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 | AnaplasticLargeCellLymphoma | Primary effusion lymphoma (PEL) | [
"Consideration of common causes of small-bowel obstruction — “Differential diagnoses include small bowel adenocarcinoma, cecal tumors, infectious or inflammatory bowel wall thickening, carcinoid syndrome, or gastrointestinal stromal tumor.”",
"Inclusion of primary omental tumors in the differential — “Primary ome... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-2",
"R-3",
"R-7"
] | I kept steps 1–3 aligned with the original differential framing. I merged all three variants’ alterations into a single composite step 4, because each error targets the same decision point (Hodgkin exclusion/when-to-subtype): (1) E-1 is preserved by not performing the original, evidence-based Hodgkin exclusion step (ab... | [
{
"error_description": "",
"error_step_indices": [
4
],
"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... | [
4,
5
] | medprmbench_00201 | [
4,
5
] | [] | [
"Consideration of common causes of small-bowel obstruction — “Differential diagnoses include small bowel adenocarcinoma, cecal tumors, infectious or inflammatory bowel wall thickening, carcinoid syndrome, or gastrointestinal stromal tumor.”",
"Inclusion of primary omental tumors in the differential — “Primary ome... | A man in his early 60s presented with a 2-week history of progressive constipation, multiple episodes of non-bilious vomiting, and inability to tolerate oral intake. He had no personal or family history of cancer. On examination, he was tachycardic with a distended but non-tender, non-rigid abdomen; no lymphadenopathy ... | Major | 0.695 | test | null | null | null |
true | Livedoid vasculopathy | Chronic biofilm-associated skin/soft tissue infection complicating a nonhealing malleolar ulcer | [
"Chronic venous insufficiency was considered but excluded because lower-extremity venous Doppler ultrasound did not show evidence of venous disease.",
"Deep venous thrombosis was considered but ruled out as lower-extremity venous Doppler ultrasound did not show evidence of deep venous thrombosis.",
"Given the c... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-2",
"R-6"
] | I kept steps 1–2 aligned with both variants (Doppler-based exclusion of venous insufficiency and DVT). For E-1, I adopted Variant 1's premature Step 3 that concludes livedoid vasculopathy from clinical appearance plus prothrombin mutation, explicitly omitting the prerequisite biopsy confirmation. For E-2, I replaced th... | [
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
3,
4
] | medprmbench_00202 | [
1,
2,
3,
4,
5
] | [] | [
"Chronic venous insufficiency was considered but excluded because “Lower extremities venous … Doppler ultrasound did not show any evidence of … venous … disease.”",
"Deep venous thrombosis was considered but ruled out as “Lower extremities venous … Doppler ultrasound did not show any evidence of … deep venous thr... | An 87‐year‐old Caucasian woman was admitted for chronic painless nonhealing skin ulcers over both malleoli and bilateral shin swelling of approximately one year’s duration, which had worsened over several weeks. She denied fever, chills, dyspnea, chest pain, cough, abdominal pain, or changes in bowel habits. Her histor... | Critical | 0.91 | test | null | 3 | 0 |
null | acute hippocampal encephalopathy | Opioid-associated amnestic syndrome (hypoxic-toxic hippocampal injury) | [
"The combination of acute altered consciousness, normal CSF (no meningitis/autoimmune markers), and bilateral symmetric hippocampal T2/FLAIR hyperintensity with diffusion restriction in a heavy cannabis user most strongly indicates a toxic cannabis-related hippocampal encephalopathy.",
"Given the very heavy canna... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"E-2",
"E-5",
"R-1",
"R-4",
"R-6",
"S-1"
] | I used Variant 2’s early framing to introduce the differential-coverage error by prematurely attributing the presentation to cannabis and explicitly de-prioritizing HSV (composite steps 1–2 and the management implication in step 4). I then inserted Variant 1’s authoritative-but-false opioid-associated amnestic syndrome... | [
{
"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,
2,
3,
5,
6
] | medprmbench_00203 | [
1,
2,
3,
4,
5,
6,
7
] | [] | [
"Autoimmune/paraneoplastic limbic encephalitis considered — “Autoimmune limbic encephalitis most commonly presents with bilateral and asymmetric limbic signal abnormalities, often involving the basal ganglia…”",
"Herpes encephalitis considered — “herpes encephalitis, which typically shows asymmetric involvement s... | A 39-year-old man from a low socioeconomic background, living in an urban area, presented with an acute disturbance of consciousness without fever. He had no significant medical or surgical history except for heavy daily smoking and excessive cannabis use (over 20 joints per day). On examination, his Glasgow Coma Scale... | Critical | 0.91 | test | null | null | null |
true | Ectopic ureter | Primary obstructive megaureter associated with a dysplastic nonfunctioning right kidney | [
"Testicular torsion was excluded because Doppler ultrasonography of the scrotum revealed normal testicular vascularization.",
"Bacterial, viral, and parasitic infection was considered given the presentation, but primary infection is rare in infants and recurrent episodes suggest an underlying cause rather than is... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-2",
"R-5"
] | I constructed a single composite chain by taking Variant 2's contradictory framing about lack of urinary tract involvement for Steps 3–4 (R-2), Variant 3's mislabeling of the ultrasound and VCUG interpretation as primary obstructive megaureter for Steps 5 and 7 (R-5), and Variant 1's premature diagnostic conclusion tha... | [
{
"error_description": "",
"error_step_indices": [
6
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
5
],
"error_type": "R-5",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
3,
4,
5,
6,
7
] | medprmbench_00204 | [
1,
2,
3,
4,
5,
6,
7
] | [] | [
"Testicular torsion was excluded because “Doppler ultrasonography of scrotum revealed normal testicular vascularization.”",
"Bacterial, viral, and parasitic infection was considered given the presentation, but primary infection is rare in infants: “Epididymitis is a rare clinical entity in the pediatric populatio... | A 5-month-old male infant was admitted with anxiety, persistent crying, and a tender right testicle. Doppler ultrasonography of the scrotum revealed normal testicular vascularization. During surgical exploration, there was no torsion but evidence of epididymitis; he was treated with antibiotics. Two months later, he pr... | Critical | 1 | test | null | null | null |
false | allopurinol-induced granulomatous hepatitis | Allopurinol-induced granulomatous hepatitis | [
"Viral hepatitis was considered but excluded because the hepatitis panel including hepatitis A, B, and C was unremarkable.",
"Autoimmune hepatitis was considered but excluded because autoimmune workup including ANA and anti-smooth muscle antibody was unremarkable.",
"Sarcoidosis was considered but ruled out: “O... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-5",
"S-1"
] | I merged Variant 1’s premature conclusion into a combined step that asserts a drug-induced pattern and allopurinol diagnosis before fully excluding other granulomatous/eosinophil-associated causes (E-1), preserving the omission as a prerequisite failure. I then incorporated Variant 2’s unsafe deprioritization of tuberc... | [
{
"error_description": "Prerequisite Sensitivity error: the reasoning jumps to allopurinol-induced granulomatous hepatitis based on biopsy pattern before completing prerequisite exclusion of other common granulomatous hepatitis etiologies and other eosinophil-associated alternatives, making the conclusion unrel... | [
4,
5,
7,
8
] | medprmbench_00205 | [
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11
] | [] | [
"Step 1: Viral hepatitis was considered but excluded because “Hepatitis panel including hepatitis A, B, and C was unremarkable.”",
"Step 2: Autoimmune hepatitis was considered but excluded because “Autoimmune workup including ANA and anti-smooth muscle antibody was unremarkable.”",
"Step 3: The finding of granu... | An 83-year-old man with a history of chronic gout and hypertension was evaluated for elevated liver enzymes. He denied abdominal pain, nausea, fever, chills, weight loss, night sweats, or jaundice and reported no use of herbal medications. He was a former heavy drinker but currently consumed two beers weekly. His medic... | Major | 0.8377 | test | null | 3 | 0 |
true | Juvenile trabecular ossifying fibroma | Ameloblastoma | [
"Ossifying fibroma was considered because of the jaw’s fibro-osseous lesion characteristics — “Based on the clinical findings and history, the differential diagnoses of ossifying fibroma, ameloblastoma and fibrous dysplasia were given.”",
"Ameloblastoma was prioritized because the lesion has been present for thre... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-2",
"R-5",
"R-6",
"R-7"
] | I kept Step 1 from the original as a non-error baseline. I then inserted Variant 2’s timing/trajectory mischaracterization at Step 2 as the R-7 root-cause error and retained its downstream misinterpretations in Steps 3–5 for coherence. To simultaneously incorporate Variant 1’s E-1 omission, I preserved Variant 2’s expl... | [
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-7",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
4
] | medprmbench_00206 | [
1,
2,
3,
4,
5
] | [] | [
"Ossifying fibroma was considered as a differential diagnosis.",
"Ameloblastoma was considered as a differential diagnosis.",
"Fibrous dysplasia was considered as a differential diagnosis.",
"Juvenile ossifying fibroma was supported by the patient’s age and imaging features.",
"Histopathology confirmed the ... | An 8-year-old girl was brought with a three-year history of a slowly enlarging swelling of the right upper posterior maxilla. The lesion was initially asymptomatic but caused pain over the past year when the lower teeth contacted it at jaw closure. There was no history of trauma or toothache. Her past medical history w... | Critical | 0.805 | test | null | 3 | 0 |
true | Tricuspid regurgitation | Thyrotoxicosis-induced right ventricular dysfunction with severe functional tricuspid regurgitation | [
"Pulmonary embolism was considered — deep vein thrombosis and pulmonary embolism were ruled out using leg ultrasound and thoracic CT.",
"Pre-eclampsia was considered — urinalysis was normal without proteinuria, making pre-eclampsia unlikely.",
"Infective endocarditis was considered — the patient remained afebri... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-1",
"R-2",
"S-2"
] | I used Variant 1’s Step 4 to implement the E-1 prerequisite-omission jump directly to isolated RV stress cardiomyopathy, thereby removing the congenital/structural TR exclusion step. I then substituted Variant 3’s Step 5 to incorporate the S-2 tautological rejection of ARVC while keeping surrounding steps aligned. Fina... | [
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
5
],
"error_type": "S-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
4,
5,
6,
8
] | medprmbench_00207 | [
1,
2,
3,
4,
5,
6,
7,
8
] | [] | [
"Pulmonary embolism was considered — “Deep vein thrombosis and pulmonary embolism were ruled out using leg ultrasound and thoracic multislice computed tomography…”",
"Pre-eclampsia was considered — “Urinary examinations revealed no abnormalities, in particular no proteinuria.”",
"Infective endocarditis was cons... | A 38-year-old woman, gravida II para I at 38 weeks’ gestation (via in vitro fertilization), had an uncomplicated spontaneous vaginal delivery. On postpartum day 5, she presented with progressive shortness of breath and bilateral leg edema. Her blood pressure was 135/85 mm Hg, heart rate 60 beats/min, respiratory rate 2... | Critical | 0.91 | test | null | null | null |
true | Papillary fibroelastoma | Culture-negative infective endocarditis | [
"The recurrent embolic strokes in the setting of a mitral valve vegetation-like mass are most consistent with infective endocarditis, and negative blood cultures do not meaningfully reduce this likelihood; therefore, the leading diagnosis remains culture-negative infective endocarditis. At the same time, because bl... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-4",
"R-5"
] | I kept a 3-step structure aligned with the originals/variants. Step 1 was merged to simultaneously include the R-5 unsafe anchoring on culture-negative endocarditis and the E-1 prerequisite omission (setting aside IE as noninfective without Duke/full workup), preserving both contradictions as they appear across variant... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "R-5",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2
] | medprmbench_00208 | [
1,
2,
3
] | [] | [
"Infective endocarditis was initially considered because of a vegetation‐like mitral mass and embolic stroke, but it was excluded when “blood cultures were negative for infective endocarditis…although she had a complete neurological recovery, the vegetation remained the same.”",
"Lambl’s excrescences, myxomas, an... | A 32‐year‐old Asian woman with hypothyroidism and primary infertility presented in 2016 with left‐sided hemiparesis and systemic hypertension. Brain MRI showed an acute ischemic infarct in the right posterior cerebral artery territory. Examination revealed a grade 2/6 short systolic murmur at the mitral area; ECG showe... | Critical | 1 | test | null | null | null |
true | GranularCellTumor | Benign vulvar schwannoma | [
"The combination of a slow-growing, firm, well-circumscribed subcutaneous vulvar mass and the characteristic granular-cell immunoprofile supports a diagnosis of a granular cell tumor (GCT) rather than other vulvar soft-tissue tumors.",
