no	16%	23%	4%	52%	4%	86604	0.062	9b5d272ef327f2f7bc9ad85c9284c1ce	[ "A: Diverticulosis", "B: Familial adenomatous polyposis", "C: Foreign object ingestion", "D: Pneumatosis cystoides coli", "E: Trichinosis" ]	D: Pneumatosis cystoides coli
109	aug-13-2015	What is the most appropriate management of this patient who presents with fatigue and dyspnea?	yes	7%	68%	3%	5%	17%	78075	0.028	8703e1aef650e5accf294c8ada0b8099	[ "A: Prompt coronary revascularization", "B: Pericardiocentesis", "C: Thoracentesis", "D: Diuresis", "E: Pacemaker placement" ]	B: Pericardiocentesis
110	aug-13-2020	A 47-year-old man presented to the emergency department with a 3-day history of a pustular rash on both hands. One week before presentation, he had started treatment with penicillin V potassium for pharyngitis. Physical examination demonstrated a rash as shown, with a similar rash being present on the soles of both of ...	yes	54%	10%	23%	11%	3%	115648	0.057	7dc5e325102b65c0e583a6dd5becf128	[ "A: Poststreptococcal pustulosis", "B: Palmoplantar psoriasis", "C: Jarisch–Herxheimer reaction", "D: Immunoglobulin A pemphigus", "E: Scabies" ]	A: Poststreptococcal pustulosis
111	aug-14-2008	What is the diagnosis?	no	12%	4%	35%	11%	39%	130705	0.121	a96407e82390e736bb25e850525b9115	[ "A: Psoriatic arthropathy", "B: Reflex sympathetic dystrophy", "C: Osteoarthritis", "D: Gout", "E: Rheumatoid arthritis" ]	C: Osteoarthritis
112	aug-14-2014	What is the most likely diagnosis in this asymptomatic 17-year-old male?	yes	49%	2%	12%	18%	19%	87215	0.069	1c1480122eb829b6a8ac247b3c22af62	[ "A: Antrochoanal polyp", "B: Foreign body", "C: Palatine tonsillitis", "D: Pharyngeal lymphoma", "E: Tonsillar abscess" ]	A: Antrochoanal polyp
113	aug-15-2013	What is the diagnosis in this patient who had been bitten by a tsetse fly?	yes	15%	10%	27%	39%	8%	79212	0.097	2bf6a9a082b678d8917424f5a91f784a	[ "A: Chagas' disease", "B: Filariasis", "C: Leishmaniasis", "D: Trypanosomiasis", "E: Tuberculous scrofula" ]	D: Trypanosomiasis
114	aug-15-2019	An 80-year-old man presented to the emergency department with a 2-day history of abdominal pain in the right upper quadrant. On physical examination, he had abdominal tenderness in the right upper quadrant, and Murphy’s sign was positive. The alanine aminotransferase, aspartate aminotransferase, bilirubin, and lipase l...	yes	5%	6%	7%	73%	9%	47154	0.018	cc384f603882a96573f98d06ebb75168	[ "A: Ascending cholangitis", "B: Duodenal diverticulitis", "C: Subhepatic appendicitis", "D: Emphysematous cholecystitis", "E: Hepatic cyst rupture" ]	D: Emphysematous cholecystitis
115	aug-16-2007	This 12-year-old boy presented with abdominal pain. What is the diagnosis?	yes	4%	4%	17%	62%	13%	124142	0.039	8a99963b2293531784da1cf373d4c244	[ "A: Cowden syndrome", "B: Cronkhite-Canada syndrome", "C: Osler-Weber-Rendu syndrome", "D: Peutz-Jeghers syndrome", "E: Von Willebrand syndrome" ]	D: Peutz-Jeghers syndrome
116	aug-16-2012	What is the most likely diagnosis in this 12-year-old boy with recurrent infections?	yes	5%	39%	28%	9%	19%	112501	0.143	b3b725e479a5e7eb0b6b4c6f869c3bb3	[ "A: Brucellosis", "B: Burkitt's lymphoma", "C: Chronic granulomatous disease", "D: Neurofibromatosis", "E: Tuberculous lymphadenitis" ]	C: Chronic granulomatous disease
117	aug-16-2018	A 31-year-old man presented to the emergency department with confusion. He was found to be anemic with a hemoglobin level of 6.7 g per deciliter. Additional laboratory tests revealed an elevated indirect bilirubin level, an elevated lactate dehydrogenase level, and undetectable haptoglobin. A peripheral-blood smear was...	yes	41%	20%	8%	15%	16%	109194	0.089	ec660f5b36e4fc3f5387a613aec9b702	[ "A: Decompensated cirrhosis", "B: Myelodysplastic syndrome", "C: Iron deficiency", "D: End-stage renal disease", "E: Vitamin B12 deficiency" ]	A: Decompensated cirrhosis
118	aug-17-2006	This patient's appearance is a consequence of what surgery?	yes	71%	7%	14%	4%	4%	88090	0.022	be62f14279d6ef427ed4779028379706	[ "A: Gastric bypass", "B: Adrenalectomy", "C: Liposuction", "D: Pancreatectomy", "E: Small bowel transplant" ]	A: Gastric bypass
119	aug-17-2017	A 52-year-old woman with rheumatoid arthritis, treated with sulfasalazine and azathioprine, presented with multiple painful, erythematous plaques on her palms and fingers. What is the diagnosis?	yes	47%	23%	15%	5%	9%	118158	0.073	f2e49b0fd681022d37390979e2391740	[ "A: Sweet’s syndrome", "B: Erythema multiforme", "C: Drug eruption", "D: Secondary syphilis", "E: Granulomatosis with polyangiitis" ]	A: Sweet’s syndrome
120	aug-17-2023	A 30-year-old male with recently diagnosed aplastic anemia presented to the emergency department with a 2-day history of fever, nonpruritic rash, and ankle and knee pain. Ten days prior, he had completed a course of horse anti-thymocyte globulin as a treatment for his aplastic anemia. Laboratory studies were notable fo...	yes	9%	14%	43%	18%	16%	43997	0.082	6bd2eeaf3c004ae351fb3598a4577a98	[ "A: Type I hypersensitivity reaction", "B: Type II hypersensitivity reaction", "C: Type III hypersensitivity reaction", "D: Type IV hypersensitivity reaction", "E: This is not a hypersensitivity reaction" ]	C: Type III hypersensitivity reaction
121	aug-18-2011	Treatment with a medication from which one of the following drug groups has been associated with the problem identified in the abdominal radiograph?	yes	44%	14%	16%	13%	13%	86191	0.079	1f461d73e15b6b870c8bfc0f319aa2ef	[ "A: Alpha-glucosidase inhibitor", "B: Biguanide", "C: Dipeptidyl-peptidase 4 inhibitor", "D: Sulfonylurea", "E: Thiazolidinedione" ]	A: Alpha-glucosidase inhibitor
122	aug-18-2016	A 79-year-old woman presented with a 1-year history of gradual neurological decline involving confusion, memory loss, and imbalance. What is the most likely diagnosis?	yes	18%	16%	45%	6%	15%	111331	0.077	e2a364b316e7ee683519a267ffa3b62e	[ "A: Colloid cyst", "B: Glioblastoma multiforme", "C: Thrombosed intracranial aneurysm", "D: Choroid plexus metastases", "E: Intraventricular meningioma" ]	C: Thrombosed intracranial aneurysm
123	aug-18-2022	A 13-year-old girl presented with new onset blurry vision in the left eye associated with painful eye movements. Three weeks earlier, weakness and paresthesias had developed in her left leg that spontaneously resolved. When a light was swung from the normal right eye (Panel A) to the affected left eye, the left pupil d...	yes	14%	11%	13%	59%	3%	31571	0.044	78e732c52f86e8d4bb4be3a2e671b358	[ "A: Acute disseminated encephalomyelitis", "B: Leber hereditary optic neuropathy", "C: Mononeuritis multiplex", "D: Multiple sclerosis", "E: Retinal detachment" ]	D: Multiple sclerosis
124	aug-19-2010	This man presented 1 day after being treated with penicillin for a toothache. What is the diagnosis?	yes	8%	14%	42%	19%	17%	104185	0.085	d7aa3f432c0d9057978ee305b4f257d3	[ "A: Acute parotitis", "B: Angioneurotic edema", "C: Ludwig's angina", "D: Penicillin allergy", "E: Peritonsillar abscess" ]	C: Ludwig's angina
125	aug-19-2021	A 30-year-old man presented with a rash on his face, hands, and feet. He had a history of HIV with a CD4+ T-cell count of 374 per cubic millimeter. Physical examination showed circinate lesions on the palms, soles, and face and patchy alopecia. What is the likely diagnosis?	yes	18%	19%	34%	15%	15%	125951	0.11	0cfb7a6dc652e12e0faf2a9c120dbe64	[ "A: Disseminated granuloma annulare", "B: Erythema annulare centrifugum", "C: Syphilis", "D: Tinea corporis", "E: Tuberculoid leprosy" ]	C: Syphilis
126	aug-20-2009	What is the diagnosis?	no	33%	6%	30%	16%	14%	104216	0.13	9e3277a4666a36b356d6d84343b54c85	[ "A: Cytomegalovirus retinitis", "B: Glaucoma", "C: Malignant hypertension", "D: Panretinal photocoagulation", "E: Retinal vein thrombosis" ]	C: Malignant hypertension
127	aug-20-2015	What is the most appropriate treatment for a child with recurrent hematuria and the following finding?	yes	7%	21%	63%	4%	4%	74460	0.038	15148292c003031ad0df15a94aaa2354	[ "A: Fluconazole", "B: Metronidazole", "C: Praziquantel", "D: Steroids", "E: Azathioprine" ]	C: Praziquantel
128	aug-20-2020	A 30-year-old pregnant woman at 34 weeks of gestation presented to the emergency department with a 5-day history of an itchy rash that began on her abdomen and then spread to her thorax and extremities. Physician examination revealed papules on her abdomen and bullous blisters on her arm. What is the diagnosis?	yes	9%	45%	5%	10%	30%	75517	0.083	056363d846fbf8e0896d55e075fd0f10	[ "A: Dermatitis herpetiformis", "B: Pemphigoid gestationis", "C: Bullous pemphigoid", "D: Erythema multiforme", "E: Pruritic urticarial papules and plaques of pregnancy (PUPPP)" ]	B: Pemphigoid gestationis
129	aug-21-2008	What is the diagnosis?	no	38%	4%	6%	10%	42%	119313	0.099	3d7c388ebdd6c5efda68be5bac79bf8f	[ "A: Basal-cell carcinoma", "B: Granuloma fissuratum", "C: Melanoma", "D: Seborrheic keratosis", "E: Squamous-cell carcinoma" ]	E: Squamous-cell carcinoma
130	aug-21-2014	What is the diagnosis?	no	3%	16%	8%	6%	67%	84026	0.029	1b861f3275da7bae56ede0afda823d19	[ "A: Diaphragmatic hernia", "B: Gastric bezoar", "C: Inferior mesenteric artery thrombosis", "D: Pancreatic phlegmon", "E: Small-bowel volvulus" ]	E: Small-bowel volvulus
131	aug-22-2013	What is the cause of this rash that developed in a patient after cesarean section in association with fever and hypotension?	yes	5%	4%	24%	23%	44%	81139	0.086	a6ff00fb6a30a938074de3c7ad647942	[ "A: Kawasaki disease", "B: Pseudoporphyria", "C: Scalded skin syndrome", "D: Toxic epidermal necrolysis", "E: Toxic shock syndrome" ]	E: Toxic shock syndrome
132	aug-22-2019	A fully immunized 48-year-old man presented to an urgent care clinic with a 3-day history of odynophagia, fever, and progressive dyspnea. Physical examination demonstrated stridor and use of accessory muscles for respiration. A lateral radiograph of the neck was performed. What is the most likely diagnosis?	yes	12%	12%	52%	9%	14%	84119	0.057	b530f2ee499b4916249a9dc3e19fdbc3	[ "A: Inhaled foreign body", "B: La Delfa malformation", "C: Epiglottitis", "D: Relapsing polychondritis", "E: Tracheal perforation" ]	C: Epiglottitis
133	aug-23-2007	Which one of the following is the most likely diagnosis?	no	18%	22%	7%	44%	9%	135514	0.081	38845ba0f402cc0418470529c81037f4	[ "A: Chronic renal failure", "B: Iron deficiency", "C: Graves' disease", "D: Chemotherapy treatment", "E: Psoriasis" ]	D: Chemotherapy treatment
134	aug-23-2012	This finding was recognized after cardiopulmonary resuscitation. What is the diagnosis?	yes	73%	4%	7%	12%	4%	81608	0.019	ee5d37763c74a6f0e38e60251d8cc326	[ "A: Air embolism", "B: Central pontine myelinolysis", "C: Intraventricular hemorrhage", "D: Middle cerebral artery dissection", "E: Skull fracture" ]	A: Air embolism
135	aug-23-2018	A4-year-old boy was brought by his father to the ophthalmology clinic with a 1-year history of enlarging white deposits in both eyes and decreasing night vision. On examination, the conjunctivae of both the right eye and the left eye appeared dry and wrinkled, with foamy, cream-colored deposits near the outer corners. ...	yes	10%	18%	52%	15%	5%	102326	0.06	fbac0c5f5163fe6cab9e9dcb162d6f48	[ "A: Sjögren's syndrome", "B: Pyridoxine deficiency", "C: Vitamin A deficiency", "D: Loiasis", "E: Type 1 diabetes" ]	C: Vitamin A deficiency
136	aug-24-2006	This lesion developed after the patient consumed raw meat from a sick goat. What is the most likely diagnosis?	yes	24%	39%	9%	13%	15%	91826	0.095	8c99cdfe80ca493355447b08e372a35f	[ "A: Brucellosis", "B: Anthrax", "C: Herpes simplex", "D: Orf", "E: Pasteurella multocida" ]	B: Anthrax
137	aug-24-2017	A 43-year-old woman had an 8-month history of non-productive cough, unresponsive to antibiotic treatment. Physical exam showed bilateral wheezing, and pulmonary function tests showed obstructive disease, unresponsive to bronchodilators. Bronchoscopy revealed the following. What is the most likely diagnosis?	yes	30%	6%	12%	3%	48%	94789	0.076	b328422dd0b517a7ea9e38f542daef41	[ "A: Bronchial polyposis", "B: Bronchial tuberculosis", "C: Pulmonary sarcoidosis", "D: Tracheal inhalation injury", "E: Eosinophilic bronchitis" ]	E: Eosinophilic bronchitis