"The tumor’s immunoprofile (S-100, CD68, PAS, neuron-specific enolase, periphe... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-2",
"R-6",
"S-1"
] | I used Variant 1’s altered Step 1 to implement E-1 by omitting the explicit immunohistochemical exclusion of key alternative diagnoses. I kept the original/Variant 2 Step 2 immunoprofile supporting GCT. I then inserted Variant 3’s two redundant steps (electron microscopy/expanded markers and pelvic MRI) to incorporate ... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
5
],
"error_type": "R-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
3,
4,
5,
6,
7
] | medprmbench_00209 | [
1,
2,
3,
4,
5,
6,
7
] | [] | [
"Multiple entities, including basal cell carcinoma, melanoma, leiomyoma, leiomyosarcoma, dermatofibrosarcoma, angiosarcoma, fibrous histiocytoma fibroma, lipoma, and hidradenoma, were considered in the differential but were excluded by distinctive immunohistochemical findings — “Immunohistochemistry aids in disting... | A 27-year-old nulliparous woman presented with a slowly enlarging lump in the vulvar region over a 2-year period. She denied pain, discharge, bleeding, prior vulvar lesions, or systemic symptoms. On examination, there was a hard, mobile, nodular subdermal mass measuring 30 × 20 mm on the mons pubis, situated about 2 cm... | Critical | 0.875 | test | null | null | null |
true | Kimuras disease | Angiolymphoid hyperplasia with eosinophilia (ALHE) | [
"Given the systemic symptoms (fever, weight loss), lymphadenopathy, and hepatomegaly, malignancy such as Hodgkin lymphoma can be set aside and the diagnostic focus should move directly to non-malignant inflammatory causes.",
"Consideration of angiolymphoid hyperplasia with eosinophilia (ALHE) — Because the presen... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-2",
"S-2"
] | I combined Step 1 from Variant 1 to preserve the premature dismissal of malignancy (E-1). I replaced Step 2 with Variant 2’s contradictory eosinophilia/ALHE framing and adjusted Step 3 to the corresponding IgG4-RD uncertainty from Variant 2 so the narrative flows from the altered Step 2 (while retaining the inconsisten... | [
{
"error_description": "Prerequisite Sensitivity: The chain skips the prerequisite of adequately ruling out malignancy (e.g., tissue diagnosis/complete malignancy workup) and prematurely dismisses Hodgkin lymphoma before moving to inflammatory differentials.",
"error_step_indices": [
1
],
"err... | [
1,
2,
4
] | medprmbench_00210 | [
1,
2,
3,
4
] | [] | [
"Consideration of Hodgkin lymphoma — “No evidence of malignancy was found.”",
"Consideration of angiolymphoid hyperplasia with eosinophilia (ALHE) — “KD usually affects younger people in the second or third decades... and is almost always accompanied by peripheral blood eosinophilia and elevated serum IgE levels.... | A 28-year-old man (BMI 24.8; heavy smoker) with asthma since age 19 and a history of hepatitis A 3 months earlier presented with one week of colicky periumbilical pain radiating to the lower abdomen and thighs, progressive abdominal distension, fatigue, fever (39.1 °C), anorexia, and 10 kg unintentional weight loss ove... | Critical | 0.805 | test | null | null | null |
false | lupus mastitis | Lupus mastitis | [
"Fat necrosis or pancreatitis-related panniculitis were considered but excluded because “Panniculitis related to trauma or pancreatitis were not taken into consideration owing to the absence of history of trauma and normal serum amylase and lipase levels.”",
"Given the chronic, bilateral subcutaneous breast masse... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"E-5",
"R-6",
"S-1"
] | I kept the original framing for excluding trauma/pancreatitis-related panniculitis, then integrated Variant 1 by replacing the early workup step with an immediate declaration of lupus mastitis (omitting prerequisite serologic confirmation). I integrated Variant 2 by adding the premature dismissal of carcinoma based on ... | [
{
"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,
6,
9
] | medprmbench_00211 | [
2,
3,
4,
5,
6,
7,
8,
9,
10
] | [] | [
"Fat necrosis or pancreatitis-related panniculitis were considered but excluded because “Panniculitis related to trauma or pancreatitis were not taken into consideration owing to the absence of history of trauma and normal serum amylase and lipase levels.”",
"Acute infectious mastitis was considered but deemed un... | A 39-year-old man presented with gradually increasing, slightly tender breast lumps bilaterally for 18 months. He denied trauma, systemic symptoms, joint pain, or known autoimmune disease. On examination, subcutaneous masses measuring approximately 3×3 cm in the left supra-areolar region and 2×2 cm in the right upper o... | Critical | 0.84 | test | null | null | null |
true | scapular nonunion | Scapular dyskinesia due to an inferior scapular body defect with subscapularis herniation | [
"Given the CT finding of a 4 cm × 2 cm inferior scapular body defect with the subscapularis muscle herniating through it, the diagnosis is subscapularis herniation through a scapular body defect.",
"Subscapularis herniation was suspected because the scapular body defect represents a herniation-type lesion, and th... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-2",
"S-2"
] | Integrated E-1 by replacing the original Step 1 with the variant that omits the nonunion prerequisite and jumps directly to herniation from CT. Integrated S-2 by using the tautological herniation justification as Step 2. Kept the original/consistent rotator cuff exclusion as Step 3. Integrated R-2 by replacing the fina... | [
{
"error_description": "Skips the prerequisite consideration/workup for symptomatic scapular fracture nonunion in persistent post-fracture pain and jumps directly from CT appearance to diagnosing subscapularis herniation.",
"error_step_indices": [
1
],
"error_type": "E-1",
"modified_steps"... | [
1,
2,
4
] | medprmbench_00212 | [
1,
2,
3,
4
] | [] | [
"Nonunion was considered because persistent symptoms can indicate a symptomatic fracture nonunion — “Persistent pain following injury requires further work up and possible surgical intervention.”",
"Subscapularis herniation was suspected based on imaging — “Computed tomography scan showed a 4 cm × 2 cm elliptical... | A 52-year-old woman presented 14 months after a motorcycle accident in which she sustained a right scapular body fracture managed non-operatively and a right clavicle fracture treated with open reduction and internal fixation. She reported constant posterior right shoulder pain along the scapula that prevented sleep an... | Critical | 0.805 | test | null | null | null |
true | Vogt-Koyanagi-Harada disease | Optic neuritis following a viral syndrome | [
"The elevated Mycoplasma pneumoniae IgM/IgG with systemic prodrome suggests a recent Mycoplasma-triggered inflammatory process, which can lead to ocular autoimmunity even after respiratory symptoms have resolved.",
"With Mycoplasma serology supporting a post-infectious trigger, proceed to the leading clinical pat... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-3",
"R-6"
] | Used Variant 1’s restructuring to create the prerequisite-skipping jump to VKH at step 2 (E-1), then replaced the infectious-workup step with Variant 3’s overconfident, fact-contradicting claim of definitively positive syphilis/TB serologies (R-4). Finally, replaced the concluding VKH step with Variant 2’s age-based ex... | [
{
"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,
4
] | medprmbench_00213 | [
1,
2,
3,
4
] | [] | [
"Consideration of active Mycoplasma pneumoniae infection — “Although the serology was positive, Pediatric Infectious Disease felt that in the absence of ongoing respiratory symptoms that there was not an active infection, but rather an autoimmune response to a previous resolved M. pneumoniae infection.”",
"Consid... | A 14-year-old Hispanic female presented with a two-week history of decreased vision, redness, and a central scotoma in her right eye. Two weeks before the onset of visual symptoms, she had fever, myalgias, headache, nuchal rigidity, nausea, and vomiting, which resolved two days after starting oseltamivir for presumed i... | Critical | 0.875 | test | null | null | null |
true | Thymolipoma | Primary mediastinal nonseminomatous germ cell tumor (teratoma) | [
"Teratoma — considered because anterior mediastinal masses may contain fat — “The differential diagnosis includes fat-containing lesions such as teratomas, lipomas and liposarcoma, thymoliposarcomas, mediastinal lipomatosis, and diaphragmatic hernias.”",
"Lipoma — included among fat-containing mediastinal tumors ... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-6",
"S-1"
] | I used Variant 1’s corrupted Step 3 to embed the prerequisite-skipping behavior (omitting the liposarcoma exclusion step) and kept the surrounding differential steps aligned with the original where possible. I then incorporated Variant 2’s fabricated tumor-marker/scrotal-ultrasound reasoning as Step 4 and preserved its... | [
{
"error_description": "Prerequisite Sensitivity error: the chain skips the critical prerequisite step of evaluating and excluding mediastinal liposarcoma using malignancy features (e.g., thick/nodular enhancing septa and/or local invasion) before concluding thymolipoma from a heterogeneous fat-containing anter... | [
3,
4,
6,
7
] | medprmbench_00214 | [
3,
4,
6,
7,
8,
9
] | [] | [
"Teratoma — considered because anterior mediastinal masses may contain fat — “The differential diagnosis includes fat-containing lesions such as teratomas, lipomas and liposarcoma, thymoliposarcomas, mediastinal lipomatosis, and diaphragmatic hernias.”",
"Lipoma — included among fat-containing mediastinal tumors ... | A 34-year-old man presented with a 4-month history of dyspnea on exertion (stage II) and intermittent chest pain without cough or hemoptysis. He had no significant past medical history. On examination, he was afebrile, conscious, with a respiratory rate of 22 breaths per minute, heart rate 85 beats per minute, and bloo... | Major | 0.6494 | test | null | null | null |
true | Mycotic aneurysm | Esophageal rupture (Boerhaave syndrome) | [
"Esophageal rupture is most likely because posterior mediastinal gas/soft-tissue density on noncontrast chest CT is classically diagnostic for Boerhaave syndrome, and in adults this finding is sufficient to prioritize esophageal perforation as the source of sepsis.",
"Given the high suspicion for aortic involveme... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-3",
"R-7"
] | I combined Variant 2’s Step 1 (R-3) to over-prioritize esophageal rupture based on mediastinal gas. I then used Variant 1’s Step 2 (E-1) so the chain treats CT angiography findings as hypothetical ('would demonstrate') rather than confirmed, preserving the missing-prerequisite flaw. Next, I incorporated Variant 3’s Ste... | [
{
"error_description": "Misapplies the Boerhaave syndrome heuristic by treating mediastinal gas on CT as effectively diagnostic for esophageal rupture in this septic embolic/vascular-context patient, over-weighting that finding despite other features suggesting an infected aortic process.",
"error_step_indi... | [
1,
2,
3
] | medprmbench_00215 | [
1,
2,
3,
4
] | [] | [
"Esophageal rupture considered — “for which the rupture of esophagus and aorta pseudoaneurysm complications were among differential diagnoses.”",
"Aortic pseudoaneurysm identified — “CT angiography scan was ordered, which demonstrated two lobulated pseudoaneurysms in descending aorta that were surrounded by gas…”... | A 66-year-old man with a history of diabetes mellitus and hypertension presented with acute onset of left-sided hemiplegia. Brain magnetic resonance imaging demonstrated diffusion-restricted lesions in the right parietooccipital and left occipital lobes with an embolic pattern. Transthoracic echocardiography revealed m... | Critical | 0.91 | test | null | null | null |
true | Struma ovarii | Graves’ disease (with an incidental ovarian adnexal mass) | [
"Graves’ disease remains the most likely cause because in severe Graves’ hyperthyroidism the thyroid can become “functionally suppressed” from very high circulating T4/T3, leading to near-zero 99mTc uptake; ophthalmopathy and goiter are not required for diagnosis, and up to a third of patients can have minimal thyr... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-3",
"R-6"
] | I used Variant 2’s Step 1 as the composite Step 1 so the R-1 incorrect uptake claim is preserved; this also inherently satisfies the E-1 omission by bypassing the original prerequisite exclusion of common thyroid causes before moving forward. I then used Variant 3’s Step 2 to incorporate the R-3 misapplication of postp... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2,
3,
4
] | medprmbench_00216 | [
1,
2,
3,
4
] | [] | [
"Graves’ disease was considered given its potential to stimulate both eutopic and ectopic thyroid tissue, but was excluded due to absence of autoimmune features — “anti-TSH receptor autoantibodies stimulate thyroid hormone production in both the eutopic and ectopic thyroid tissues…she did not have any features sugg... | A 36-year-old woman presented with 5 days of intense, colicky left lower abdominal pain radiating to the groin and lower back, accompanied by nausea. She denied fever, genitourinary symptoms, or bowel changes. Over the preceding 6 months, she noted palpitations, heat intolerance, a 7-kg unintentional weight loss, insom... | Critical | 0.835 | test | null | null | null |
true | Carotid artery dissection | Reversible cerebral vasoconstriction syndrome (RCVS) | [
"Consider relapse of TTP given her prior pregnancy-associated TTP and current focal neurologic deficits suggestive of an ischemic event.",