138	aug-24-2023	A 73-year-old woman presented with a 2-day history of left flank pain. Findings from a physical examination were normal. Laboratory testing was notable for a platelet count of 652,000 per cubic millimeter (reference range, 150,000 to 400,000) with an otherwise normal complete blood count. No previous platelet count was...	yes	11%	12%	11%	59%	8%	19582	0.043	d5e26dec105cfbdfe0262247a9dd9fdd	[ "A: BCR-ABL1", "B: CTLA4", "C: FLT3", "D: JAK2", "E: MYC" ]	D: JAK2
139	aug-25-2011	What is the diagnosis?	no	6%	22%	14%	47%	10%	98776	0.072	aa562d4bcfa366405246cd97f4ed21bc	[ "A: Bullous pemphigoid", "B: Hypoparathyroidism", "C: Osteosarcoma", "D: Scleroderma", "E: Wilson's disease" ]	D: Scleroderma
140	aug-25-2016	A 42-year-old man with diabetes presented with a history of urinary incontinence and severe dysuria over several days. What diagnosis does his computed tomographic (CT) scan suggest?	yes	3%	12%	2%	63%	20%	70074	0.039	f798784cf0f08665195c6bd3124a9e33	[ "A: Benign prostatic hypertrophy", "B: Bladder perforation", "C: Urethritis", "D: Emphysematous prostatitis", "E: Colovesical fistula" ]	D: Emphysematous prostatitis
141	aug-25-2022	A 32-year-old man presented with a 6-week history of tingling in his arms and legs and a 2-week history of inability to walk. A positive Romberg test, sensory ataxia, impaired proprioception and vibratory sensation, and preserved nociception were noted. Magnetic resonance imaging of the whole spine showed hyperintensit...	yes	19%	35%	16%	14%	16%	48197	0.106	dce8f92ff3772c7353482f31256c4ce4	[ "A: Copper", "B: Nitrous oxide", "C: Organophosphates", "D: Tetrodotoxin (pufferfish poisoning)", "E: Thallium" ]	B: Nitrous oxide
142	aug-26-2010	What is the diagnosis?	no	6%	27%	20%	38%	9%	79773	0.102	43919b7d0566691a3a7291fbc3f89099	[ "A: Closed-angle glaucoma", "B: Cholesterol embolism", "C: Diabetes mellitus", "D: Malignant hypertension", "E: Syphilis" ]	D: Malignant hypertension
143	aug-26-2021	A 54-year-old woman presented with abdominal pain and difficulty walking. Abdominal imaging showed multiple abscesses surrounding an intrauterine device (IUD). Aspiration with gram stain identified branching, filamentous, gram-positive rods. What is the most likely diagnosis?	yes	52%	12%	5%	14%	17%	43221	0.059	ecc3dc350033786378eb9271db05ea49	[ "A: Actinomycosis", "B: Aspergillosis", "C: Crohn’s disease", "D: Listeriosis", "E: Nocardiosis" ]	A: Actinomycosis
144	aug-27-2009	What is the diagnosis?	no	7%	18%	40%	10%	25%	100140	0.094	d5a07a8e51806e82345831bdf3557b9d	[ "A: Diverticular abscess", "B: Hirschsprung's disease", "C: Sigmoid volvulus", "D: Small-bowel obstruction", "E: Trichobezoar" ]	C: Sigmoid volvulus
145	aug-27-2015	What is the most likely diagnosis in an infant with poor feeding and vomiting?	yes	20%	4%	5%	56%	15%	88708	0.052	23280f35409a276f27ebdab9c925e2d7	[ "A: Hirschsprung's disease", "B: Incarcerated inguinal hernia", "C: Meckel's diverticulum", "D: Gastric pneumatosis", "E: Intussusception" ]	D: Gastric pneumatosis
146	aug-27-2020	An 89-year-old woman presented to the ophthalmology clinic with a 4-month history of redness and a sensation of a foreign body in her right eye. Slit-lamp examination revealed a red, raised lesion on the conjunctiva that extended onto the cornea with accompanying prominent blood vessels. What is the diagnosis?	yes	45%	14%	16%	10%	15%	71088	0.076	a6cef569909a17226d48accf9fd4fe43	[ "A: Conjunctival squamous-cell carcinoma", "B: Pinguecula", "C: Pterygium", "D: Episcleritis", "E: Pyogenic granuloma" ]	A: Conjunctival squamous-cell carcinoma
147	aug-28-2008	This 6-day-old infant's mother had developed intensely pruritic lesions at 33 weeks of gestation. What is the diagnosis?	yes	20%	14%	8%	39%	19%	142237	0.095	12afc26bcd424e9712a0f09702b87004	[ "A: Congenital syphilis", "B: Epidermolysis bullosa acquisita", "C: Neonatal gonorrhea", "D: Herpes gestationis", "E: Pruritic plaques of pregnancy" ]	D: Herpes gestationis
148	aug-28-2014	What is the diagnosis in this patient who developed burning pain, pruritus, and edema of the hands upon their exposure to water and who had this image taken under a Wood's lamp?	yes	25%	46%	15%	6%	9%	73987	0.078	a440f770f4b07e6b7f043be42e53bb9c	[ "A: Acquired acral mycosis", "B: Aquagenic keratoderma", "C: Dyshidrotic eczema", "D: Leprosy", "E: Ochronosis" ]	B: Aquagenic keratoderma
149	aug-29-2013	What is the diagnosis?	no	16%	11%	7%	9%	57%	80507	0.047	f243b7d5025f9d3895035af666b85591	[ "A: Bowenoid papulosis", "B: Fibrous pseudotumor", "C: Keloid", "D: Onchocerciasis", "E: Scrotal calcinosis" ]	E: Scrotal calcinosis
150	aug-29-2019	A 49-year-old man with a 3-month history of progressive voice changes and pain with swallowing presents to the otorhinolaryngology clinic. He has a history of hypertension and type 2 diabetes mellitus and is a smoker. He denies any recent weight loss or other systemic symptoms. Fiberoptic laryngoscopy was performed and...	yes	16%	39%	16%	12%	18%	105891	0.094	2ba8c628527ca177490821752026c036	[ "A: Vocal-cord granuloma", "B: Carcinoma", "C: Pachydermia larynges", "D: Reinke’s edema", "E: Subglottic stenosis in granulomatosis with polyangiitis" ]	B: Carcinoma
151	aug-30-2007	What is the diagnosis?	no	10%	28%	15%	12%	35%	116897	0.138	b19d21d9dbeb06731a3223786c663f7c	[ "A: Cytomegalovirus retinitis", "B: Lipemia retinalis", "C: Central retinal vein occlusion", "D: Diabetic retinopathy", "E: Retinitis pigmentosa" ]	B: Lipemia retinalis
152	aug-30-2012	What is the diagnosis in this patient with abdominal pain?	yes	9%	6%	49%	10%	27%	86913	0.071	3a6d9d844e56166346bf270b1d1a295d	[ "A: Amyloidosis", "B: Familial Mediterranean fever", "C: Lead poisoning", "D: Leukemia", "E: Scurvy" ]	C: Lead poisoning
153	aug-30-2018	A 55-year-old woman was admitted to hospital after sustaining a severe crush injury to both legs in a motor vehicle accident. A polymicrobial wound infection developed and she received antibiotic treatment. Black discoloration of her tongue was observed within 1 week of starting treatment, and the patient reported naus...	yes	49%	7%	12%	16%	16%	132736	0.066	247b11675bd9fa810011e76ff8a782d0	[ "A: Tetracyclines", "B: Penicillins", "C: Macrolides", "D: Fluoroquinolones", "E: Sulfonamides" ]	A: Tetracyclines
154	aug-31-2006	This 38-year-old woman developed recurrent right-sided chest pain synchronously with her menses. What is the most likely diagnosis?	yes	5%	7%	12%	70%	6%	74267	0.023	0937b4171b27705c8a99f8c91de9fa6c	[ "A: Recurrent pulmonary emboli", "B: Alpha-1 antitrypsin deficiency", "C: Meig's syndrome", "D: Thoracic endometriosis", "E: Lymphangioleiomyomatosis" ]	D: Thoracic endometriosis
155	aug-31-2017	A 64-year-old man with a history of bladder cancer treated with radical cystectomy and orthotopic neobladder construction with intestinal segments presented to the emergency department with left flank pain and urinary retention. CT of the abdomen and pelvis showed a very large stone in the neobladder. What is the predo...	yes	11%	7%	27%	48%	7%	79431	0.073	7c1ae90c762688326e175e4aca646ec0	[ "A: Struvite", "B: Uric acid", "C: Calcium oxalate", "D: Calcium phosphate", "E: Cystine" ]	D: Calcium phosphate
156	aug-31-2023	A 53-year-old man who had been admitted to the hospital after a fall was noted to have an abnormal indentation of the lower eyelids. He had a history of corneal transplantation in both eyes. He had recently experienced progressive visual impairment, which had led to his fall. Ophthalmologic examination was notable for ...	yes	3%	5%	60%	20%	12%	28870	0.044	03b951452803a3cf89b0e633adb656aa	[ "A: Astigmatism", "B: Corneal ulcer", "C: Keratoconus", "D: Keratoglobus", "E: Pellucid marginal degeneration" ]	C: Keratoconus
157	dec-01-2005	What is the diagnosis?	no	55%	13%	10%	18%	3%	90257	0.053	19ea40f5a02cb3f0403351f0cae2ce2d	[ "A: Gout", "B: Rheumatoid arthritis", "C: Gonococcal arthritis", "D: Leprosy", "E: Psoriasis" ]	A: Gout
158	dec-01-2011	What cranial nerve palsy is most clearly illustrated in this image?	yes	4%	18%	49%	13%	16%	91735	0.067	3462113104b588ef471b90b96f89b679	[ "A: Left facial nerve", "B: Left glossopharyngeal nerve", "C: Left hypoglossal nerve", "D: Right glossopharyngeal nerve", "E: Right hypoglossal nerve" ]	C: Left hypoglossal nerve
159	dec-01-2016	An 18-year-old Fijian woman presented with a 3-year history of a concentric scaly rash on her trunk and upper and lower limbs. Her brother had similar skin findings. What is the diagnosis?	yes	22%	7%	15%	50%	6%	107203	0.066	79052dfd5083d9893043e1ee0dad5d1b	[ "A: Erythema gyratum repens", "B: Tinea corporis", "C: Discoid eczema", "D: Tinea imbricata", "E: Erythrasma" ]	D: Tinea imbricata
160	dec-01-2022	A 26-year-old man presented to the outpatient clinic with a 1-month history of pain and swelling in the scrotum and low-grade fevers. On examination, there was swelling and tenderness of the right side of the scrotum. Laboratory studies showed peripheral eosinophilia. An ultrasound of the scrotum showed echogenic, line...	yes	19%	17%	31%	18%	15%	47633	0.119	ccfd645f3d2e8cc4e49fdfd42d8ab563	[ "A: Aquatic snail", "B: Blackfly", "C: Mosquito", "D: Sandfly", "E: Tsetse fly" ]	C: Mosquito
161	dec-02-2010	What is the diagnosis?	no	13%	8%	10%	35%	34%	121633	0.118	cc5cc8d8863410efa97986a56fa6f08a	[ "A: Arsenic poisoning", "B: Cushing's syndrome", "C: Pellagra", "D: Self-flagellation", "E: Treatment with bleomycin" ]	E: Treatment with bleomycin
162	dec-02-2021	A female infant delivered at term had a “blueberry muffin” rash at birth. Laboratory tests and imaging studies were normal. Skin biopsy showed a dense infiltrate of cells with kidney-shaped nuclei and positive S100+ and CD1a+ on immunohistochemistry. What is the most likely diagnosis?	yes	19%	19%	41%	11%	9%	105113	0.088	9d66f0c092bd77b19234d8a59d090c6f	[ "A: Congenital cytomegalovirus infection", "B: Congenital rubella syndrome", "C: Langerhans-cell histiocytosis", "D: Leukemia cutis", "E: Transient myeloproliferative disorder of Down syndrome" ]	C: Langerhans-cell histiocytosis
163	dec-03-2009	What is the diagnosis?	no	18%	54%	11%	6%	11%	93698	0.054	528caf7d114bd9380fdc0c94366950d1	[ "A: Central retinal vein occlusion", "B: Cholesterol embolism", "C: Retinoschisis", "D: Temporal arteritis", "E: Toxoplasmosis" ]	B: Cholesterol embolism
164	dec-03-2015	What is the most likely diagnosis associated with this finding?	no	49%	10%	5%	26%	10%	85147	0.07	91968ee9fce22422f9fd2ebdd0297633	[ "A: Squamous-cell carcinoma", "B: Paronychia", "C: Verruca vulgaris", "D: Onychomycosis", "E: Pyogenic granuloma" ]	A: Squamous-cell carcinoma
165	dec-03-2020	A 46-year-old man presented to the emergency department with a 2-week history of diarrhea, nausea, abdominal pain, and weakness along with a weight loss of 8 kg in the preceding 2 months. An enzyme-linked immunosorbent assay for the human immunodeficiency virus was positive. Laboratory studies revealed a serum creatini...	yes	23%	54%	4%	8%	12%	37904	0.057	f7f6ed3f66032827eb0eea10b04622bf	[ "A: Focal segmental glomerulosclerosis", "B: Renal cryptococcosis", "C: Diabetic nephropathy", "D: Tubulocystic renal-cell carcinoma", "E: IgA Nephropathy" ]	B: Renal cryptococcosis
166	dec-04-2008	This patient recently returned from Brazil. What is the diagnosis?	yes	23%	6%	13%	14%	44%	132406	0.081	a400905c8cb5652cbba99748a3999468	[ "A: Dracunculiasis", "B: Ingrown toenail", "C: Leptospirosis", "D: Scabies", "E: Tungiasis" ]	E: Tungiasis
167	dec-04-2014	This patient would be predicted to have a higher-than-average risk for which one of the following diseases?	yes	11%	58%	14%	6%	11%	95923	0.045	768cf19f7e8258ff7c8ada1a6bb2e00c	[ "A: Cirrhosis", "B: Coronary artery disease", "C: Gout", "D: Hemorrhagic stroke", "E: Hypothyroidism" ]	B: Coronary artery disease
168	dec-05-2013	What is the diagnosis in this patient who presented with high fever?	yes	9%	17%	5%	40%	29%	77737	0.097	29fda6a662e0e8e3a96d5120e1b1c2bb	[ "A: Bowel infarction", "B: Caval thrombophlebitis", "C: Hepatoma", "D: Liver abscess", "E: Perforated gastric ulcer" ]	D: Liver abscess
169	dec-05-2019	Physical examination of a 1-day-old girl born at 36 weeks of gestation revealed a soft mass protruding from the external genitalia. The mass was noted to increase in size when the infant cried. The physical examination was otherwise normal. What is the diagnosis?	yes	45%	19%	17%	11%	8%	121132	0.077	a94a540e7c8f50d6930fedd5461ac195	[ "A: Hydrocolpos", "B: Prolapsed uterus", "C: Interlabial cyst", "D: McKusick-Kaufman syndrome", "E: Rhabdomyosarcoma" ]	A: Hydrocolpos
170	dec-06-2007	This patient is most likely to have presented with which one of the following findings?	no	11%	12%	5%	12%	60%	118703	0.041	7a8871070f5d6a5283428a7fdc90dde6	[ "A: Amnesia", "B: Ataxia", "C: Dysphagia", "D: Hemianopia", "E: Hemiparesis" ]	E: Hemiparesis
171	dec-06-2012	What is the diagnosis?	no	11%	63%	10%	14%	3%	76178	0.036	85d3893a6f732bdd29cd4d20f6eb2f8f	[ "A: Nephrogenic systemic sclerosis", "B: Keratoderma", "C: Poikiloderma", "D: Punctate psoriasis", "E: Verrucae" ]	B: Keratoderma
172	dec-06-2018	A 67-year-old woman presented to the emergency department with a 6-week history of progressive exertional dyspnea. Her medical history was notable for lung transplantation that had been performed 8 years earlier. Laboratory studies showed normocytic anemia, with a hemoglobin level of 6.9 g per deciliter (reference rang...	yes	13%	19%	15%	50%	3%	69778	0.065	938c98c873ad940865156d9c3bcd4b70	[ "A: Chronic lung allograft dysfunction", "B: Acute promyelocytic leukemia", "C: Adverse reaction to an immunosuppressant", "D: Parvovirus B19 infection", "E: Acute hepatitis B infection" ]	D: Parvovirus B19 infection
173	dec-07-2006	This 19-year-old man presented with a 10-month history of Raynaud's phenomenon, fever, abdominal pain, and hypertension. What diagnosis is suggested by the findings on his angiogram?	yes	19%	13%	5%	9%	54%	75310	0.055	12c1b52fd58a587cd372400f4cff78d9	[ "A: Takayasu's arteritis", "B: Wegener's granulomatosis", "C: Paraganglioma", "D: Systemic lupus erythematosus", "E: Polyarteritis nodosa" ]	E: Polyarteritis nodosa
174	dec-07-2017	A 23-day-old male infant was brought to the emergency department after 5 days of increasing vomiting. Physical exam revealed mild dehydration and an olive-sized abdominal mass. Upper gastrointestinal radiography showed a distended, air-filled stomach. What is the likely diagnosis?	yes	5%	63%	13%	8%	11%	68967	0.035	9337c0915b7d134aa934925ad737beb5	[ "A: Gastric duplication", "B: Pyloric stenosis", "C: Duodenal atresia", "D: Intestinal malrotation", "E: Mid-gut volvulus" ]	B: Pyloric stenosis
175	dec-07-2023	A previously healthy 26-year-old man presented to the emergency department with a 5-day history of an asymptomatic rash, sore throat, fevers, chills, and malaise. On physical examination, scattered, erythematous papules and macules could be seen across the upper chest and anterior neck (left). In the mouth, palatal pet...	yes	6%	15%	46%	21%	12%	28509	0.075	f4b4a38a1543c6ec0daf95feba582e91	[ "A: HIV IgG antibody", "B: HIV IgM antibody", "C: HIV nucleic acid test", "D: p24 antigen", "E: Western Blot" ]	C: HIV nucleic acid test
176	dec-08-2005	This urine sample was photographed under light microscopy. What type of crystal is illustrated?	yes	24%	41%	13%	13%	8%	71344	0.089	5d102db1390e782dbd736d24d58382a6	[ "A: Urate", "B: Oxalate", "C: Cysteine", "D: Ethylene glycol", "E: Triphosphate" ]	B: Oxalate
177	dec-08-2011	What is the diagnosis?	no	16%	11%	18%	44%	11%	98917	0.079	9f41e326e8ec140dafc69954f102d8a5	[ "A: Dermatitis herpetiformis", "B: Erythema multiforme", "C: Guttate psoriasis", "D: Pemphigus vulgaris", "E: Varicella-zoster infection" ]	D: Pemphigus vulgaris
178	dec-08-2016	A 60-year-old woman presented with fevers, chills, myalgias, headache, and two pruritic areas on her back after returning from Botswana and Zimbabwe. She was found to have thrombocytopenia, and this finding on her blood smear. What organism is responsible for her presentation?	yes	7%	6%	23%	51%	13%	97991	0.064	9216195656fad4fe67de9307be9aef14	[ "A: Wuchereria bancrofti", "B: Toxoplasma gondii", "C: Plasmodium falciparum", "D: Trypanosoma brucei", "E: Leishmania donovani" ]	D: Trypanosoma brucei
179	dec-08-2022	An 81-year-old woman with a history of hepatitis C virus-related cirrhosis and hepatocellular carcinoma, who was treated 9 days earlier with transarterial chemoembolization with the use of doxorubicin-eluting beads, presented with painful, progressively worsening skin lesions over the abdomen. A skin biopsy revealed ep...	yes	5%	6%	66%	10%	13%	27480	0.03	399be4a4e0d39491636fee3fdf9a2176	[ "A: Air Embolism", "B: Bacterial Embolism", "C: Drug-Eluting Bead Embolism", "D: Cholesterol Embolism", "E: Tumor Embolism" ]	C: Drug-Eluting Bead Embolism
180	dec-09-2010	What is the diagnosis?	no	22%	30%	9%	19%	20%	103140	0.125	52aa7efca98239ce3feb1083b4a2d671	[ "A: Ascaris lumbricoides", "B: Dirofilaria repens", "C: Paragonimus westermani", "D: Toxocara canis", "E: Wuchereria bancrofti" ]	B: Dirofilaria repens
181	dec-09-2021	A 74-year-old woman presented with a 3-day history of headaches and tongue swelling and several hours of blindness in the right eye. On examination, the tongue was discolored and ulcerated. What is the diagnosis?	yes	14%	13%	47%	8%	18%	70643	0.071	5f66ae7118a6bdadc87edb8c3deca59a	[ "A: Carcinoma of the tongue", "B: Carotid artery stenosis", "C: Giant-cell arteritis", "D: Oral lichen planus", "E: Thromboembolic disease" ]	C: Giant-cell arteritis
182	dec-10-2009	What is the diagnosis?	no	59%	20%	5%	9%	7%	96131	0.045	8e03f38d0e2ce48f168de1e9246ec1de	[ "A: Atlanto-occipital dislocation", "B: Atlanto-axial subluxation", "C: Pillar fracture", "D: Spinous process avulsion", "E: Wedge fracture" ]	A: Atlanto-occipital dislocation
183	dec-10-2015	Which of the following is the least likely cause of eschars as seen here?	yes	10%	16%	12%	49%	13%	84442	0.065	c31d2e0ac2272907098bf7bf1ecad085	[ "A: Scrub typhus", "B: Cutaneous anthrax", "C: Rickettsia akari", "D: Chickenpox", "E: Brown recluse spider bite" ]	D: Chickenpox
184	dec-10-2020	A 50-year-old man with a history of large-cell neuroendocrine carcinoma of the lung presented with a 5-day history of shortness of breath, chest pain, and a cough. Physical examination noted diminished breath sounds in the right lower lobe and cough after fluid intake. What is the diagnosis?	yes	79%	6%	6%	7%	2%	31194	0.011	5182b543d7eae201da48e79dadbb3bbb	[ "A: Bronchoesophageal fistula", "B: Aspiration pneumonia", "C: Pharyngeal pseudodiverticulum", "D: Zenker’s diverticulum", "E: Gastroesophageal reflux disease" ]	A: Bronchoesophageal fistula
185	dec-11-2008	What is the most likely diagnosis?	no	9%	11%	9%	63%	9%	125016	0.035	32d8f3387cc477f0dcf3823ca0c93b50	[ "A: Alport syndrome", "B: Angelman syndrome", "C: Fragile X syndrome", "D: Turner syndrome", "E: Williams syndrome" ]	D: Turner syndrome
186	dec-11-2014	What is the most likely diagnosis?	no	9%	16%	49%	19%	6%	92174	0.067	abb8d7fcaf43c8a40588266636cd02ad	[ "A: Hypophosphatasia", "B: Osteosarcoma", "C: Paget's disease", "D: Rickets", "E: Tuberculosis" ]	C: Paget's disease
187	dec-12-2013	What is the diagnosis?	no	11%	8%	61%	15%	5%	77381	0.039	8e893dfc22f9934f663d33f100478640	[ "A: Aphthous stomatitis", "B: Pyogenic granuloma", "C: Squamous-cell carcinoma", "D: Syphilis", "E: Traumatic fibroma" ]	C: Squamous-cell carcinoma
188	dec-12-2019	A 51-year-old man with history of type 2 diabetes and human immunodeficiency virus infection presented with a 3-year history of worsening swelling of the left wrist associated with pain and numbness in the fingers. Physical examination was notable for an extension deficit in the proximal interphalangeal joint of all fo...	yes	13%	11%	8%	24%	43%	74413	0.084	f52d9aa34f63cf242839a6364d7671b1	[ "A: Pigmented villonodular synovitis (PVNS)", "B: Reichel syndrome", "C: Calcium hydroxyapatite deposition disease", "D: Fibrolipomatous hamartoma of ulnar nerve", "E: Mycobacterial tenosynovitis due to Mycobacterium avium complex" ]	E: Mycobacterial tenosynovitis due to Mycobacterium avium complex
189	dec-13-2007	What is the most likely diagnosis in this 36-year-old woman with chronic renal failure?	yes	4%	16%	7%	33%	40%	138043	0.1	a8bfff9a5722d62e75b42d7f84218bc5	[ "A: Lipoma", "B: Osteitis fibrosa", "C: Osteosarcoma", "D: Fistula", "E: Calcinos" ]	E: Calcinos
190	dec-13-2012	What is the most likely diagnosis?	no	10%	16%	29%	32%	12%	105178	0.131	bd578d3ec7a7eab3d198ecbda9e38b0a	[ "A: Abscess", "B: Cavernous hemangioma", "C: Lipoma", "D: Mucocele", "E: Sialolith" ]	C: Lipoma
191	dec-13-2018	An 18-year-old man presented to the emergency department with chest pain. What is the most likely childhood diagnosis associated with the findings of this coronary angiogram?	yes	67%	7%	18%	5%	3%	68739	0.03	14ef8b9f9c59ebab1c27319131a7edf9	[ "A: Kawasaki's disease", "B: Rheumatic heart disease", "C: Marfan's syndrome", "D: Familial hypercholesterolemia", "E: Hodgkin's lymphoma" ]	A: Kawasaki's disease
192	dec-14-2006	What is the diagnosis?	no	22%	13%	6%	44%	15%	93835	0.081	683367bc6c213f1dda84d3af820e81f4	[ "A: Pulmonary hydatid disease", "B: Bullous emphysema", "C: Pulmonary silicosis", "D: Multiple bacterial abscesses", "E: Aspergillosis" ]	D: Multiple bacterial abscesses
193	dec-14-2017	A 27-year-old man presented with a 2-year history of acne and the recurrence of multiple painful lesions in the genital and perineal areas. Examination revealed inflamed and noninflamed nodules and scar tissue in the genitofemoral area, axilla, intergluteal area, and behind the ears. What is the diagnosis?	yes	10%	6%	53%	24%	7%	103597	0.059	7507647c7993364c438140f2b48d81db	[ "A: Blastomycosis", "B: Cat scratch disease", "C: Hidradenitis suppurativa", "D: Lymphogranuloma venereum", "E: Epidermal inclusion cyst" ]	C: Hidradenitis suppurativa
194	dec-14-2023	A 49-year-old woman with a history of Graves' disease presented to the endocrinology clinic with a 3-year history of skin changes on her arms and legs and a 1-year history of thyrotoxicosis symptoms. She had intermittently adhered to carbimazole therapy since her diagnosis 10 years earlier. On physical examination, vio...	yes	6%	8%	18%	18%	50%	21875	0.065	aa950e5771672f62c509523b52113f37	[ "A: C-peptide", "B: Glutamic acid decarboxylase antibodies", "C: Thyroglobulin antibodies", "D: Thyroid peroxidase antibodies", "E: Thyrotropin receptor antibodies" ]	E: Thyrotropin receptor antibodies
195	dec-15-2005	What is the diagnosis?	no	6%	15%	21%	46%	13%	70458	0.076	08e1b4933be5a74361446b7f171bc447	[ "A: Pterygium", "B: Retroorbital hematoma", "C: Retained suture", "D: Loa loa", "E: Toxocariasis" ]	D: Loa loa
196	dec-15-2011	What is the diagnosis?	no	9%	6%	19%	63%	4%	87027	0.037	392adb1cbe38f0967bf2b61aca122367	[ "A: Achalasia", "B: Aortic dissection", "C: Esophageal perforation", "D: Pneumopericardium", "E: Ventricular rupture" ]	D: Pneumopericardium
197	dec-15-2016	A 36-year-old man presented with 1 month of fever and pain in his shoulders and knees after having a sore throat. He subsequently developed this evanescent nonpruritic macular rash (marked with a skin marking pen). What is the diagnosis?	yes	9%	21%	11%	6%	52%	114942	0.06	2d559cfa6b576d056764316bde784229	[ "A: Erythema infectiosum", "B: Erythema multiforme", "C: Erythema migrans", "D: Erythema nodosum", "E: Erythema marginatum" ]	E: Erythema marginatum
198	dec-15-2022	A 58-year-old woman with a history of metastatic uterine leiomyosarcoma presented with a 1-month history of a nonpruritic rash on her arms. On examination, hyperpigmented plaques were observed on the dorsa of both hands at the sites of previous intravenous access. The darkened skin extended up the arms in a linear patt...	yes	25%	8%	10%	44%	13%	45173	0.082	754b9f51279c5916e2336ca38c6ca294	[ "A: Bleomycin-induced flagellate erythema", "B: Erythema ab igne", "C: Phlegmasia cerulea dolens", "D: Serpentine supravenous hyperpigmentation", "E: Superficial thrombophlebitis" ]	D: Serpentine supravenous hyperpigmentation
199	dec-16-2010	What is the diagnosis?	no	12%	3%	20%	20%	45%	102139	0.08	bb8fab14b6952f81bf5650749731de55	[ "A: Anthrax", "B: Cellulitis", "C: Lichen planus", "D: Psoriasis", "E: Tinea" ]	E: Tinea
200	dec-16-2021	A 37-year-old man presented to the neurosurgery clinic with blurry vision, headache, and difficulty looking upward. On exam, he had diplopia, upward gaze palsy, and vertical misalignment of the eyes. His pupils only minimally constricted to light but constricted to near objects. What is the name of this pupillary exam ...	yes	17%	7%	23%	33%	19%	63916	0.114	53d9d28dd5c67cbaf667d795b105d44a	[ "A: Adie’s pupil", "B: Anisocoria", "C: Argyll Robertson pupil", "D: Light-near dissociation", "E: Relative afferent pupillary defect (e.g., Marcus Gunn pupil)" ]	D: Light-near dissociation