"Given her history of stroke in the setting of TTP and low ADAMTS13 activity (16% a week earlier), presume this presentation represents an atypical TTP relapse and attribute t... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-4",
"R-1"
] | I kept the chain at three steps for natural flow. From Variant 1, Step 2 was replaced to preserve the prerequisite-omission error (jumping to TTP relapse without excluding it on current labs). Then I merged Variants 2 and 3 into Step 3 by simultaneously (a) treating the reported ICA dissection as artifact/vasospasm to ... | [
{
"error_description": "Prerequisite Sensitivity: skips the prerequisite step of excluding active TTP relapse using current hematologic evidence (platelets/hemolysis) and prematurely attributes the neurologic event to TTP relapse.",
"error_step_indices": [
2
],
"error_type": "E-1",
"modifi... | [
2,
3
] | medprmbench_00217 | [
1,
2,
3
] | [] | [
"Considered relapse of TTP — “Previous case reports have demonstrated that despite no findings of thrombocytopenia or microangiopathic hemolytic anemia on CBC, a patient presenting with stroke-like symptoms may be experiencing an atypical presentation of TTP…”",
"Excluded active TTP relapse — “CBC was significant... | A 35-year-old African American woman, gravida 2 para 0-1-0-0, at 18 weeks of gestation presented with sudden onset of left-sided upper and lower extremity weakness during intercourse. The weakness lasted about 30 minutes and then resolved. Sixty minutes after onset, she developed tingling in her left arm and leg, slurr... | Critical | 0.94 | test | null | null | null |
true | foregut cyst | Thyroglossal duct cyst | [
"Dermoid and epidermoid cysts were considered but were excluded by histologic findings demonstrating endodermal epithelia rather than squamous lining — “Microscopic sections showed a cyst which is lined by respiratory-type ciliated pseudostratified columnar epithelium punctuated at multiple sites by short segments ... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-5",
"R-7",
"S-2"
] | I used Variant 1’s Step 2 to inject the prerequisite omission and premature ranula labeling (E-1), kept the original Step 1 and Step 3 content, replaced Step 4 with Variant 3’s tautological justification (S-2), and replaced Step 5 with Variant 2’s time-course-over-histology conclusion and deferral recommendation (R-7).... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "S-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
4,
5
] | medprmbench_00218 | [
2,
3,
4,
5
] | [] | [
"Dermoid and epidermoid cysts were considered but were excluded by histologic findings demonstrating endodermal epithelia rather than squamous lining — “Microscopic sections showed a cyst which is lined by respiratory-type ciliated pseudostratified columnar epithelium punctuated at multiple sites by short segments ... | An infant girl presented at 6 weeks of age with a cystic mass on the floor of her mouth that had been noted at birth and had grown slowly to approximately 2 cm in diameter. Her weight was 4.075 kg (11th percentile); she had no feeding or breathing difficulties, and the family history was unremarkable. Physical examinat... | Critical | 0.735 | test | null | null | null |
true | Pyoderma gangrenosum | Cocaine-induced pyoderma gangrenosum | [
"ANCA-associated vasculitis is less likely because C-ANCA and P-ANCA testing was negative.",
"Leukocytoclastic vasculitis is considered because the ulcerations look vasculitic, and leukocytoclastic vasculitis is supported because the ulcerations have a vasculitic morphology; however, given the temporal relationsh... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-1",
"S-2"
] | I kept Step 1 from the original/variants (ANCA vasculitis less likely). For Step 2, I merged Variant 2's leukocytoclastic-vasculitis tautology (S-2) with Variant 1's prerequisite-skipping jump to cocaine-induced PG (E-1) in the same step, so leukocytoclastic vasculitis is both circularly asserted and then prematurely b... | [
{
"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,
3
] | medprmbench_00219 | [
1,
2,
3,
4,
5
] | [] | [
"ANCA-associated vasculitis considered — “C-ANCA, p-ANCA testing was negative.”",
"Leukocytoclastic vasculitis considered — “Differential diagnoses included ANCA-associated and leukocytoclastic vasculitis.”",
"Levamisole-induced vasculitis considered — “Levamisole is a common adulterant added to cocaine… levami... | A 41-year-old man with a history of pyoderma gangrenosum, type 2 diabetes mellitus, hypertension, and long-standing cocaine abuse presented with an 8-day history of worsening pain and ulceration. He noted the lesions began to worsen approximately 10 days after his most recent cocaine use. He denied fever, respiratory o... | Critical | 0.805 | test | null | null | null |
true | kaposiform hemangioendothelioma | Tufted angioma | [
"Initial consideration of tufted angioma based on biopsy histology — showing fibrovascular tissue containing compact nests of variably sized and ill-defined vascular channels.",
"The immunohistochemistry pattern (CD31/CD34 positive, partial D2-40 positivity, GLUT-1 negative) is more supportive of kaposiform heman... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-2",
"R-7"
] | I kept Step 1 aligned with the original (histology initially suggesting tufted angioma). I then imported Variant 2’s contradictory Step 2 (IHC claimed to favor KHE) to embed the R-2 inconsistency. For Step 3, I used Variant 3’s time-course reinterpretation that downplays MRI infiltration as reactive/chronic to preserve... | [
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2,
3
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error... | [
2,
3
] | medprmbench_00220 | [
1,
2,
3
] | [] | [
"Initial consideration of tufted angioma based on biopsy histology — “showing fibrovascular tissue containing compact nests of variably sized and ill-defined vascular channels.”",
"Support for tufted angioma from immunohistochemistry — “partially reactive for D2-40 ... did not definitively rule out KHE but did in... | An 11-month-old male with a history of nasolacrimal duct stenosis and a small thyroglossal duct cyst was evaluated for left facial swelling of 9 months’ duration. Six months earlier, a mass was noted on the left cheek, which had enlarged progressively over the preceding 2 months. The patient had intermittent fevers in ... | Critical | 0.875 | test | null | null | null |
true | Pernicious anemia | Traumatic splenic laceration with secondary acute hemolytic anemia | [
"Splenic infiltration by malignancy (infiltrative disease or lymphoma) was initially considered but excluded based on prior pathology/workup not supporting these diagnoses.",
"Given the CT-confirmed grade III splenic laceration with perisplenic hemorrhage and concurrent hemolysis markers (elevated LDH, low haptog... | medcasereasoning | A | [
"Sensitivity"
] | [
"E-1",
"E-4",
"E-5"
] | I used the shared Step 1 from the variants as the non-error baseline. For Step 2, I adopted Variant 3’s premature closure that traumatic splenic laceration explains the entire picture and that other dangerous etiologies need not be pursued (E-5). For Step 3, I incorporated Variant 2’s explicit reticulocyte/hemoglobin a... | [
{
"error_description": "Prematurely narrows the differential to traumatic splenic laceration as the sole unifying diagnosis and dismisses other high-risk causes of Coombs-negative hemolysis/pancytopenia (e.g., TTP/HUS, PNH, acute leukemia) without a worst-first differential or confirmatory testing.",
"error... | [
2,
3,
4
] | medprmbench_00221 | [
1,
2,
3,
4
] | [] | [
"Splenic infiltration by malignancy (infiltrative disease or lymphoma) was initially considered but excluded—“Initially, it was thought that this patient could have splenomegaly due to infiltrative disease or lymphoma, however, the pathology report was not consistent with either of the differentials and the diagnos... | A 48-year-old man with a history of small-bowel obstruction requiring laparotomy, chronic pancytopenia, hepatosplenomegaly, and known but untreated pernicious anemia presented with 5–6 days of left upper-quadrant abdominal pain, early satiety, decreased appetite, and shortness of breath. He noted dark-orange urine but ... | Critical | 0.91 | test | null | null | null |
false | verruciform xanthoma | Oral verruciform xanthoma | [
"Squamous cell carcinoma was initially suspected clinically based on the verrucous palatal lesion in a smoker.",
"Traumatic ulcer was also considered clinically as part of the initial presumptive diagnosis.",
"Verruca vulgaris was included in the differential because the lesion had a verrucous surface.",
"Giv... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-1",
"S-1"
] | I used Variant 1’s omission/shortcut as the core E-1 corruption by replacing the malignancy-exclusion Ki-67 step with an immediate OVX diagnosis (composite step 4). I then inserted Variant 3’s redundant lipid and metabolic evaluation steps as composite steps 5–6 and retained the follow-up statement about systemic lipid... | [
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
5,
6
],
"error_type": "S-1",
"modified_steps": null
},
{
"error_description": "",
"error... | [
4,
5,
6,
8
] | medprmbench_00222 | [
1,
2,
3,
4,
5,
6,
7,
8,
9
] | [] | [
"Squamous cell carcinoma was initially suspected clinically — “The presumptive diagnosis was squamous cell carcinoma or traumatic ulcer.”",
"Traumatic ulcer was considered clinically — “The presumptive diagnosis was squamous cell carcinoma or traumatic ulcer.”",
"Verruca vulgaris was included in the differentia... | A 43-year-old man presented for evaluation of a painless lesion on the hard palate that was discovered during a routine dental examination two months earlier. He was a current smoker. On oral examination, there was a ~5 mm lesion with a verrucous surface and scattered erythematous spots adjacent to the first upper righ... | Critical | 0.805 | test | null | null | null |
true | Superior mesenteric vein thrombosis | Severe acute cholangitis due to COVID-19–associated acalculous cholecystitis/biliary obstruction | [
"The initial presentation was attributed to COVID-19 or mesenteric adenitis given the positive SARS‑CoV‑2 test, viral prodrome, mild right lower quadrant tenderness, normal chest radiograph, and lack of peritoneal signs.",
"Acute appendicitis was considered less likely and effectively excluded after his pain impr... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-2",
"R-7"
] | I kept Step 1 aligned with the original and all variants. To integrate E-1, Step 2 was rewritten to explicitly exclude appendicitis clinically yet then jump directly to diagnosing complicated perforated appendicitis without confirming it by contrast CT. To integrate both R-1 and R-2, Step 3 was constructed to simultane... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3,
4
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error... | [
2,
3,
4
] | medprmbench_00223 | [
1,
2,
3,
4
] | [] | [
"Symptoms attributed to COVID-19 or mesenteric adenitis — “His symptoms were attributed to COVID-19 or mesenterial adenitis.”",
"Acute appendicitis initially considered but excluded after pain decreased and lack of peritoneal signs — “Physical examination still revealed mild tenderness upon pressure in the right ... | A 26-year-old man with autism and attention-deficit hyperactivity disorder presented after four days of cough, rhinorrhea, nausea with occasional vomiting, and diffuse abdominal pain. He had tested positive for SARS-CoV-2 two days earlier. On examination, his temperature was 38.4 °C, blood pressure 128/86 mmHg, heart r... | Critical | 0.94 | test | null | null | null |
true | dengue_encephalopathy | Hyponatremic encephalopathy (dengue-associated) | [
"Dengue hemorrhagic fever with vascular leakage causing cerebral edema is unlikely because the ultrasound scan did not reveal any pleural effusions or ascites, excluding early signs of capillary vascular leakage.",
"Given the unremarkable respiratory, cardiovascular, and abdominal examinations, dengue shock–relat... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-4",
"R-1",
"R-6"
] | I kept the shared baseline structure from the original/variants, adopted Variant 1’s Step 2 to embed the missing hemodynamic prerequisite (E-1), and replaced the electrolyte step with a merged Step 7 that simultaneously contains the sodium conversion mistake (E-4) and the timing/empiric-treatment claims (R-7). To prese... | [
{
"error_description": "",
"error_step_indices": [
7
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
7
],
"error_type": "E-4",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
7,
8,
10
] | medprmbench_00224 | [
1,
2,
3,
4,
5,
6,
7,
8,
9,
10
] | [] | [
"Dengue hemorrhagic fever with vascular leakage causing cerebral edema — “Ultrasound scan did not reveal any pleural effusions or ascites excluding the early signs of capillary vascular leakage.”",
"Dengue shock–related cerebral hypoperfusion — “Respiratory, cardiovascular and abdominal examinations were unremark... | A 28-year-old woman at 37 weeks’ gestation presented with a 4-day history of fever. On day 5 she became irritable, somnolent, and aggressive, and subsequently unresponsive to commands. Examination revealed T 38.5 °C, anicteric sclerae, no pallor, and a Glasgow Coma Scale score of 9 (E2 V2 M5). Respiratory, cardiovascul... | Critical | 0.91 | test | null | null | null |
true | Epiploic appendagitis | Mechanical small-bowel obstruction due to adhesions | [
"The presentation with migrating pain to the right lower quadrant, rebound tenderness, and a positive McBurney sign supports acute appendicitis, so proceeding to operative management is appropriate.",
"The intraoperative finding of a macroscopically normal, non-irritated appendix does not rule out appendicitis, b... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-4"
] | I kept the overall structure of the original chain but replaced Step 2 with the shared appendicitis-preserving intraoperative interpretation from Variants 1/2, which simultaneously implements E-1 (failure to shift away from appendicitis after a normal appendix) and R-1 (incorrect medical claim that a grossly normal app... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2,
5
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error... | [
2,
4,
5
] | medprmbench_00225 | [
1,
2,
3,
4,
5
] | [] | [
"Final Diagnosis: Epiploic appendagitis. Acute appendicitis was the leading consideration given the presentation with right lower quadrant pain, rebound tenderness, and a positive McBurney sign.",
"Initial logic and parameters are validated.",
"Standard processing applied.",
"Standard processing applied.",
... | A 50-year-old Caucasian man presented with a 72-hour history of right lower quadrant pain. Three days before presentation, the pain began in the mid-epigastrium and gradually shifted to the right lower quadrant. He denied nausea, vomiting, or changes in bowel and urinary habits. His medical history was notable for obes... | Critical | 0.835 | test | null | 3 | 0 |
true | Warthin tumor | Warthin-like variant of papillary thyroid carcinoma metastatic to an intraparotid lymph node | [
"The bilayered oncocytic papillary proliferation with lymphoid stroma is characteristic of Warthin’s tumor and not pleomorphic adenoma — “The sections stained with Hematoxylin and Eosin revealed cystic spaces lined by a papillary epithelial proliferation which was bilayered… At the core of papillary projections a v... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-1",
"R-2",
"S-2"
] | I retained Variant 1’s corrupted Step 2 to embed the prerequisite-skipping error (E-1). I then replaced Step 7 with Variant 2’s contradictory thyroid-feature/thyroglobulin-positive assertion (R-2) and adapted Steps 9–10 to follow Variant 2’s thyroid-carcinoma direction so the chain remains coherent despite the contradi... | [
{
"error_description": "",
"error_step_indices": [
2
],
"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... | [
2,
7,
8,
10
] | medprmbench_00226 | [
2,
7,
8,
9,
10
] | [] | [
"The bilayered oncocytic papillary proliferation with lymphoid stroma is characteristic of Warthin’s tumor and not pleomorphic adenoma — “The sections stained with Hematoxylin and Eosin revealed cystic spaces lined by a papillary epithelial proliferation which was bilayered… At the core of papillary projections a v... | A 65-year-old man presented with a six-year history of swelling below the left earlobe. The lesion was insidious in onset and had gradually increased to about 5 cm in greatest dimension. His medical and family histories were noncontributory; he had smoked for 25 years but did not drink alcohol. Examination revealed a s... | Major | 0.63 | test | null | null | null |
false | Glioblastoma | Glioblastoma (GBM) | [
"APXA is excluded because the recurrent specimen lacks eosinophilic granular bodies, so the lesion should be classified as glioblastoma based on the high-grade histologic features.",
"Glioblastoma was strongly favored on histology because the proliferation index is effectively very high: if ~21% of cells are Ki-6... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"E-4",
"R-1",
"R-3",
"S-2"
] | I used Variant 1 as the backbone because it introduces the prerequisite-omission error and also changes downstream framing to a GBM conclusion. I then replaced the histology/proliferation step with Variant 2’s numerically corrupted Ki-67 conversion (210% per 1000 cells) to incorporate the quantitative error while keepi... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-4",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2,
4
] | medprmbench_00227 | [
1,
2,
3,
4,
5
] | [] | [
"APXA was considered because of recurrence after PXA resection and increased mitotic activity but excluded by the absence of eosinophilic granular bodies — “As recurrence happened after the PXA resection, APXA was expected due to poorer histological findings; however, the tumor had no characteristic feature of PXA ... | A 19-year-old Japanese woman presented with left temporal headache. Brain MRI revealed a well-defined, heterogeneously contrast-enhancing 10 mm lesion in the left temporal lobe with high T2 signal. She underwent left frontotemporal craniotomy and gross total resection. Histology showed an astrocytic tumor with fewer th... | Critical | 0.875 | test | null | null | null |
true | Brown tumor | Multifocal giant cell tumor of bone | [
"The absence of a primary tumor on thorax/abdomen/brain CT makes metastatic carcinoma unlikely, so the most likely explanation for multifocal lytic lesions with high alkaline phosphatase is a brown tumor from hyperparathyroidism.",
"Other lytic bone lesions were considered, but the lab pattern can be quantified a... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1"
] | I used Variant 1’s Step 1 to introduce the prerequisite-skipping jump to brown tumor/hyperparathyroidism without PTH confirmation (E-1). I then used Variant 2’s Step 2 to preserve the specific numeric miscalculation of ALP elevation (580/30 ≈ 19×) and its resulting bias toward metastasis/myeloma (E-4), keeping the chai... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2,
3
],
"error_type": "R-1",
"modified_steps": null
}
] | [
1,
2,
3
] | medprmbench_00228 | [
1,
2,
3
] | [] | [
"Final Result: Brown tumor. Initial logic and parameters are validated.",
"Standard processing applied.",
"Brown tumor from hyperparathyroidism is supported by the combination of multifocal lytic bone lesions, elevated alkaline phosphatase, and hypophosphatemia in the setting of chronic kidney disease, which pr... | A 58-year-old man was referred to primary care for pleuritic chest pain. He has a history of hypertension, stage III chronic kidney disease, chronic obstructive pulmonary disease, heart failure, atrial fibrillation, and treated hyperthyroidism. He is obese (BMI 39 kg/m2) and a current smoker.
On examination he was af... | Critical | 0.835 | test | null | 3 | 0 |
true | melanosis vesicae | Primary malignant melanoma of the urinary bladder | [
"Bladder melanoma considered — “the main differential diagnosis to rule out is bladder melanoma, thus highlighting the importance of performing biopsies of the suspected lesions.”",
"Malignant melanoma favored — “histology demonstrates atypical melanocytic proliferation consistent with malignant melanoma rather t... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-1",
"R-2",
"R-7",
"S-1"
] | I used Variant 3’s expanded step structure (inserting the redundant urine cytology/CT urogram and enhanced cystoscopic mapping steps) to set the composite step count. I then replaced the original Step 2 with Variant 2’s contradictory melanoma-favoring assertion (preserving the R-2 inconsistency) and kept Variant 2’s al... | [
{
"error_description": "",
"error_step_indices": [
2
],
"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,
4,
5,
8
] | medprmbench_00229 | [
2,
4,
5,
6,
7,
8
] | [] | [
"Bladder melanoma considered — “the main differential diagnosis to rule out is bladder melanoma, thus highlighting the importance of performing biopsies of the suspected lesions.”",
"Malignant melanoma excluded — “vesical melanosis is characterized by the deposition of pigments without the presence of atypical me... | An 85-year-old man with a 50–pack-year smoking history and benign prostatic hyperplasia managed with phytotherapy and tamsulosin presented with lower urinary tract symptoms. He reported nocturia and daytime frequency with an International Prostate Symptom Score of 11. Renal and bladder ultrasonography revealed normal b... | Major | 0.63 | test | null | null | null |
true | Vulvar hematoma | Left internal pudendal vein thrombosis (vulvar venous thrombosis) | [
"Acute unilateral labial swelling with severe throbbing pain after repeated intercourse plus CT showing a hyperdense ovoid focus in the labial region (e.g., ~6.6 x 4.8 cm) most strongly supports a vulvar hematoma (focal hemorrhage).",
"Given the CT appearance and history, conclude this is a vulvar hematoma withou... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-6",
"S-1"
] | I kept the original overall structure but merged in each variant’s single error at its corresponding location. From Variant 1, I replaced the infectious-mimic differentiation step with the premature conclusion (composite Step 2). From Variant 2, I inserted the hallucinated CT venous-phase thrombus and thrombophilia pan... | [
{
"error_description": "Skipped the prerequisite step of differentiating vulvar hematoma from key infectious mimics (e.g., Bartholin’s abscess/folliculitis) before settling on the diagnosis.",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": [
2
]
},
{
... | [
2,
3,
6
] | medprmbench_00230 | [
1,
2,
3,
4,
5,
6,
7,
8,
9
] | [] | [
"Vulvar hematoma was considered because of acute labial swelling and pain with recent coitus, supported by CT findings of a hyperdense ovoid focus in the left labial region.",
"Bartholin’s gland abscess or folliculitis was considered because inflammation and edema can mimic an abscess, but the acute presentation ... | A 25-year-old woman presented to the emergency department complaining of left-sided vaginal pain and swelling that began approximately five hours earlier and was progressively worsening. She described severe, throbbing pain that prevented comfortable sitting or walking. The patient reported five episodes of sexual inte... | Critical | 0.805 | test | null | 3 | 0 |
true | Gastric Schwannoma | Gastric gastrointestinal stromal tumor (GIST) | [
"Gastrointestinal stromal tumor (GIST) is the leading diagnosis based on imaging and cytology, and the intensely enhancing exophytic gastric mass on CT is highly typical for GIST.",
"The upper gastrointestinal endoscopy clearly and definitively confirms a large ulcerated submucosal mass arising from the greater c... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-6",
"R-7",
"S-2"
] | All three variants inject their respective errors into Step 2, so the composite chain keeps Step 1 from the R-4 variant (GIST-leading by imaging/cytology) and Step 3 from the R-4 variant (concluding GIST based on the false endoscopic 'confirmation'). Step 2 is merged to simultaneously contain: (1) the R-4 contradiction... | [
{
"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
] | medprmbench_00231 | [
1,
2,
3
] | [] | [
"Gastrointestinal stromal tumor — favored by imaging and cytology findings — “Ultrasonography ... suggestive of Gastrointestinal Stromal Tumor (GIST).” It was excluded by “lack of immunoreactivity with CD117 (Fig. 5 B).”",
"Leiomyoma or leiomyosarcoma — considered among spindle cell neoplasms identifiable by desm... | A 20-year-old woman presented with a 6-month history of dyspeptic symptoms including early satiety, postprandial fullness, and heartburn. Two months before evaluation, she noted a nonpainful lump in her upper abdomen. She had no significant past medical or surgical history. On examination, she was mildly pale, and ther... | Critical | 0.805 | test | null | null | null |
true | Stenotrophomonas maltophilia pneumonia | Acute radiation pneumonitis | [
"Typical bacterial pneumonia was unlikely given sterile sputum and blood cultures — “Initial septic workup was negative, which included sputum bacterial culture… bacterial and fungal blood culture…”",
"With pulmonary tuberculosis effectively ruled out, we can focus on non-mycobacterial etiologies suggested by the... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-3",
"R-6",
"R-7"
] | I used Variant 1’s TB step as the composite Step 2 to preserve the prerequisite-omission framing (treating TB as effectively ruled out without addressing adequacy/sensitivity). I then replaced the fungal step with Variant 2’s transplant-context exclusion language as Step 3. For the timing/trajectory error, I adopted Va... | [
{
"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,
4
] | medprmbench_00232 | [
2,
3,
4,
5,
9
] | [] | [
"Typical bacterial pneumonia was unlikely given sterile sputum and blood cultures — “Initial septic workup was negative, which included sputum bacterial culture… bacterial and fungal blood culture…”",
"Pulmonary tuberculosis was excluded by negative mycobacterial studies — “Initial septic workup was negative, whi... | A 36-year-old woman with diffuse large B-cell lymphoma presented on day 17 of her sixth cycle of CHOP chemotherapy with a 2-day history of fever (maximum 38.1°C) and nonproductive cough. Physical examination was otherwise unremarkable. Laboratory studies showed an absolute neutrophil count of 0.6×10^9/L, an erythrocyte... | Major | 0.6494 | test | null | null | null |
true | osteoma cutis | Subungual exostosis | [
"Histopathology demonstrated bony elements within the dermis, which can be seen with subungual exostosis.",
"Given the clinical presentation and biopsy showing dermal bone, proceed to diagnose subungual exostosis as the most likely cause of a painful enlarging subungual papule, without first confirming imaging co... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-2",
"R-1"
] | I used Variant 1 to replace the early reasoning with the premature jump from dermal bone on a transected shave biopsy directly to subungual exostosis, explicitly omitting the prerequisite imaging-correlation step (E-1 at composite step 2). I then merged Variant 2 and Variant 3 into a single composite middle step (compo... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
4,
6
] | medprmbench_00233 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Histopathology supported subungual exostosis — “Histopathology demonstrated bony elements within the dermis, consistent with subungual exostosis.”",
"Radiograph argued against exostosis — “These results were not consistent with subungual exostosis, and a calcified epidermal inclusion cyst was favored.”",