101

aug-10-2017

An 8-year-old girl with atopic dermatitis presented with a 3-day history of diffuse eruption of pruritic, umbilicated, erythematous vesicles with erosion and crusting on the flexor surfaces of the legs and arms. What is the diagnosis?

yes

19%

56%

4%

2%

20%

104878

0.054

e31b058554eee81a962648760ef7e6a4

[ "A: Impetigo", "B: Eczema herpeticum", "C: Contact dermatitis", "D: Drug eruption", "E: Dermatitis herpetiformis" ]

B: Eczema herpeticum

102

aug-10-2023

A 3-year-old girl presented to the emergency department with a 1-day history of dark urine and jaundice after the development of an upper respiratory tract infection 1 week earlier. The physical examination was notable for pharyngeal erythema and exudates, conjunctival pallor, and scleral icterus. There was no hepatosp...

yes

44%

10%

17%

10%

20%

36693

0.08

e7a04d81db7f73488f38809e70fb4ce1

[ "A: Cold agglutinin syndrome", "B: G6PD Deficiency", "C: Hemolytic uremic syndrome", "D: Hereditary spherocytosis", "E: Warm autoimmune hemolytic anemia" ]

A: Cold agglutinin syndrome

103

aug-11-2011

What is the diagnosis?

no

4%

17%

12%

5%

62%

94634

0.038

1a551fe3af8f4aa05609462a34e659f8

[ "A: Calciphylaxis", "B: Epidermoid cysts", "C: Hidradenitis suppurativa", "D: Onchocerciasis", "E: Scrotal calcinosis" ]

E: Scrotal calcinosis

104

aug-11-2016

A 36-year-old woman presented with uncontrolled hypertension after an emergency cesarean section and was found to have bilateral renal artery stenosis and this imaging finding. What is the most likely diagnosis?

yes

54%

15%

14%

10%

7%

78509

0.054

cca64b63e391dd6b7f400f58998171e2

[ "A: Takayasu’s arteritis", "B: Aortic dissection", "C: Classical polyarteritis nodosa", "D: Abdominal aortic aneurysm", "E: Microscopic polyangiitis" ]

A: Takayasu’s arteritis

105

aug-11-2022

An 86-year-old woman presented with 1 day of nausea, vomiting, and right-sided abdominal pain. Computed tomography of the abdomen and pelvis revealed a distended gallbladder with a thickened wall outside the gallbladder fossa. There was also swirling of the cystic artery and duct but no dilatation of the common bile du...

yes

13%

11%

6%

12%

59%

25053

0.043

cb94e603949b810597086131c5bf3981

[ "A: Acalculous cholecystitis", "B: Cholangiocarcinoma", "C: Cholangitis", "D: Ectopic gallbladder", "E: Gallbladder volvulus" ]

E: Gallbladder volvulus

106

aug-12-2010

What is the diagnosis?

no

53%

17%

5%

4%

21%

85343

0.06

56d53fcaab5a5b998914e95001e4f016

[ "A: Bladder diverticula", "B: Orthotopic neobladder", "C: Schistosomiasis", "D: Transitional-cell carcinoma", "E: Vesicolithiasis" ]

A: Bladder diverticula

107

aug-12-2021

A 26-year-old woman with the Peutz–Jeghers syndrome presented to the emergency department with abdominal pain and nonbilious vomiting. A tender mass was palpable in the upper abdomen. What is the most likely diagnosis?

yes

10%

7%

18%

49%

15%

56268

0.066

ff699608f459e8c3183b11a628058713

[ "A: Acute necrotizing pancreatitis", "B: Cholangiocarcinoma", "C: Gastric leiomyosarcoma", "D: Gastrogastric intussusception", "E: Pancreatic adenocarcinoma with gastric invasion" ]

D: Gastrogastric intussusception

108

aug-13-2009

What is the diagnosis?

no

16%

23%

4%

52%

4%

86604

0.062

9b5d272ef327f2f7bc9ad85c9284c1ce

[ "A: Diverticulosis", "B: Familial adenomatous polyposis", "C: Foreign object ingestion", "D: Pneumatosis cystoides coli", "E: Trichinosis" ]

D: Pneumatosis cystoides coli

109

aug-13-2015

What is the most appropriate management of this patient who presents with fatigue and dyspnea?

yes

7%

68%

3%

5%

17%

78075

0.028

8703e1aef650e5accf294c8ada0b8099

[ "A: Prompt coronary revascularization", "B: Pericardiocentesis", "C: Thoracentesis", "D: Diuresis", "E: Pacemaker placement" ]

B: Pericardiocentesis

110

aug-13-2020

A 47-year-old man presented to the emergency department with a 3-day history of a pustular rash on both hands. One week before presentation, he had started treatment with penicillin V potassium for pharyngitis. Physical examination demonstrated a rash as shown, with a similar rash being present on the soles of both of ...

yes

54%

10%

23%

11%

3%

115648

0.057

7dc5e325102b65c0e583a6dd5becf128

[ "A: Poststreptococcal pustulosis", "B: Palmoplantar psoriasis", "C: Jarisch–Herxheimer reaction", "D: Immunoglobulin A pemphigus", "E: Scabies" ]

A: Poststreptococcal pustulosis

111

aug-14-2008

What is the diagnosis?

no

12%

4%

35%

11%

39%

130705

0.121

a96407e82390e736bb25e850525b9115

[ "A: Psoriatic arthropathy", "B: Reflex sympathetic dystrophy", "C: Osteoarthritis", "D: Gout", "E: Rheumatoid arthritis" ]

C: Osteoarthritis

112

aug-14-2014

What is the most likely diagnosis in this asymptomatic 17-year-old male?

yes

49%

2%

12%

18%

19%

87215

0.069

1c1480122eb829b6a8ac247b3c22af62

[ "A: Antrochoanal polyp", "B: Foreign body", "C: Palatine tonsillitis", "D: Pharyngeal lymphoma", "E: Tonsillar abscess" ]

A: Antrochoanal polyp

113

aug-15-2013

What is the diagnosis in this patient who had been bitten by a tsetse fly?

yes

15%

10%

27%

39%

8%

79212

0.097

2bf6a9a082b678d8917424f5a91f784a

[ "A: Chagas' disease", "B: Filariasis", "C: Leishmaniasis", "D: Trypanosomiasis", "E: Tuberculous scrofula" ]

D: Trypanosomiasis

114

aug-15-2019

An 80-year-old man presented to the emergency department with a 2-day history of abdominal pain in the right upper quadrant. On physical examination, he had abdominal tenderness in the right upper quadrant, and Murphy’s sign was positive. The alanine aminotransferase, aspartate aminotransferase, bilirubin, and lipase l...

yes

5%

6%

7%

73%

9%

47154

0.018

cc384f603882a96573f98d06ebb75168

[ "A: Ascending cholangitis", "B: Duodenal diverticulitis", "C: Subhepatic appendicitis", "D: Emphysematous cholecystitis", "E: Hepatic cyst rupture" ]

D: Emphysematous cholecystitis

115

aug-16-2007

This 12-year-old boy presented with abdominal pain. What is the diagnosis?

yes

4%

17%

62%

13%

124142

0.039

8a99963b2293531784da1cf373d4c244

[ "A: Cowden syndrome", "B: Cronkhite-Canada syndrome", "C: Osler-Weber-Rendu syndrome", "D: Peutz-Jeghers syndrome", "E: Von Willebrand syndrome" ]

D: Peutz-Jeghers syndrome

116

aug-16-2012

What is the most likely diagnosis in this 12-year-old boy with recurrent infections?

yes

5%

39%

28%

9%

19%

112501

0.143

b3b725e479a5e7eb0b6b4c6f869c3bb3

[ "A: Brucellosis", "B: Burkitt's lymphoma", "C: Chronic granulomatous disease", "D: Neurofibromatosis", "E: Tuberculous lymphadenitis" ]

C: Chronic granulomatous disease

117

aug-16-2018

A 31-year-old man presented to the emergency department with confusion. He was found to be anemic with a hemoglobin level of 6.7 g per deciliter. Additional laboratory tests revealed an elevated indirect bilirubin level, an elevated lactate dehydrogenase level, and undetectable haptoglobin. A peripheral-blood smear was...

yes

41%

20%

8%

15%

16%

109194

0.089

ec660f5b36e4fc3f5387a613aec9b702

[ "A: Decompensated cirrhosis", "B: Myelodysplastic syndrome", "C: Iron deficiency", "D: End-stage renal disease", "E: Vitamin B12 deficiency" ]

A: Decompensated cirrhosis

118

aug-17-2006

This patient's appearance is a consequence of what surgery?

yes

71%

7%

14%

4%

88090

0.022

be62f14279d6ef427ed4779028379706

[ "A: Gastric bypass", "B: Adrenalectomy", "C: Liposuction", "D: Pancreatectomy", "E: Small bowel transplant" ]

A: Gastric bypass

119

aug-17-2017

A 52-year-old woman with rheumatoid arthritis, treated with sulfasalazine and azathioprine, presented with multiple painful, erythematous plaques on her palms and fingers. What is the diagnosis?

yes

47%

23%

15%

5%

9%

118158

0.073

f2e49b0fd681022d37390979e2391740

[ "A: Sweet’s syndrome", "B: Erythema multiforme", "C: Drug eruption", "D: Secondary syphilis", "E: Granulomatosis with polyangiitis" ]

A: Sweet’s syndrome

120

aug-17-2023

A 30-year-old male with recently diagnosed aplastic anemia presented to the emergency department with a 2-day history of fever, nonpruritic rash, and ankle and knee pain. Ten days prior, he had completed a course of horse anti-thymocyte globulin as a treatment for his aplastic anemia. Laboratory studies were notable fo...

yes

9%

14%

43%

18%

16%

43997

0.082

6bd2eeaf3c004ae351fb3598a4577a98

[ "A: Type I hypersensitivity reaction", "B: Type II hypersensitivity reaction", "C: Type III hypersensitivity reaction", "D: Type IV hypersensitivity reaction", "E: This is not a hypersensitivity reaction" ]

C: Type III hypersensitivity reaction

121

aug-18-2011

Treatment with a medication from which one of the following drug groups has been associated with the problem identified in the abdominal radiograph?

yes

44%

14%

16%

13%

86191

0.079

1f461d73e15b6b870c8bfc0f319aa2ef

[ "A: Alpha-glucosidase inhibitor", "B: Biguanide", "C: Dipeptidyl-peptidase 4 inhibitor", "D: Sulfonylurea", "E: Thiazolidinedione" ]

A: Alpha-glucosidase inhibitor

122

aug-18-2016

A 79-year-old woman presented with a 1-year history of gradual neurological decline involving confusion, memory loss, and imbalance. What is the most likely diagnosis?

yes

18%

16%

45%

6%

15%

111331

0.077

e2a364b316e7ee683519a267ffa3b62e

[ "A: Colloid cyst", "B: Glioblastoma multiforme", "C: Thrombosed intracranial aneurysm", "D: Choroid plexus metastases", "E: Intraventricular meningioma" ]

C: Thrombosed intracranial aneurysm

123

aug-18-2022

A 13-year-old girl presented with new onset blurry vision in the left eye associated with painful eye movements. Three weeks earlier, weakness and paresthesias had developed in her left leg that spontaneously resolved. When a light was swung from the normal right eye (Panel A) to the affected left eye, the left pupil d...

yes

14%

11%

13%

59%

3%

31571

0.044

78e732c52f86e8d4bb4be3a2e671b358

[ "A: Acute disseminated encephalomyelitis", "B: Leber hereditary optic neuropathy", "C: Mononeuritis multiplex", "D: Multiple sclerosis", "E: Retinal detachment" ]

D: Multiple sclerosis

124

aug-19-2010

This man presented 1 day after being treated with penicillin for a toothache. What is the diagnosis?

yes

8%

14%

42%

19%

17%

104185

0.085

d7aa3f432c0d9057978ee305b4f257d3

[ "A: Acute parotitis", "B: Angioneurotic edema", "C: Ludwig's angina", "D: Penicillin allergy", "E: Peritonsillar abscess" ]

C: Ludwig's angina

125

aug-19-2021

A 30-year-old man presented with a rash on his face, hands, and feet. He had a history of HIV with a CD4+ T-cell count of 374 per cubic millimeter. Physical examination showed circinate lesions on the palms, soles, and face and patchy alopecia. What is the likely diagnosis?

yes

18%

19%

34%

15%

125951

0.11

0cfb7a6dc652e12e0faf2a9c120dbe64

[ "A: Disseminated granuloma annulare", "B: Erythema annulare centrifugum", "C: Syphilis", "D: Tinea corporis", "E: Tuberculoid leprosy" ]

C: Syphilis

126

aug-20-2009

What is the diagnosis?

no

33%

6%

30%

16%

14%

104216

0.13

9e3277a4666a36b356d6d84343b54c85

[ "A: Cytomegalovirus retinitis", "B: Glaucoma", "C: Malignant hypertension", "D: Panretinal photocoagulation", "E: Retinal vein thrombosis" ]

C: Malignant hypertension

127

aug-20-2015

What is the most appropriate treatment for a child with recurrent hematuria and the following finding?

yes

7%

21%

63%

4%

74460

0.038

15148292c003031ad0df15a94aaa2354

[ "A: Fluconazole", "B: Metronidazole", "C: Praziquantel", "D: Steroids", "E: Azathioprine" ]