"Epid... | A 41-year-old man presented with a 6-month history of a painful, enlarging papule beneath the nail of the right fourth finger. On examination, there was a 6 mm skin-colored, smooth, tender subungual papule elevating the central nail plate. A shave biopsy of the exophytic portion encountered a firm structure. Histopatho... | Major | 0.805 | test | null | null | null |
true | mural aortic thrombus | Descending thoracic aortic myxoma | [
"The aortic filling defect raises concern for a primary arterial/aortic tumor as part of the differential for an intraluminal aortic mass.",
"Because myxomas are the most common primary cardiac tumor in adults and can present with embolic phenomena, and because her symptoms have been progressive over four days (a... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-3",
"R-7"
] | I kept the overall 5-step structure but merged the single corrupted elements into a coherent composite. Step 2 was rewritten to simultaneously (a) assert myxoma as most consistent by misapplying cardiac epidemiology to an aortic lesion (R-3), (b) use the 4-day symptom trajectory and recent diuresis to argue for a slowl... | [
{
"error_description": "Prerequisite sensitivity error: skips the prerequisite confirmatory characterization step (e.g., MRI/alternative imaging to distinguish thrombus from tumor/myxoma) and makes a definitive diagnosis based on CTA appearance alone.",
"error_step_indices": [
2
],
"error_type... | [
2
] | medprmbench_00234 | [
1,
2,
3,
4,
5
] | [] | [
"Primary arterial/aortic tumor — “Differential diagnosis … included … primary arterial/aortic tumor…”",
"Primary myxoma — “Differential diagnosis … included … primary myxoma…”",
"Xanthogranulomatous sarcomas — “Differential diagnosis … included … xanthogranulomatous sarcomas.”",
"Infectious aortitis — “Infect... | A 65-year-old woman with a history of sigmoidectomy and end colostomy for postoperative anastomotic leak presented to the emergency department with four days of progressive dyspnea, orthopnea, and new pitting edema. Four days earlier she had been treated for acute hypoxic respiratory failure and clinical congestive hea... | Critical | 0.91 | test | null | null | null |
true | secondary chondrosarcoma | Tumoral calcium pyrophosphate deposition disease (pseudotophaceous CPPD) | [
"The combination of periarticular soft-tissue mineralization, progressive erosions, and large synovial-based masses on MRI is most consistent with primary synovial chondromatosis in a mono-articular process.",
"Although aspiration did not show crystals, the long history of arthritis with chondrocalcinosis at the ... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-1",
"R-5"
] | I used Variant 1’s Step 1 as the composite Step 1 to preserve the prerequisite-omission error (skipping initial crystal arthropathy adjudication before moving to PSC/chondrosarcoma framing). I then kept a brief aspiration-related bridging step (adapted from Variant 3’s notion that crystals can be missed) to allow the n... | [
{
"error_description": "",
"error_step_indices": [
1
],
"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... | [
1,
2,
3,
4
] | medprmbench_00235 | [
1,
2,
3,
4
] | [] | [
"Crystal arthropathy (gout) was considered because of the long history of arthritis and mild hyperuricaemia — “the long clinical history and bilateral polyarthopathy with involvement of MCP joints, periarticular soft-tissue mineralization and mild hyperuricaemia on his blood investigations raised the possibility of... | A 78-year-old right-handed man presented with a 7-year history of soft-tissue swelling on his right wrist, recently increasing in size and accompanied by new tingling and numbness in the median-nerve distribution and progressive functional impairment. He had longstanding bilateral wrist arthritis managed with oral anal... | Critical | 1 | test | null | null | null |
false | Ruptured subserosal uterine leiomyoma | Hemoperitoneum from spontaneous rupture of a degenerating subserosal uterine leiomyoma | [
"Ruptured ectopic pregnancy was considered but excluded by a negative pregnancy test — “the result of her pregnancy test was negative.”",
"Hemorrhagic ovarian cyst was considered but excluded when ultrasonography showed “both ovaries were normal.”",
"Ruptured ovarian cyst was considered unlikely because ovarian... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-3",
"R-5",
"R-6"
] | I kept Steps 1–2 aligned with the original. I replaced Step 3 with Variant 3’s contextual-misapplication rationale (R-3). For Step 4, I merged Variant 2’s incorrect degeneration-to-rupture mechanism (R-1) with Variant 1’s removal of operative confirmation (E-1) by making the final diagnosis based on ultrasound/clinical... | [
{
"error_description": "",
"error_step_indices": [
4
],
"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... | [
3,
4
] | medprmbench_00236 | [
3,
4
] | [] | [
"Ruptured ectopic pregnancy was considered but excluded by a negative pregnancy test — “the result of her pregnancy test was negative.”",
"Hemorrhagic ovarian cyst was considered but excluded when ultrasonography showed “both ovaries were normal.”",
"Ruptured ovarian cyst was considered but excluded when ultras... | A 38-year-old Persian woman, virgin, presented with sudden onset of right-sided abdominal pain that began in the right upper quadrant 2 hours earlier and was accompanied by one fainting episode. Her last menstrual period was 7 days ago. She reported no trauma or prior surgery. On examination, her pulse rate was 110 bea... | Major | 0.765 | test | null | 3 | 0 |
true | Infectious pseudochromhidrosis | Noninfectious pseudochromhidrosis due to exogenous pigment contamination | [
"Apocrine chromhidrosis was considered but deemed unlikely because the generalized distribution of the blue sweat made apocrine chromhidrosis less likely.",
"Apocrine chromhidrosis related to lipofuscin oxidation was further disfavored because the negative Wood’s lamp examination made a diagnosis of apocrine chro... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-2"
] | Both variants place their root-cause error at Step 4, so Step 4 was merged to simultaneously (a) assert the incorrect Wood’s lamp-based exclusion of infectious causes and favor exogenous pigment (R-1) while also (b) prematurely naming infectious pseudochromhidrosis without waiting for culture confirmation (E-1). Step 5... | [
{
"error_description": "",
"error_step_indices": [
4
],
"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... | [
4,
5
] | medprmbench_00237 | [
1,
2,
3,
4,
5
] | [] | [
"Apocrine chromhidrosis was considered but deemed unlikely — “the generalized distribution of the blue sweat made apocrine chromhidrosis less likely.”",
"Apocrine chromhidrosis related to lipofuscin oxidation was further disfavored — “the negative Wood’s lamp examination made a diagnosis of apocrine chromhidrosis... | A 15-year-old boy presented with a 7-month history of blue discoloration of his sweat. His dermatologic history was notable for atopic dermatitis treated with dupilumab injections every 14 days for 3 months, keratosis pilaris, pincer nail deformity, and chronic paronychia. He also had food and environmental allergies a... | Major | 0.835 | test | null | null | null |
false | Progressive multifocal leukoencephalopathy | JC virus–associated progressive multifocal leukoencephalopathy (PML) | [
"A cerebrovascular event was considered given the focal deficits, but angiography ruled out stenosis or occlusion — “There was no flow-limiting stenosis, occlusion, or aneurysm.”",
"CNS lymphoma recurrence was suspected due to his oncologic history, but PET imaging showed no active lesions — “PET scan revealed no... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-4",
"R-6"
] | I kept steps 1–3 from the original. From Variant 2, I replaced step 4 with the incorrect claim that normal ACE rules out neurosarcoidosis (R-1). For step 5, I merged Variant 1’s premature conclusion of PML without first using CSF JCV PCR (E-1) with Variant 3’s overconfident contradiction that CSF JCV PCR is clearly pos... | [
{
"error_description": "",
"error_step_indices": [
5
],
"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... | [
4,
5,
6
] | medprmbench_00238 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Step 1: A cerebrovascular event was considered given the focal deficits, but angiography ruled out stenosis or occlusion — “There was no flow-limiting stenosis, occlusion, or aneurysm.”",
"Step 2: CNS lymphoma recurrence was suspected due to his oncologic history, but PET imaging showed no active lesions — “PET ... | A 69-year-old man with stage IIIB follicular lymphoma, atrial fibrillation, and pulmonary sarcoidosis presented with two months of progressive dysarthria and right-sided weakness. He had completed six cycles of rituximab and bendamustine one year earlier for lymphoma. MRI of the brain showed multiple confluent T2-weigh... | Major | 0.73 | test | null | 3 | 0 |
true | scleroderma esophagus | Achalasia | [
"Achalasia was considered because the barium swallow demonstrated classic imaging features — a dilated esophagus with distal narrowing and delayed emptying.",
"Given these classic barium swallow findings, achalasia is the most likely diagnosis.",
"The manometry pattern can be interpreted as severe outflow obstr... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-4",
"R-4",
"R-5"
] | I used Variant 1’s premature conclusion of achalasia after the barium swallow as the composite Step 2 to preserve the prerequisite-skipping E-1 error. I then incorporated Variant 3’s incorrect pathophysiologic claim about “burned-out” achalasia with hypotensive LES into Step 3 to retain the R-1 error while keeping the ... | [
{
"error_description": "",
"error_step_indices": [
2
],
"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... | [
2,
3,
4
] | medprmbench_00239 | [
1,
2,
3,
4,
5
] | [] | [
"Achalasia was considered because the barium swallow demonstrated classic imaging features — “Findings consistent with achalasia.”",
"Achalasia was excluded when manometry showed paradoxically low LES pressure inconsistent with impaired relaxation — “paradoxically, low LES pressure.”",
"Scleroderma esophagus wa... | A 44-year-old woman presents for evaluation of persistent gastroesophageal reflux. She has a 25-year history of GERD refractory to high-dose proton-pump inhibitors and reports sleeping in a recumbent position on a wedge to alleviate nighttime symptoms. Six years earlier, she was diagnosed with scleroderma and pulmonary... | Critical | 0.905 | test | null | null | null |
false | MulticentricReticulohistiocytosis | Multicentric reticulohistiocytosis | [
"Rheumatoid arthritis was considered due to symmetric polyarthritis — “Joint involvement often takes the form of symmetric polyarthritis … frequently impacting proximal interphalangeal (76%), knee (73%), and wrist (64%) joints.”",
"Psoriatic arthritis was considered among inflammatory arthritides — “From an arthr... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-5",
"R-7"
] | I preserved the original step structure and content wherever possible, then substituted Step 3 with Variant 1’s premature reactive-arthritis conclusion (introducing the prerequisite-sensitivity error) and substituted Step 10 with Variant 2’s statement deferring malignancy evaluation (introducing the safety-awareness er... | [
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
10
],
"error_type": "R-5",
"modified_steps": null
},
{
"error_description": "",
"error_step_in... | [
3,
10
] | medprmbench_00240 | [
3,
10
] | [] | [
"Rheumatoid arthritis was considered due to symmetric polyarthritis — “Joint involvement often takes the form of symmetric polyarthritis … frequently impacting proximal interphalangeal (76%), knee (73%), and wrist (64%) joints.”",
"Psoriatic arthritis was considered among inflammatory arthritides — “From an arthr... | A 38-year-old woman with no prior medical history tested positive for SARS-CoV-2 by PCR (August 24, 2021) and experienced mild rhinorrhea and fatigue. Ten days later, she noted persistent arthralgias affecting her shoulders, knees, and hands, with significant tenderness and decreased range of motion but without morning... | Major | 0.6086 | test | null | null | null |
true | pancreatic acinar cell carcinoma | Metastatic well-differentiated pancreatic neuroendocrine tumour (pancreatic tail primary with liver metastasis) | [
"Sarcoidosis was initially suspected based on erythema nodosum–like lesions, inflammatory markers, and arthralgia, so prednisolone was started.",
"Vasculitis was considered to explain eosinophilia and cholestatic liver enzyme abnormalities despite negative ANCA.",
"Other possibilities such as allergy or hepatic... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-5"
] | I kept steps 1–3 aligned with the original differential evolution. To integrate E-1 and R-5, I replaced the original immunohistochemistry-based exclusion/confirmation sequence with the variant’s premature imaging/marker-based definitive diagnosis and explicitly stated that tissue confirmation is unnecessary (step 4), t... | [
{
"error_description": "Prerequisite Sensitivity: skips the prerequisite confirmatory step of histopathology/immunohistochemical validation before concluding the tumor type, jumping directly from imaging and chromogranin A to a definitive diagnosis of metastatic well-differentiated pancreatic neuroendocrine tum... | [
4,
6
] | medprmbench_00241 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Sarcoidosis was initially suspected — “the rheumatologist’s provisional diagnosis was sarcoidosis and the patient commenced on oral prednisolone 15 mg…”",