C: Praziquantel

128

aug-20-2020

A 30-year-old pregnant woman at 34 weeks of gestation presented to the emergency department with a 5-day history of an itchy rash that began on her abdomen and then spread to her thorax and extremities. Physician examination revealed papules on her abdomen and bullous blisters on her arm. What is the diagnosis?

yes

9%

45%

5%

10%

30%

75517

0.083

056363d846fbf8e0896d55e075fd0f10

[ "A: Dermatitis herpetiformis", "B: Pemphigoid gestationis", "C: Bullous pemphigoid", "D: Erythema multiforme", "E: Pruritic urticarial papules and plaques of pregnancy (PUPPP)" ]

B: Pemphigoid gestationis

129

aug-21-2008

What is the diagnosis?

no

38%

4%

6%

10%

42%

119313

0.099

3d7c388ebdd6c5efda68be5bac79bf8f

[ "A: Basal-cell carcinoma", "B: Granuloma fissuratum", "C: Melanoma", "D: Seborrheic keratosis", "E: Squamous-cell carcinoma" ]

E: Squamous-cell carcinoma

130

aug-21-2014

What is the diagnosis?

no

3%

16%

8%

6%

67%

84026

0.029

1b861f3275da7bae56ede0afda823d19

[ "A: Diaphragmatic hernia", "B: Gastric bezoar", "C: Inferior mesenteric artery thrombosis", "D: Pancreatic phlegmon", "E: Small-bowel volvulus" ]

E: Small-bowel volvulus

131

aug-22-2013

What is the cause of this rash that developed in a patient after cesarean section in association with fever and hypotension?

yes

5%

4%

24%

23%

44%

81139

0.086

a6ff00fb6a30a938074de3c7ad647942

[ "A: Kawasaki disease", "B: Pseudoporphyria", "C: Scalded skin syndrome", "D: Toxic epidermal necrolysis", "E: Toxic shock syndrome" ]

E: Toxic shock syndrome

132

aug-22-2019

A fully immunized 48-year-old man presented to an urgent care clinic with a 3-day history of odynophagia, fever, and progressive dyspnea. Physical examination demonstrated stridor and use of accessory muscles for respiration. A lateral radiograph of the neck was performed. What is the most likely diagnosis?

yes

12%

52%

9%

14%

84119

0.057

b530f2ee499b4916249a9dc3e19fdbc3

[ "A: Inhaled foreign body", "B: La Delfa malformation", "C: Epiglottitis", "D: Relapsing polychondritis", "E: Tracheal perforation" ]

C: Epiglottitis

133

aug-23-2007

Which one of the following is the most likely diagnosis?

no

18%

22%

7%

44%

9%

135514

0.081

38845ba0f402cc0418470529c81037f4

[ "A: Chronic renal failure", "B: Iron deficiency", "C: Graves' disease", "D: Chemotherapy treatment", "E: Psoriasis" ]

D: Chemotherapy treatment

134

aug-23-2012

This finding was recognized after cardiopulmonary resuscitation. What is the diagnosis?

yes

73%

4%

7%

12%

4%

81608

0.019

ee5d37763c74a6f0e38e60251d8cc326

[ "A: Air embolism", "B: Central pontine myelinolysis", "C: Intraventricular hemorrhage", "D: Middle cerebral artery dissection", "E: Skull fracture" ]

A: Air embolism

135

aug-23-2018

A4-year-old boy was brought by his father to the ophthalmology clinic with a 1-year history of enlarging white deposits in both eyes and decreasing night vision. On examination, the conjunctivae of both the right eye and the left eye appeared dry and wrinkled, with foamy, cream-colored deposits near the outer corners. ...

yes

10%

18%

52%

15%

5%

102326

0.06

fbac0c5f5163fe6cab9e9dcb162d6f48

[ "A: Sjögren's syndrome", "B: Pyridoxine deficiency", "C: Vitamin A deficiency", "D: Loiasis", "E: Type 1 diabetes" ]

C: Vitamin A deficiency

136

aug-24-2006

This lesion developed after the patient consumed raw meat from a sick goat. What is the most likely diagnosis?

yes

24%

39%

9%

13%

15%

91826

0.095

8c99cdfe80ca493355447b08e372a35f

[ "A: Brucellosis", "B: Anthrax", "C: Herpes simplex", "D: Orf", "E: Pasteurella multocida" ]

B: Anthrax

137

aug-24-2017

A 43-year-old woman had an 8-month history of non-productive cough, unresponsive to antibiotic treatment. Physical exam showed bilateral wheezing, and pulmonary function tests showed obstructive disease, unresponsive to bronchodilators. Bronchoscopy revealed the following. What is the most likely diagnosis?

yes

30%

6%

12%

3%

48%

94789

0.076

b328422dd0b517a7ea9e38f542daef41

[ "A: Bronchial polyposis", "B: Bronchial tuberculosis", "C: Pulmonary sarcoidosis", "D: Tracheal inhalation injury", "E: Eosinophilic bronchitis" ]

E: Eosinophilic bronchitis

138

aug-24-2023

A 73-year-old woman presented with a 2-day history of left flank pain. Findings from a physical examination were normal. Laboratory testing was notable for a platelet count of 652,000 per cubic millimeter (reference range, 150,000 to 400,000) with an otherwise normal complete blood count. No previous platelet count was...

yes

11%

12%

11%

59%

8%

19582

0.043

d5e26dec105cfbdfe0262247a9dd9fdd

[ "A: BCR-ABL1", "B: CTLA4", "C: FLT3", "D: JAK2", "E: MYC" ]

D: JAK2

139

aug-25-2011

What is the diagnosis?

no

6%

22%

14%

47%

10%

98776

0.072

aa562d4bcfa366405246cd97f4ed21bc

[ "A: Bullous pemphigoid", "B: Hypoparathyroidism", "C: Osteosarcoma", "D: Scleroderma", "E: Wilson's disease" ]

D: Scleroderma

140

aug-25-2016

A 42-year-old man with diabetes presented with a history of urinary incontinence and severe dysuria over several days. What diagnosis does his computed tomographic (CT) scan suggest?

yes

3%

12%

2%

63%

20%

70074

0.039

f798784cf0f08665195c6bd3124a9e33

[ "A: Benign prostatic hypertrophy", "B: Bladder perforation", "C: Urethritis", "D: Emphysematous prostatitis", "E: Colovesical fistula" ]

D: Emphysematous prostatitis

141

aug-25-2022

A 32-year-old man presented with a 6-week history of tingling in his arms and legs and a 2-week history of inability to walk. A positive Romberg test, sensory ataxia, impaired proprioception and vibratory sensation, and preserved nociception were noted. Magnetic resonance imaging of the whole spine showed hyperintensit...

yes

19%

35%

16%

14%

16%

48197

0.106

dce8f92ff3772c7353482f31256c4ce4

[ "A: Copper", "B: Nitrous oxide", "C: Organophosphates", "D: Tetrodotoxin (pufferfish poisoning)", "E: Thallium" ]

B: Nitrous oxide

142

aug-26-2010

What is the diagnosis?

no

6%

27%

20%

38%

9%

79773

0.102

43919b7d0566691a3a7291fbc3f89099

[ "A: Closed-angle glaucoma", "B: Cholesterol embolism", "C: Diabetes mellitus", "D: Malignant hypertension", "E: Syphilis" ]

D: Malignant hypertension

143

aug-26-2021

A 54-year-old woman presented with abdominal pain and difficulty walking. Abdominal imaging showed multiple abscesses surrounding an intrauterine device (IUD). Aspiration with gram stain identified branching, filamentous, gram-positive rods. What is the most likely diagnosis?

yes

52%

12%

5%

14%

17%

43221

0.059

ecc3dc350033786378eb9271db05ea49

[ "A: Actinomycosis", "B: Aspergillosis", "C: Crohn’s disease", "D: Listeriosis", "E: Nocardiosis" ]

A: Actinomycosis

144

aug-27-2009

What is the diagnosis?

no

7%

18%

40%

10%

25%

100140

0.094

d5a07a8e51806e82345831bdf3557b9d

[ "A: Diverticular abscess", "B: Hirschsprung's disease", "C: Sigmoid volvulus", "D: Small-bowel obstruction", "E: Trichobezoar" ]

C: Sigmoid volvulus

145

aug-27-2015

What is the most likely diagnosis in an infant with poor feeding and vomiting?

yes

20%

4%

5%

56%

15%

88708

0.052

23280f35409a276f27ebdab9c925e2d7

[ "A: Hirschsprung's disease", "B: Incarcerated inguinal hernia", "C: Meckel's diverticulum", "D: Gastric pneumatosis", "E: Intussusception" ]

D: Gastric pneumatosis

146

aug-27-2020

An 89-year-old woman presented to the ophthalmology clinic with a 4-month history of redness and a sensation of a foreign body in her right eye. Slit-lamp examination revealed a red, raised lesion on the conjunctiva that extended onto the cornea with accompanying prominent blood vessels. What is the diagnosis?

yes

45%

14%

16%

10%

15%

71088

0.076

a6cef569909a17226d48accf9fd4fe43

[ "A: Conjunctival squamous-cell carcinoma", "B: Pinguecula", "C: Pterygium", "D: Episcleritis", "E: Pyogenic granuloma" ]

A: Conjunctival squamous-cell carcinoma

147

aug-28-2008

This 6-day-old infant's mother had developed intensely pruritic lesions at 33 weeks of gestation. What is the diagnosis?

yes

20%

14%

8%

39%

19%

142237

0.095

12afc26bcd424e9712a0f09702b87004

[ "A: Congenital syphilis", "B: Epidermolysis bullosa acquisita", "C: Neonatal gonorrhea", "D: Herpes gestationis", "E: Pruritic plaques of pregnancy" ]

D: Herpes gestationis

148

aug-28-2014

What is the diagnosis in this patient who developed burning pain, pruritus, and edema of the hands upon their exposure to water and who had this image taken under a Wood's lamp?

yes

25%

46%

15%

6%

9%

73987

0.078

a440f770f4b07e6b7f043be42e53bb9c

[ "A: Acquired acral mycosis", "B: Aquagenic keratoderma", "C: Dyshidrotic eczema", "D: Leprosy", "E: Ochronosis" ]

B: Aquagenic keratoderma

149

aug-29-2013

What is the diagnosis?

no

16%

11%

7%

9%

57%

80507

0.047

f243b7d5025f9d3895035af666b85591

[ "A: Bowenoid papulosis", "B: Fibrous pseudotumor", "C: Keloid", "D: Onchocerciasis", "E: Scrotal calcinosis" ]

E: Scrotal calcinosis

150

aug-29-2019

A 49-year-old man with a 3-month history of progressive voice changes and pain with swallowing presents to the otorhinolaryngology clinic. He has a history of hypertension and type 2 diabetes mellitus and is a smoker. He denies any recent weight loss or other systemic symptoms. Fiberoptic laryngoscopy was performed and...

yes

16%

39%

16%

12%

18%

105891

0.094

2ba8c628527ca177490821752026c036

[ "A: Vocal-cord granuloma", "B: Carcinoma", "C: Pachydermia larynges", "D: Reinke’s edema", "E: Subglottic stenosis in granulomatosis with polyangiitis" ]

B: Carcinoma

151

aug-30-2007

What is the diagnosis?

no

10%

28%

15%

12%

35%

116897

0.138

b19d21d9dbeb06731a3223786c663f7c

[ "A: Cytomegalovirus retinitis", "B: Lipemia retinalis", "C: Central retinal vein occlusion", "D: Diabetic retinopathy", "E: Retinitis pigmentosa" ]

B: Lipemia retinalis

152

aug-30-2012

What is the diagnosis in this patient with abdominal pain?

yes

9%

6%

49%

10%

27%

86913

0.071

3a6d9d844e56166346bf270b1d1a295d

[ "A: Amyloidosis", "B: Familial Mediterranean fever", "C: Lead poisoning", "D: Leukemia", "E: Scurvy" ]

C: Lead poisoning

153

aug-30-2018

A 55-year-old woman was admitted to hospital after sustaining a severe crush injury to both legs in a motor vehicle accident. A polymicrobial wound infection developed and she received antibiotic treatment. Black discoloration of her tongue was observed within 1 week of starting treatment, and the patient reported naus...

yes

49%

7%

12%

16%

132736

0.066

247b11675bd9fa810011e76ff8a782d0

[ "A: Tetracyclines", "B: Penicillins", "C: Macrolides", "D: Fluoroquinolones", "E: Sulfonamides" ]

A: Tetracyclines

154

aug-31-2006

This 38-year-old woman developed recurrent right-sided chest pain synchronously with her menses. What is the most likely diagnosis?

yes

5%

7%

12%

70%

6%

74267

0.023

0937b4171b27705c8a99f8c91de9fa6c

[ "A: Recurrent pulmonary emboli", "B: Alpha-1 antitrypsin deficiency", "C: Meig's syndrome", "D: Thoracic endometriosis", "E: Lymphangioleiomyomatosis" ]

D: Thoracic endometriosis

155

aug-31-2017

A 64-year-old man with a history of bladder cancer treated with radical cystectomy and orthotopic neobladder construction with intestinal segments presented to the emergency department with left flank pain and urinary retention. CT of the abdomen and pelvis showed a very large stone in the neobladder. What is the predo...

yes

11%

7%

27%

48%

7%

79431

0.073

7c1ae90c762688326e175e4aca646ec0

[ "A: Struvite", "B: Uric acid", "C: Calcium oxalate", "D: Calcium phosphate", "E: Cystine" ]

D: Calcium phosphate

156

aug-31-2023

A 53-year-old man who had been admitted to the hospital after a fall was noted to have an abnormal indentation of the lower eyelids. He had a history of corneal transplantation in both eyes. He had recently experienced progressive visual impairment, which had led to his fall. Ophthalmologic examination was notable for ...

yes

3%

5%

60%

20%

12%

28870

0.044

03b951452803a3cf89b0e633adb656aa

[ "A: Astigmatism", "B: Corneal ulcer", "C: Keratoconus", "D: Keratoglobus", "E: Pellucid marginal degeneration" ]

C: Keratoconus

157

dec-01-2005

What is the diagnosis?

no

55%

13%

10%

18%

3%

90257

0.053

19ea40f5a02cb3f0403351f0cae2ce2d

[ "A: Gout", "B: Rheumatoid arthritis", "C: Gonococcal arthritis", "D: Leprosy", "E: Psoriasis" ]

A: Gout

158

dec-01-2011

What cranial nerve palsy is most clearly illustrated in this image?

yes

4%

18%

49%

13%

16%

91735

0.067

3462113104b588ef471b90b96f89b679

[ "A: Left facial nerve", "B: Left glossopharyngeal nerve", "C: Left hypoglossal nerve", "D: Right glossopharyngeal nerve", "E: Right hypoglossal nerve" ]

C: Left hypoglossal nerve

159

dec-01-2016

An 18-year-old Fijian woman presented with a 3-year history of a concentric scaly rash on her trunk and upper and lower limbs. Her brother had similar skin findings. What is the diagnosis?

yes

22%

7%

15%

50%

6%

107203

0.066

79052dfd5083d9893043e1ee0dad5d1b

[ "A: Erythema gyratum repens", "B: Tinea corporis", "C: Discoid eczema", "D: Tinea imbricata", "E: Erythrasma" ]

D: Tinea imbricata

160

dec-01-2022

A 26-year-old man presented to the outpatient clinic with a 1-month history of pain and swelling in the scrotum and low-grade fevers. On examination, there was swelling and tenderness of the right side of the scrotum. Laboratory studies showed peripheral eosinophilia. An ultrasound of the scrotum showed echogenic, line...

yes

19%

17%

31%

18%

15%

47633

0.119

ccfd645f3d2e8cc4e49fdfd42d8ab563

[ "A: Aquatic snail", "B: Blackfly", "C: Mosquito", "D: Sandfly", "E: Tsetse fly" ]

C: Mosquito

161

dec-02-2010

What is the diagnosis?

no

13%

8%

10%

35%

34%

121633

0.118

cc5cc8d8863410efa97986a56fa6f08a

[ "A: Arsenic poisoning", "B: Cushing's syndrome", "C: Pellagra", "D: Self-flagellation", "E: Treatment with bleomycin" ]

E: Treatment with bleomycin

162

dec-02-2021

A female infant delivered at term had a “blueberry muffin” rash at birth. Laboratory tests and imaging studies were normal. Skin biopsy showed a dense infiltrate of cells with kidney-shaped nuclei and positive S100+ and CD1a+ on immunohistochemistry. What is the most likely diagnosis?

yes

19%

41%

11%

9%

105113

0.088

9d66f0c092bd77b19234d8a59d090c6f

[ "A: Congenital cytomegalovirus infection", "B: Congenital rubella syndrome", "C: Langerhans-cell histiocytosis", "D: Leukemia cutis", "E: Transient myeloproliferative disorder of Down syndrome" ]

C: Langerhans-cell histiocytosis

163

dec-03-2009

What is the diagnosis?

no

18%

54%

11%

6%

11%

93698

0.054

528caf7d114bd9380fdc0c94366950d1

[ "A: Central retinal vein occlusion", "B: Cholesterol embolism", "C: Retinoschisis", "D: Temporal arteritis", "E: Toxoplasmosis" ]

B: Cholesterol embolism

164

dec-03-2015

What is the most likely diagnosis associated with this finding?

no

49%

10%

5%

26%

10%

85147

0.07

91968ee9fce22422f9fd2ebdd0297633

[ "A: Squamous-cell carcinoma", "B: Paronychia", "C: Verruca vulgaris", "D: Onychomycosis", "E: Pyogenic granuloma" ]

A: Squamous-cell carcinoma

165

dec-03-2020

A 46-year-old man presented to the emergency department with a 2-week history of diarrhea, nausea, abdominal pain, and weakness along with a weight loss of 8 kg in the preceding 2 months. An enzyme-linked immunosorbent assay for the human immunodeficiency virus was positive. Laboratory studies revealed a serum creatini...

yes

23%

54%

4%

8%

12%

37904

0.057

f7f6ed3f66032827eb0eea10b04622bf

[ "A: Focal segmental glomerulosclerosis", "B: Renal cryptococcosis", "C: Diabetic nephropathy", "D: Tubulocystic renal-cell carcinoma", "E: IgA Nephropathy" ]

B: Renal cryptococcosis

166

dec-04-2008

This patient recently returned from Brazil. What is the diagnosis?

yes

23%

6%

13%

14%

44%

132406

0.081

a400905c8cb5652cbba99748a3999468

[ "A: Dracunculiasis", "B: Ingrown toenail", "C: Leptospirosis", "D: Scabies", "E: Tungiasis" ]

E: Tungiasis

167

dec-04-2014

This patient would be predicted to have a higher-than-average risk for which one of the following diseases?

yes

11%

58%

14%

6%

11%

95923

0.045

768cf19f7e8258ff7c8ada1a6bb2e00c

[ "A: Cirrhosis", "B: Coronary artery disease", "C: Gout", "D: Hemorrhagic stroke", "E: Hypothyroidism" ]

B: Coronary artery disease

168

dec-05-2013

What is the diagnosis in this patient who presented with high fever?

yes

9%

17%

5%

40%

29%

77737

0.097

29fda6a662e0e8e3a96d5120e1b1c2bb

[ "A: Bowel infarction", "B: Caval thrombophlebitis", "C: Hepatoma", "D: Liver abscess", "E: Perforated gastric ulcer" ]

D: Liver abscess

169

dec-05-2019

Physical examination of a 1-day-old girl born at 36 weeks of gestation revealed a soft mass protruding from the external genitalia. The mass was noted to increase in size when the infant cried. The physical examination was otherwise normal. What is the diagnosis?

yes

45%

19%

17%

11%

8%

121132

0.077

a94a540e7c8f50d6930fedd5461ac195

[ "A: Hydrocolpos", "B: Prolapsed uterus", "C: Interlabial cyst", "D: McKusick-Kaufman syndrome", "E: Rhabdomyosarcoma" ]

A: Hydrocolpos

170

dec-06-2007

This patient is most likely to have presented with which one of the following findings?

no

11%

12%

5%

12%

60%

118703

0.041

7a8871070f5d6a5283428a7fdc90dde6

[ "A: Amnesia", "B: Ataxia", "C: Dysphagia", "D: Hemianopia", "E: Hemiparesis" ]

E: Hemiparesis

171

dec-06-2012

What is the diagnosis?

no

11%

63%

10%

14%

3%

76178

0.036

85d3893a6f732bdd29cd4d20f6eb2f8f

[ "A: Nephrogenic systemic sclerosis", "B: Keratoderma", "C: Poikiloderma", "D: Punctate psoriasis", "E: Verrucae" ]

B: Keratoderma

172

dec-06-2018

A 67-year-old woman presented to the emergency department with a 6-week history of progressive exertional dyspnea. Her medical history was notable for lung transplantation that had been performed 8 years earlier. Laboratory studies showed normocytic anemia, with a hemoglobin level of 6.9 g per deciliter (reference rang...

yes

13%

19%

15%

50%

3%

69778

0.065

938c98c873ad940865156d9c3bcd4b70

[ "A: Chronic lung allograft dysfunction", "B: Acute promyelocytic leukemia", "C: Adverse reaction to an immunosuppressant", "D: Parvovirus B19 infection", "E: Acute hepatitis B infection" ]

D: Parvovirus B19 infection

173

dec-07-2006

This 19-year-old man presented with a 10-month history of Raynaud's phenomenon, fever, abdominal pain, and hypertension. What diagnosis is suggested by the findings on his angiogram?

yes

19%

13%

5%

9%

54%

75310

0.055

12c1b52fd58a587cd372400f4cff78d9

[ "A: Takayasu's arteritis", "B: Wegener's granulomatosis", "C: Paraganglioma", "D: Systemic lupus erythematosus", "E: Polyarteritis nodosa" ]

E: Polyarteritis nodosa

174

dec-07-2017

A 23-day-old male infant was brought to the emergency department after 5 days of increasing vomiting. Physical exam revealed mild dehydration and an olive-sized abdominal mass. Upper gastrointestinal radiography showed a distended, air-filled stomach. What is the likely diagnosis?

yes

5%

63%

13%

8%

11%

68967

0.035

9337c0915b7d134aa934925ad737beb5

[ "A: Gastric duplication", "B: Pyloric stenosis", "C: Duodenal atresia", "D: Intestinal malrotation", "E: Mid-gut volvulus" ]

B: Pyloric stenosis

175

dec-07-2023

A previously healthy 26-year-old man presented to the emergency department with a 5-day history of an asymptomatic rash, sore throat, fevers, chills, and malaise. On physical examination, scattered, erythematous papules and macules could be seen across the upper chest and anterior neck (left). In the mouth, palatal pet...

yes

6%

15%

46%

21%

12%

28509

0.075

f4b4a38a1543c6ec0daf95feba582e91

[ "A: HIV IgG antibody", "B: HIV IgM antibody", "C: HIV nucleic acid test", "D: p24 antigen", "E: Western Blot" ]

C: HIV nucleic acid test

176

dec-08-2005

This urine sample was photographed under light microscopy. What type of crystal is illustrated?