"Vasculitis was considered for eosinophilia and abnormal LFTs — “the deranged liver function was of uncertain significance as was the eosinophilia, thought po... | A 71-year-old woman presented to her primary physician with dyspnoea, cough, and fever, treated as a lower respiratory tract infection. One month later, she developed painful erythematous lesions on both lower limbs with pedal edema, clinically consistent with erythema nodosum, along with tenderness of the hands, wrist... | Critical | 0.895 | test | null | null | null |
false | cervical spinal epidural venous engorgement | Cervical epidural venous engorgement due to intracranial hypotension after lumbar puncture | [
"Epidural abscess is considered because the cervical MRI shows a 76 mm long and 8 mm thick ventral enhancing process suspicious for abscess versus hematoma.",
"Epidural hematoma is favored because after lumbar puncture, a spinal epidural hematoma classically presents with a post-dural puncture positional headache... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-1",
"S-1"
] | I kept the overall structure from the original while incorporating each variant’s single injected error. From Variant 2, I replaced the hematoma consideration step with the incorrect evidence-based claim that positional headache and smooth ventral enhancement are classic for epidural hematoma (R-1) and retained the dow... | [
{
"error_description": "Incorrectly attributes post–lumbar puncture positional headache and smooth anterior epidural enhancement to spinal epidural hematoma, mischaracterizing both typical hematoma presentation and MRI enhancement patterns of acute epidural blood.",
"error_step_indices": [
2
],
... | [
2,
4,
5,
6
] | medprmbench_00242 | [
1,
2,
3,
4,
5,
6,
7
] | [] | [
"Epidural abscess — “a 76 mm long and 8 mm thick ventral enhancing process… suspicious for epidural abscess versus hematoma.”",
"Epidural hematoma — “a 76 mm long and 8 mm thick ventral enhancing process… suspicious for epidural abscess versus hematoma.”",
"Infectious meningitis — “no evidence of fever or menin... | A 42-year-old woman with a history of Barrett’s esophagus, erosive gastritis, and prior gastric sleeve surgery presented with a one-year history of progressive bilateral lower-extremity distal weakness and burning, which had advanced proximally to the knees and, more recently, was affecting her hands. On examination, s... | Critical | 0.94 | test | null | null | null |
false | ExtraskeletalEwingSarcoma | Intradural extraskeletal Ewing sarcoma (IEES) | [
"Myxopapillary ependymoma was initially suspected—“our case was initially assumed to be myxopapillary ependymoma tumor but was finally diagnosed as an extraskeletal Ewing sarcoma.”",
"Common intradural spinal tumors (ependymomas, astrocytomas, meningiomas) were considered given location and presentation—“The diag... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-3"
] | I kept steps 1–2 and 6–7 close to the original. I merged Variant 3’s age-based exclusion (R-3) into step 3 while also preserving Variant 1’s prerequisite omission (E-1) by not performing the full negative-marker exclusion before moving to an IEES conclusion in step 5. I incorporated Variant 2’s incorrect CD45/LCA claim... | [
{
"error_description": "Prerequisite Sensitivity: The chain omits the prerequisite immunohistochemical exclusion step (negative markers for carcinoma/rhabdomyosarcoma/lymphoma/melanoma/neuroendocrine tumors) before concluding Ewing sarcoma based on CD99/clinicoradiologic pattern.",
"error_step_indices": [
... | [
3,
4
] | medprmbench_00243 | [
3,
4,
5,
6,
7
] | [] | [
"Myxopapillary ependymoma was initially suspected—“our case was initially assumed to be myxopapillary ependymoma tumor but was finally diagnosed as an extraskeletal Ewing sarcoma.”",
"Common intradural spinal tumors (ependymomas, astrocytomas, meningiomas) were considered given location and presentation—“The diag... | A 58-year-old man with no significant past medical history presented with a 2-month history of mild lower back pain that responded to celecoxib. Over that time, he developed bilateral numbness along the back of his legs, worse on the left, consistent with S1 radiculopathy. A lumbosacral CT scan was unremarkable, and sy... | Major | 0.705 | test | null | null | null |
true | BoerhaaveSyndrome | Malignant pleural effusion from metastatic lung adenocarcinoma | [
"Pneumonia with parapneumonic effusion was initially suspected given imaging and presentation — “Cefepime ... were started for coverage of pneumonia with parapneumonic effusion.”",
"Malignant pleural effusion became the leading diagnosis because the pleural fluid cytology reportedly showed atypical gland-forming ... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-3",
"R-6"
] | I kept Step 1 aligned with the original. I merged Variant 2 and Variant 3 by combining their malignancy-anchoring content into a single Step 2: it simultaneously (a) invents positive cytology and a spiculated lung mass/lymphadenopathy (R-6) and (b) also includes the misapplied age-based claim about negative cytology be... | [
{
"error_description": "",
"error_step_indices": [
3
],
"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,
3,
5
] | medprmbench_00244 | [
2,
3,
4,
5
] | [] | [
"Pneumonia with parapneumonic effusion was initially suspected given imaging and presentation — “Cefepime ... were started for coverage of pneumonia with parapneumonic effusion.”",
"Malignant pleural effusion was considered given exudative fluid but was ruled out — “pleural fluid cytology was negative for maligna... | A 64-year-old man with hypertension, arthritis, seizure disorder, Parkinson’s disease, hiatal hernia, and chronic anemia presented with three months of non-bloody, non-bilious vomiting, decreased oral intake, one month of progressive weakness, and new dyspnea that left him bed-bound by the day before presentation. He t... | Critical | 0.84 | test | null | null | null |
false | thrombosed round ligament varicosity | Thrombosed round ligament varicosity | [
"The postpartum patient has a tender, erythematous, irreducible right groin mass extending into the vulva, which raises concern for an incarcerated inguinal hernia clinically.",
"Given the irreducibility, tenderness, erythema, and absent cough impulse, this should be treated as a strangulated inguinal hernia, and... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-2"
] | I kept Step 1 close to the original concern for incarcerated hernia. I merged Variant 2 (E-5) and Variant 3 (R-2) into a single Step 2 that both prematurely commits to strangulated hernia and reinterprets the serpentine imaging as herniated bowel/omentum, setting up the later contradiction. I then retained Variant 2’s ... | [
{
"error_description": "Prematurely narrows the differential to strangulated inguinal hernia and dismisses clinically important alternatives (notably thrombosed round ligament varicosity) despite imaging suggestive of a serpentine venous structure.",
"error_step_indices": [
2
],
"error_type": ... | [
2,
4
] | medprmbench_00245 | [
1,
2,
3,
4,
5
] | [] | [
"Incarcerated inguinal hernia — “Clinicians were concerned about an incarcerated inguinal hernia.”",
"Strangulated inguinal hernia — “A thrombosed RLV presents similarly to a strangulated inguinal hernia with an irreducible, erythematous, tender groin mass.” Exclusion: “They are differentiated by … recognizing th... | A 35-year-old G2P1 woman presented 7 days postpartum with a 1-day history of right groin swelling extending from the inguinal canal to the right vulva. On examination, there was an ~8-cm longitudinal right groin mass with ill-defined borders, erythema, and tenderness; the mass was irreducible, and a cough impulse was a... | Critical | 0.91 | test | null | null | null |
false | Grzybowski’s generalized eruptive keratoacanthomas | Generalized eruptive keratoacanthomas (Grzybowski type) | [
"Ferguson–Smith multiple KA was excluded because it is typically nonpruritic and affects younger patients in familial clusters.",
"Witten–Zak multiple KA was excluded because the Witten–Zak familial type is often found in association with prurigo simplex subacuta.",
"Localized pruritic multiple KA was unlikely ... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-3"
] | I used Variant 1’s omission-related jump to a Grzybowski-type diagnosis as the composite Step 7, thereby removing the prerequisite hematologic-malignancy exclusion step entirely while keeping the earlier differential steps intact. I then incorporated Variant 2’s HPV-related misinterpretation as the composite Step 9, ad... | [
{
"error_description": "Prerequisite Sensitivity error: the chain prematurely concludes generalized eruptive keratoacanthomas (Grzybowski type) without first completing the prerequisite exclusion of hematologic malignancy (CBC/FACS), making later non-hematologic reasoning unreliable.",
"error_step_indices":... | [
7,
9,
10
] | medprmbench_00246 | [
1,
2,
3,
4,
5,
6,
7,
8,
9,
10
] | [] | [
"Step 1: Ferguson‑Smith multiple keratoacanthoma was excluded because it is typically nonpruritic and affects younger patients in familial clusters.",
"Step 2: Witten‑Zak multiple keratoacanthoma was excluded because it is often found in association with prurigo simplex subacuta.",
"Step 3: Localized pruritic m... | A 51-year-old Caucasian man presented with a 10-month history of intensely pruritic papules on sun-exposed areas of his extremities, causing sleep disturbance. He had no prior dermatologic evaluation and no personal or family history of cancer. His medical history was significant for arterial hypertension, hyperuricemi... | Critical | 0.835 | test | null | 3 | 0 |
true | Adrenalcyst | Pancreatic pseudocyst | [
"Urinoma was considered because of the recent poorly managed urinary diversion but was ruled out intraoperatively when the cyst proved well-encapsulated and separable from the parietes — “a well capsulated cyst that easily stripped off the pariates rendering our initial diagnosis of urinoma improbable.”",
"Becaus... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-2",
"R-6",
"R-7"
] | I kept Step 1 from the original (no error there). For Step 2, I used Variant 1’s adrenal-cyst conclusion, preserving the prerequisite-sensitivity error by asserting adrenal cyst as most likely without adrenal secretory testing. For Step 3, I used Variant 3’s timeline-based deprioritization of lymphangioma, preserving t... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "R-7",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
4
] | medprmbench_00247 | [
2,
3,
4
] | [] | [
"Urinoma was considered because of the recent poorly managed urinary diversion but was ruled out intraoperatively when the cyst proved well-encapsulated and separable from the parietes — “a well capsulated cyst that easily stripped off the pariates rendering our initial diagnosis of urinoma improbable.”",
"A rena... | A 63-year-old man presented 10 days after suprapubic cystostomy for bladder outlet obstruction and hematuria. He reported an indefinite history of a left-sided abdominal mass but denied trauma, abdominal pain, or gastrointestinal symptoms. On examination he was septic, with an infected, draining cystostomy wound. His b... | Critical | 0.7175 | test | null | null | null |
true | Fibroadenoma | Lipoma | [
"Lymphoma is unlikely because the mass is solitary, mobile, well-defined, and the CBC/ESR and chest radiograph are normal, making a malignant lymphoproliferative process less probable.",
"Tuberculosis lymphadenitis is unlikely here because, in immunocompetent adults, TB lymphadenitis typically presents with const... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-3",
"R-6",
"R-7"
] | I used Variant 2’s overall narrowing-to-lipoma structure as the base because it changes steps 1, 3, and 4, then merged Variant 1 and Variant 3 into the tuberculosis step by combining their key elements: (a) ruling out TB solely on absent symptoms/normal CXR and moving on without targeted TB testing (E-1) and (b) the co... | [
{
"error_description": "",
"error_step_indices": [
2
],
"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,
3,
4
] | medprmbench_00248 | [
1,
2,
3,
4
] | [] | [
"Lymphoma was considered because an axillary mass can represent lymphadenopathy; “it may clinically mimic … lymphoma” but was excluded when “Lymphoid cells were not seen.”",
"Tuberculosis lymphadenitis was considered given the location of lymphadenopathy; “a provisional clinical impression of axillary lymphadenop... | A 28-year-old Ethiopian woman presented with a 3-year history of a left axillary swelling that was initially small but had progressively increased in size. She reported mild local discomfort but denied cough, fever, weight loss, night sweats, or other constitutional symptoms. Her medical history was unremarkable; she h... | Critical | 0.805 | test | null | null | null |
true | osteoid osteoma | Tension-type headache | [
"Eosinophilic granuloma was initially considered because of the classic central opacity (“button sequestrum”) in a lytic skull lesion — “with the initial diagnosis of eosinophilic granuloma, the patient underwent surgery for ablation of the lesion.”",
"Given the imaging pattern of a small central nidus with surro... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-1",
"R-4"
] | I kept Step 1 from the original/variants. I replaced Step 2 with Variant 1’s imaging-only conclusion to preserve the missing histopathology prerequisite (E-1). For Step 3, I combined Variant 3’s overconfident contradiction that imaging is entirely normal and consequent tension-type headache diagnosis (R-4) with Variant... | [
{
"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
] | medprmbench_00249 | [
1,
2,
3
] | [] | [
"Eosinophilic granuloma was initially considered but was excluded by histopathologic examination.",
"Osteoid osteoma was diagnosed based on histopathologic findings.",
"Other causes of a lytic skull lesion with surrounding sclerosis were considered less likely given the clinical and imaging features."
] | A 12-year-old girl presented with a 6-month history of dull, constant right‐sided head pain rated 7/10, exacerbated by combing her hair. She denied trauma. Examination showed moderate tenderness over the right parietal bone without palpable mass or neurologic deficits. One month earlier she had undergone appendectomy c... | Major | 0.7583 | test | null | 3 | 0 |
true | tuberculosis | Serohepatic tuberculosis | [
"Considered serohepatic tuberculosis given the combination of subcapsular collections and capsular enhancement — “There is a mild subcapsular collection in the liver with a few subcapsular hypodense lesions, and thickening and enhancement of the liver capsule and sub capsule.”",
"Considered bacterial or fungal mi... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-3",
"S-2"
] | I kept the original step structure but replaced Step 3 with Variant 2’s adult-metastasis-leading heuristic (R-3) and replaced Step 5 with Variant 3’s tautological lymphoma rationale (S-2). To integrate Variant 1 (E-1), I removed the original confirmatory AFB/cytology step and instead used Variant 1’s imaging-only concl... | [
{
"error_description": "Prerequisite sensitivity error: skips the critical confirmatory step (aspiration cytology/AFB detection) and jumps from imaging-based suspicion directly to a definitive tubercular diagnosis.",
"error_step_indices": [
6
],
"error_type": "E-1",
"modified_steps": [
... | [
3,
5,
6
] | medprmbench_00250 | [
3,
5,
6,
7
] | [] | [
"Considered serohepatic tuberculosis given the combination of subcapsular collections and capsular enhancement — “There is a mild subcapsular collection in the liver with a few subcapsular hypodense lesions, and thickening and enhancement of the liver capsule and sub capsule.”",
"Considered bacterial or fungal mi... | A 17-year-old previously healthy male presented with a 6-week history of dull, poorly localized abdominal discomfort. He reported evening fevers up to 101.4°F without chills or rigor but with significant diaphoresis, and an 8-kg weight loss over 6 months. Laboratory studies showed a C-reactive protein level of 6.2 mg/L... | Major | 0.725 | test | null | null | null |
true | immune-related adverse event | Takotsubo (stress) cardiomyopathy with Horner syndrome and pembrolizumab-induced thyroiditis causing hypothyroid myopathy | [
"Myasthenia gravis was considered given ptosis and dysphagia, but negative anti-AChR/LRP4 antibodies and the prominent cardiac conduction disease make MG less likely as the unifying diagnosis.",
"Lambert-Eaton syndrome was considered due to proximal muscle weakness, but the negative anti-VGCC antibodies and lack ... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-4",
"R-1"
] | I kept the overall 6-step structure of the original chain while combining the specific corrupted content from each single-error variant. Step 3 was replaced with the R-1 mischaracterization of Horner syndrome, and Step 4 was adapted to retain the R-1 downstream redirection toward ACS while also incorporating the E-4 tr... | [
{
"error_description": "Incorrectly claims Horner syndrome commonly causes bilateral ptosis and bulbar symptoms (dysarthria/dysphagia), making it seem like a plausible explanation and redirecting the differential away from ICI-related neuromuscular disease and toward non-inflammatory/cardiac explanations.",
... | [
3,
4,
5
] | medprmbench_00251 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Myasthenia gravis was considered given ptosis and dysphagia – “Once the diagnostic process was completed, Myasthenia gravis … could be excluded as possible differential diagnoses.”",
"Lambert-Eaton syndrome was considered due to proximal muscle weakness – “Once the diagnostic process was completed, … Lambert Eat... | A 78-year-old woman with osseous and pulmonary metastatic endometrial carcinoma receiving pembrolizumab (200 mg every 3 weeks; three cycles completed, last dose 12 days before admission) presented with 10 days of bilateral but left-predominant ptosis, new dysphagia, dysarthria, and head drop due to inability to sustain... | Critical | 0.94 | test | null | null | null |
true | Reverse Takotsubo syndrome | Acute pulmonary embolism (with left popliteal deep vein thrombosis) | [
"Myocardial infarction — an emergent coronary angiography was performed that excluded coronary artery disease.",
"Pulmonary embolism — In addition to CT excluding PE, her markedly elevated D-dimer (3,200 ng/mL FEU) and bedside venous Doppler showing an acute left popliteal DVT strongly support an acute pulmonary ... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-6",
"S-2"
] | I kept the original 7-step structure and merged the single corrupted steps from each variant at their respective positions: Step 2 from the R-6 variant (adding fabricated D-dimer/DVT evidence despite negative CT), Step 4 from the S-2 variant (tautological exclusion of peripartum cardiomyopathy), and Step 5 from the E-1... | [
{
"error_description": "Prerequisite Sensitivity error: myocarditis is ruled out without performing the prerequisite confirmatory evaluation (e.g., cardiac MRI or other myocarditis workup) before using that exclusion to narrow the differential.",
"error_step_indices": [
5
],
"error_type": "E-1... | [
2,
4,
5
] | medprmbench_00252 | [
1,
2,
3,
4,
5,
6,
7
] | [] | [
"Myocardial infarction — “an emergent coronary angiography was performed that excluded coronary artery disease.”",
"Pulmonary embolism — “Both pulmonary embolism … were excluded.”",
"Acute aortic syndrome — “acute aortic syndrome were excluded.”",
"Peripartum cardiomyopathy — “midventricular and basal balloon... | A 36-year-old woman, 8 months postpartum and still breastfeeding, with no prior medical history, presented to the emergency department with sudden onset of dyspnea, palpitations, and oppressive chest pain radiating to her left shoulder for more than 1 hour. She denied recent emotional stress, infection, or medication u... | Critical | 0.91 | test | null | null | null |
true | acute respiratory distress syndrome | Gadolinium-induced pulmonary thrombotic microangiopathy | [
"Cardiogenic pulmonary edema was excluded — “B-type natriuretic peptide and troponin levels were low, and the echocardiogram was normal.”",
"Pulmonary embolism was reconsidered as possible despite CT pulmonary angiography — using the D-dimer quantitatively: D-dimer 1.7 mg/mL = 1700 ng/mL (since 1 mg/mL = 1000 ng/... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-3",
"R-6"
] | I kept Step 1 from the original. I replaced Step 2 with the quantitative-error variant’s PE/D-dimer conversion argument. I then used Variant 1’s thrombotic-microangiopathy distractor as Step 3 (keeping its fabricated ISTH claim) so it could coexist with the PE push from Step 2 while still flowing as an alternative thro... | [
{
"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,
5
] | medprmbench_00253 | [
2,
3,
4,
5,
6
] | [] | [
"Cardiogenic pulmonary edema was excluded — “B-type natriuretic peptide and troponin levels were low, and the echocardiogram was normal.”",
"Pulmonary embolism was ruled out — “A CT pulmonary angiography ruled out the diagnosis of pulmonary embolism.”",
"Sepsis-related ARDS was considered unlikely — “the absenc... | A 15-year-old previously healthy girl underwent contrast-enhanced pelvic MRI with a gadolinium-based agent for evaluation of persistent pelvic pain. A few minutes after receiving gadolinium, she developed shortness of breath, chest pain, dizziness, nausea, and vomiting, and presented to the emergency department. On arr... | Critical | 0.8217 | test | null | null | null |
false | Erdheim-Chester disease | Erdheim–Chester disease | [
"Although xanthogranulomatous pyelonephritis (XPG) is often unilateral and linked to stones/UTIs, this patient already has biopsy-proven xanthomatous histiocytes and chronic inflammatory fibrosis, making recurrent/progressive XPG the most coherent explanation for the perinephric soft-tissue process and ureteral obs... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-6"
] | I kept the overall 5-step structure of the original chain, but replaced Step 1 with Variant 2’s narrowed, XPG-centric framing to embed the E-5 differential-coverage error. I retained the original Step 2 (IgG4 exclusion) unchanged. For Step 3, I merged Variant 1’s premature conclusion of Erdheim–Chester disease (creatin... | [
{
"error_description": "Prematurely narrows the differential to progressive/recurrent XPG as the single best diagnosis and dismisses broader worst-first malignant/systemic alternatives without a systematic differential framework, leading to an overly infection-focused framing.",
"error_step_indices": [
... | [
1,
3
] | medprmbench_00254 | [
1,
2,
3
] | [] | [
"Xanthogranulomatous pyelonephritis was considered, but “XPG is a rare form of unilateral chronic pyelonephritis, affecting mostly peri‐menopausal women, associated with obstructive renal calculi and a history of recurrent urinary tract infections, mostly Proteus Mirabilis and Escherichia Coli.”",
"IgG4-related d... | A 69-year-old man was admitted with severe left back pain, acute kidney injury, and an inflammatory syndrome. Two years earlier, he had been diagnosed with bilateral xanthogranulomatous pyelonephritis after abdominal CT showed diffuse bilateral irregular perinephric soft-tissue thickening with ureteral dilatation, and ... | Major | 0.665 | test | null | null | null |
false | pseudoaneurysm | Radiation-induced pseudoaneurysm of a left internal iliac artery branch eroding into the rectum | [
"Given the history of pelvic radiotherapy and the endoscopic finding of focal pulsations in friable necrotic rectal mucosa with brisk hematochezia, the most likely etiology is a radiation-induced pseudoaneurysm involving a pelvic arterial branch eroding into the rectal wall.",
"Traumatic or iatrogenic pseudoaneur... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-3"
] | I used Variant 1’s premature conclusion as the new Step 1 to preserve the prerequisite-skip error (E-1). I retained the original traumatic/iatrogenic exclusion as a subsequent step for continuity. I then replaced the cancer-associated PSA exclusion with Variant 3’s prostate-radiotherapy-based rationale (R-3). I kept th... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "R-3",
"modified_steps": null
}
] | [
1,
3
] | medprmbench_00255 | [
1,
2,
3,
4,
5
] | [] | [
"Traumatic or iatrogenic pseudoaneurysm considered — “The most common causes of PSAs are iatrogenic or traumatic. However in our case, prior procedures ... were distant from the location of the LIIA branch PSA. The contrast enhanced CT ... did not show any PSA. Thus the possibility of this PSA being secondary to tr... | A 48-year-old man with a history of rectal adenocarcinoma (initial clinical stage T2N0M0) treated by low anterior resection followed by adjuvant pelvic radiotherapy (4500 cGy in 25 fractions plus 900 cGy boost) and concurrent capecitabine chemotherapy presented 2 years later with multiple episodes of syncope and progre... | Critical | 0.875 | test | null | null | null |
true | Seromucinous hamartoma | Infected congenital dacryocystocele (nasolacrimal duct cyst) | [
"Consider congenital and sinonasal causes of a medial canthal mass in a child, including dermoid/epidermoid, glioma/encephalocele, vascular lesions, inflammatory lesions, and sinonasal epithelial lesions.",
"Given a well-defined expansile cystic lesion centered in the agger nasi/anterior ethmoid region with orbit... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-2",
"R-1"