yes

24%

41%

13%

8%

71344

0.089

5d102db1390e782dbd736d24d58382a6

[ "A: Urate", "B: Oxalate", "C: Cysteine", "D: Ethylene glycol", "E: Triphosphate" ]

B: Oxalate

177

dec-08-2011

What is the diagnosis?

no

16%

11%

18%

44%

11%

98917

0.079

9f41e326e8ec140dafc69954f102d8a5

[ "A: Dermatitis herpetiformis", "B: Erythema multiforme", "C: Guttate psoriasis", "D: Pemphigus vulgaris", "E: Varicella-zoster infection" ]

D: Pemphigus vulgaris

178

dec-08-2016

A 60-year-old woman presented with fevers, chills, myalgias, headache, and two pruritic areas on her back after returning from Botswana and Zimbabwe. She was found to have thrombocytopenia, and this finding on her blood smear. What organism is responsible for her presentation?

yes

7%

6%

23%

51%

13%

97991

0.064

9216195656fad4fe67de9307be9aef14

[ "A: Wuchereria bancrofti", "B: Toxoplasma gondii", "C: Plasmodium falciparum", "D: Trypanosoma brucei", "E: Leishmania donovani" ]

D: Trypanosoma brucei

179

dec-08-2022

An 81-year-old woman with a history of hepatitis C virus-related cirrhosis and hepatocellular carcinoma, who was treated 9 days earlier with transarterial chemoembolization with the use of doxorubicin-eluting beads, presented with painful, progressively worsening skin lesions over the abdomen. A skin biopsy revealed ep...

yes

5%

6%

66%

10%

13%

27480

0.03

399be4a4e0d39491636fee3fdf9a2176

[ "A: Air Embolism", "B: Bacterial Embolism", "C: Drug-Eluting Bead Embolism", "D: Cholesterol Embolism", "E: Tumor Embolism" ]

C: Drug-Eluting Bead Embolism

180

dec-09-2010

What is the diagnosis?

no

22%

30%

9%

19%

20%

103140

0.125

52aa7efca98239ce3feb1083b4a2d671

[ "A: Ascaris lumbricoides", "B: Dirofilaria repens", "C: Paragonimus westermani", "D: Toxocara canis", "E: Wuchereria bancrofti" ]

B: Dirofilaria repens

181

dec-09-2021

A 74-year-old woman presented with a 3-day history of headaches and tongue swelling and several hours of blindness in the right eye. On examination, the tongue was discolored and ulcerated. What is the diagnosis?

yes

14%

13%

47%

8%

18%

70643

0.071

5f66ae7118a6bdadc87edb8c3deca59a

[ "A: Carcinoma of the tongue", "B: Carotid artery stenosis", "C: Giant-cell arteritis", "D: Oral lichen planus", "E: Thromboembolic disease" ]

C: Giant-cell arteritis

182

dec-10-2009

What is the diagnosis?

no

59%

20%

5%

9%

7%

96131

0.045

8e03f38d0e2ce48f168de1e9246ec1de

[ "A: Atlanto-occipital dislocation", "B: Atlanto-axial subluxation", "C: Pillar fracture", "D: Spinous process avulsion", "E: Wedge fracture" ]

A: Atlanto-occipital dislocation

183

dec-10-2015

Which of the following is the least likely cause of eschars as seen here?

yes

10%

16%

12%

49%

13%

84442

0.065

c31d2e0ac2272907098bf7bf1ecad085

[ "A: Scrub typhus", "B: Cutaneous anthrax", "C: Rickettsia akari", "D: Chickenpox", "E: Brown recluse spider bite" ]

D: Chickenpox

184

dec-10-2020

A 50-year-old man with a history of large-cell neuroendocrine carcinoma of the lung presented with a 5-day history of shortness of breath, chest pain, and a cough. Physical examination noted diminished breath sounds in the right lower lobe and cough after fluid intake. What is the diagnosis?

yes

79%

6%

7%

2%

31194

0.011

5182b543d7eae201da48e79dadbb3bbb

[ "A: Bronchoesophageal fistula", "B: Aspiration pneumonia", "C: Pharyngeal pseudodiverticulum", "D: Zenker’s diverticulum", "E: Gastroesophageal reflux disease" ]

A: Bronchoesophageal fistula

185

dec-11-2008

What is the most likely diagnosis?

no

9%

11%

9%

63%

9%

125016

0.035

32d8f3387cc477f0dcf3823ca0c93b50

[ "A: Alport syndrome", "B: Angelman syndrome", "C: Fragile X syndrome", "D: Turner syndrome", "E: Williams syndrome" ]

D: Turner syndrome

186

dec-11-2014

What is the most likely diagnosis?

no

9%

16%

49%

19%

6%

92174

0.067

abb8d7fcaf43c8a40588266636cd02ad

[ "A: Hypophosphatasia", "B: Osteosarcoma", "C: Paget's disease", "D: Rickets", "E: Tuberculosis" ]

C: Paget's disease

187

dec-12-2013

What is the diagnosis?

no

11%

8%

61%

15%

5%

77381

0.039

8e893dfc22f9934f663d33f100478640

[ "A: Aphthous stomatitis", "B: Pyogenic granuloma", "C: Squamous-cell carcinoma", "D: Syphilis", "E: Traumatic fibroma" ]

C: Squamous-cell carcinoma

188

dec-12-2019

A 51-year-old man with history of type 2 diabetes and human immunodeficiency virus infection presented with a 3-year history of worsening swelling of the left wrist associated with pain and numbness in the fingers. Physical examination was notable for an extension deficit in the proximal interphalangeal joint of all fo...

yes

13%

11%

8%

24%

43%

74413

0.084

f52d9aa34f63cf242839a6364d7671b1

[ "A: Pigmented villonodular synovitis (PVNS)", "B: Reichel syndrome", "C: Calcium hydroxyapatite deposition disease", "D: Fibrolipomatous hamartoma of ulnar nerve", "E: Mycobacterial tenosynovitis due to Mycobacterium avium complex" ]

E: Mycobacterial tenosynovitis due to Mycobacterium avium complex

189

dec-13-2007

What is the most likely diagnosis in this 36-year-old woman with chronic renal failure?

yes

4%

16%

7%

33%

40%

138043

0.1

a8bfff9a5722d62e75b42d7f84218bc5

[ "A: Lipoma", "B: Osteitis fibrosa", "C: Osteosarcoma", "D: Fistula", "E: Calcinos" ]

E: Calcinos

190

dec-13-2012

What is the most likely diagnosis?

no

10%

16%

29%

32%

12%

105178

0.131

bd578d3ec7a7eab3d198ecbda9e38b0a

[ "A: Abscess", "B: Cavernous hemangioma", "C: Lipoma", "D: Mucocele", "E: Sialolith" ]

C: Lipoma

191

dec-13-2018

An 18-year-old man presented to the emergency department with chest pain. What is the most likely childhood diagnosis associated with the findings of this coronary angiogram?

yes

67%

7%

18%

5%

3%

68739

0.03

14ef8b9f9c59ebab1c27319131a7edf9

[ "A: Kawasaki's disease", "B: Rheumatic heart disease", "C: Marfan's syndrome", "D: Familial hypercholesterolemia", "E: Hodgkin's lymphoma" ]

A: Kawasaki's disease

192

dec-14-2006

What is the diagnosis?

no

22%

13%

6%

44%

15%

93835

0.081

683367bc6c213f1dda84d3af820e81f4

[ "A: Pulmonary hydatid disease", "B: Bullous emphysema", "C: Pulmonary silicosis", "D: Multiple bacterial abscesses", "E: Aspergillosis" ]

D: Multiple bacterial abscesses

193

dec-14-2017

A 27-year-old man presented with a 2-year history of acne and the recurrence of multiple painful lesions in the genital and perineal areas. Examination revealed inflamed and noninflamed nodules and scar tissue in the genitofemoral area, axilla, intergluteal area, and behind the ears. What is the diagnosis?

yes

10%

6%

53%

24%

7%

103597

0.059

7507647c7993364c438140f2b48d81db

[ "A: Blastomycosis", "B: Cat scratch disease", "C: Hidradenitis suppurativa", "D: Lymphogranuloma venereum", "E: Epidermal inclusion cyst" ]

C: Hidradenitis suppurativa

194

dec-14-2023

A 49-year-old woman with a history of Graves' disease presented to the endocrinology clinic with a 3-year history of skin changes on her arms and legs and a 1-year history of thyrotoxicosis symptoms. She had intermittently adhered to carbimazole therapy since her diagnosis 10 years earlier. On physical examination, vio...

yes

6%

8%

18%

50%

21875

0.065

aa950e5771672f62c509523b52113f37

[ "A: C-peptide", "B: Glutamic acid decarboxylase antibodies", "C: Thyroglobulin antibodies", "D: Thyroid peroxidase antibodies", "E: Thyrotropin receptor antibodies" ]

E: Thyrotropin receptor antibodies

195

dec-15-2005

What is the diagnosis?

no

6%

15%

21%

46%

13%

70458

0.076

08e1b4933be5a74361446b7f171bc447

[ "A: Pterygium", "B: Retroorbital hematoma", "C: Retained suture", "D: Loa loa", "E: Toxocariasis" ]

D: Loa loa

196

dec-15-2011

What is the diagnosis?

no

9%

6%

19%

63%

4%

87027

0.037

392adb1cbe38f0967bf2b61aca122367

[ "A: Achalasia", "B: Aortic dissection", "C: Esophageal perforation", "D: Pneumopericardium", "E: Ventricular rupture" ]

D: Pneumopericardium

197

dec-15-2016

A 36-year-old man presented with 1 month of fever and pain in his shoulders and knees after having a sore throat. He subsequently developed this evanescent nonpruritic macular rash (marked with a skin marking pen). What is the diagnosis?

yes

9%

21%

11%

6%

52%

114942

0.06

2d559cfa6b576d056764316bde784229

[ "A: Erythema infectiosum", "B: Erythema multiforme", "C: Erythema migrans", "D: Erythema nodosum", "E: Erythema marginatum" ]

E: Erythema marginatum

198

dec-15-2022

A 58-year-old woman with a history of metastatic uterine leiomyosarcoma presented with a 1-month history of a nonpruritic rash on her arms. On examination, hyperpigmented plaques were observed on the dorsa of both hands at the sites of previous intravenous access. The darkened skin extended up the arms in a linear patt...

yes

25%

8%

10%

44%

13%

45173

0.082

754b9f51279c5916e2336ca38c6ca294

[ "A: Bleomycin-induced flagellate erythema", "B: Erythema ab igne", "C: Phlegmasia cerulea dolens", "D: Serpentine supravenous hyperpigmentation", "E: Superficial thrombophlebitis" ]

D: Serpentine supravenous hyperpigmentation

199

dec-16-2010

What is the diagnosis?

no

12%

3%

20%

45%

102139

0.08

bb8fab14b6952f81bf5650749731de55

[ "A: Anthrax", "B: Cellulitis", "C: Lichen planus", "D: Psoriasis", "E: Tinea" ]

E: Tinea

200

dec-16-2021

A 37-year-old man presented to the neurosurgery clinic with blurry vision, headache, and difficulty looking upward. On exam, he had diplopia, upward gaze palsy, and vertical misalignment of the eyes. His pupils only minimally constricted to light but constricted to near objects. What is the name of this pupillary exam ...

yes

17%

7%

23%

33%

19%

63916

0.114

53d9d28dd5c67cbaf667d795b105d44a

[ "A: Adie’s pupil", "B: Anisocoria", "C: Argyll Robertson pupil", "D: Light-near dissociation", "E: Relative afferent pupillary defect (e.g., Marcus Gunn pupil)" ]

D: Light-near dissociation