] | I used Variant 1’s structure to preserve the E-1 omission by removing the intracranial-connection exclusion step entirely and making Step 2 an immediate mucocele conclusion from imaging. I then merged Variant 2 and Variant 3 into the same later root-cause step (Step 4) by combining the fabricated guideline/statistics f... | [
{
"error_description": "Prerequisite Sensitivity: The chain jumps to diagnosing an anterior ethmoid/agger nasi mucocele based on imaging before completing the prerequisite systematic exclusion of lesions with intracranial connection (e.g., encephalocele/glioma via dedicated skull-base/intracranial continuity as... | [
2,
4
] | medprmbench_00256 | [
1,
2,
3,
4,
5
] | [] | [
"Step 1: Congenital midline nasal masses (nasal glioma, encephalocele, dermoid, epidermoid, teratoma, hemangioma) should be considered in the differential diagnosis of a medial canthal mass.",
"Step 2: The absence of Furstenberg sign and imaging (CT showing no skull base erosion or bone remodeling, MRI showing no... | A 2-year-old girl was brought by her parents with a one-year history of a mass at the right medial canthal area, noted to enlarge during upper respiratory infections. There was intermittent purulent discharge from the right eye, and she had been treated several times for presumed bacterial conjunctivitis. There was no ... | Critical | 0.94 | test | null | 2 | 1 |
true | adenosarcoma | Low-grade extrauterine endometrial stromal sarcoma arising in endometriosis | [
"The markedly elevated CA-125/HE4 with ascites, omental thickening, and a vascular solid-cystic adnexal mass essentially confirms advanced epithelial ovarian carcinoma, so alternative causes of ascites/omental thickening (e.g., metastatic GI malignancy, primary peritoneal carcinoma, tubal carcinoma, or uterine sarc... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-6"
] | I combined Variant 2’s Step 1 (prematurely “confirming” advanced epithelial ovarian carcinoma and dismissing alternatives) with Variant 1’s Step 2 (diagnosing low-grade ESS directly from IHC without the prerequisite comprehensive histopathologic distinction from adenosarcoma). I then used Variant 3’s Step 3 to preserve... | [
{
"error_description": "Prematurely narrows the differential to advanced epithelial ovarian carcinoma based on markers/imaging and explicitly deprioritizes other high-risk alternatives; this narrowed framing also propagates by downplaying the need for careful pathology-based distinctions.",
"error_step_indi... | [
1,
2,
3
] | medprmbench_00257 | [
1,
2,
3,
4
] | [] | [
"Final Diagnosis: adenosarcoma. Initial logic and parameters are validated.",
"Standard processing applied.",
"Standard processing applied.",
"The final diagnosis was adenosarcoma with sarcomatous overgrowth, based on the presence of both benign epithelial glands and a malignant sarcomatous stromal component ... | A 77-year-old multiparous woman presented with a 2-week history of generalized abdominal pain and distention. She had undergone menopause at age 50 and had a history of dysmenorrhea without prior gynecologic follow-up. On examination, mild to moderate ascites was noted. Pelvic ultrasound showed severe abdominopelvic as... | Critical | 0.875 | test | null | 3 | 0 |
false | letrozole-induced hypercalcemia | Letrozole-induced hypercalcemia | [
"Malignancy-related hypercalcemia was considered and excluded — “parathyroid hormone related peptide was 0.28 pmol/L … and bone scan was normal, thus making malignancy-related hypercalcemia unlikely.”",
"Primary hyperparathyroidism was considered and excluded — “although serum phosphorus was normal and iPTH was n... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-3",
"R-5"
] | I kept the original step structure but substituted in the corrupted versions from each single-error variant at their respective root-cause steps: Variant 1 replaced Step 3 to omit the confirmatory FHH biochemical prerequisite (E-1); Variant 3 replaced Step 11 to inappropriately keep pituitary causes on the differential... | [
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
11
],
"error_type": "R-3",
"modified_steps": null
},
{
"error_description": "",
"error_step_in... | [
3,
11,
13,
14
] | medprmbench_00258 | [
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14
] | [] | [
"Final Diagnosis: letrozole-induced hypercalcemia. Initial logic and parameters are validated.",
"Standard processing applied.",
"Standard processing applied.",
"Standard processing applied.",
"Standard processing applied.",
"Standard processing applied.",
"Standard processing applied.",
"Standard pro... | A 52-year-old woman was referred for evaluation of mild hypercalcemia discovered during routine oncologic follow-up. One year earlier she had undergone left mastectomy for estrogen-receptor–positive, progesterone-receptor–positive, HER2-negative breast cancer and had been taking letrozole 2.5 mg daily for the past 10 m... | Major | 0.555 | test | null | 3 | 0 |
true | Chronic subdural hematoma | Subdural hygroma due to intracranial hypotension after dural puncture (post–spinal anesthesia) | [
"Primary headaches were considered because postpartum headaches are quite common (39%), and the majority are primary headaches such as migraine, tension-type, and cluster headache and are therefore considered first in the differential diagnosis.",
"Given the recent spinal anesthesia and persistent postpartum head... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-1",
"R-6"
] | I kept Step 1 aligned with the original. For Step 2, I replaced the original PDPH exclusion with Variant 1’s premature assumption of PDPH, preserving the prerequisite-skip error (E-1). Step 3 was merged to simultaneously include Variant 2’s premature narrowing to subdural hygroma with dismissal of other dangerous cause... | [
{
"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
] | medprmbench_00259 | [
1,
2,
3,
4,
5
] | [] | [
"Primary headaches were considered because “Postpartum headaches are quite common (39%); majority of them are primary headaches such as migraine, tension‐type, and cluster headache and are therefore considered first in the differential diagnosis.”",
"Post-dural puncture headache was considered but excluded becaus... | A 25-year-old woman presented with a 3-day history of a persistent, progressive, non-postural headache. The headache was insidious in onset and was not associated with nausea, vomiting, altered consciousness, focal weakness, or numbness. Sixteen days earlier, she underwent a lower segment cesarean section under spinal ... | Critical | 0.94 | test | null | null | null |
true | Leber hereditary optic neuropathy | Neuromyelitis optica spectrum disorder (NMOSD) presenting with optic neuritis | [
"The sequential, painless central vision loss with optic disc hyperemia/pseudopapilledema and peripapillary telangiectatic vessels (without fluorescein leakage), along with basal ganglia involvement and dystonia, is most consistent with Leber hereditary optic neuropathy (LHON) with neurologic features (LHON-plus)."... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-2",
"R-6"
] | I used Variant 1’s Step 1 to implement the prerequisite-omission jump to LHON-plus (E-1) and kept the remainder structure. I then replaced Steps 2–5 with Variant 2’s leukodystrophy-leaning sequence to preserve the galactocerebrosidase state reversal and its downstream propagation (R-2). Finally, I replaced the last ste... | [
{
"error_description": "",
"error_step_indices": [
1
],
"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... | [
1,
2,
6
] | medprmbench_00260 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Demyelinating or inflammatory neurologic disease was considered — “Cerebrospinal fluid analysis showed … normal cell count … and no cerebrospinal fluid–specific oligoclonal bands.”",
"Krabbe disease was considered — “Galactocerebrosidase enzyme levels in lymphocytes … were normal.”",
"Adrenoleukodystrophy was ... | An 18-year-old male first noted right-sided dystonia at age 15. At 16, neurologic examination showed right arm rigidity, bilateral postural tremor of the hands (right dominant), and an inward-turning right foot posture when walking. Cerebrospinal fluid analysis revealed normal cell count, protein, and glucose concentra... | Critical | 0.91 | test | null | 3 | 0 |
false | Xanthogranuloma | Juvenile xanthogranuloma of the limbus | [
"The presentation is most consistent with a benign ocular surface lesion related to chronic contact lens wear and rubbing; given the well-circumscribed yellow limbal mass with superficial corneal extension and vascularization, the most likely diagnosis is a limbal dermoid/epibulbar choristoma.",
"Because dermoids... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-2"
] | I kept the question unchanged. I used Variant 2’s narrowing-to-dermoid framing as the early chain context and preserved its dismissal of broad differential/biopsy as the E-5 root-cause at step 2. To integrate Variant 1 (E-1), I inserted a step that makes a direct clinical leap to juvenile xanthogranuloma without first ... | [
{
"error_description": "Prematurely narrows the differential to limbal dermoid/choristoma based on appearance/age and dismisses a systematic worst-first differential (omitting important malignant/lymphoproliferative/histiocytic possibilities), asserting noninvasive assessment is sufficient and downplaying the n... | [
2,
3
] | medprmbench_00261 | [
1,
2,
3,
4
] | [] | [
"Wide clinical differential diagnosis considered, including dermoid, lipoderma, pyogenic granuloma, lymphoproliferative disorders, histiocytic disorders, and benign and malignant neoplasms—“The differential diagnosis of yellowish limbal mass includes dermoid, lipoderma, pyogenic granuloma, lymphoproliferative disor... | A 27-year-old man presented with irritation and a yellowish mass in his left eye. He had worn soft contact lenses monthly for more than 10 years, frequently sleeping in them and rubbing his left eye because of itching. Two months before presentation, he felt a tiny mass at the superior limbus, which gradually enlarged.... | Critical | 0.875 | test | null | null | null |
true | mucormycosis | Zoster ophthalmicus with orbital apex syndrome | [
"Bell’s palsy was considered but excluded because of involvement of ocular motor and trigeminal nerves rather than the facial nerve — these findings suggest 3rd, 4th, and 6th cranial nerves involvement rather than 7th (facial nerve) involvement.",
"Optic neuritis was considered but excluded by the presence of oph... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-3",
"R-5"
] | I kept steps 1–2 aligned with the original (excluding Bell’s palsy and optic neuritis). To integrate both E-1 and E-3, I merged their corrupted content into a single composite step 3: it simultaneously (a) claims orbital cellulitis is the only reasonable diagnosis and inappropriately discourages early antifungal/antivi... | [
{
"error_description": "Prerequisite Sensitivity: skips the prerequisite imaging-confirmation step and jumps from clinical findings to diagnosing cavernous sinus thrombosis, then uses that unconfirmed diagnosis to support mucormycosis.",
"error_step_indices": [
3
],
"error_type": "E-1",
"m... | [
3,
4
] | medprmbench_00262 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Bell’s palsy was considered but excluded because of involvement of ocular motor and trigeminal nerves rather than the facial nerve — “These findings suggest 3rd, 4th, and 6th cranial nerves involvement rather than 7th (facial nerve) involvement, excluding the possibility of Bell’s palsy and optic neuritis.”",
"O... | A 34-year-old woman with a history of gestational diabetes and COVID-19 infection 30 days earlier presented with 3 weeks of worsening left facial pain and recent loss of vision and movement on the left side. Her COVID-19 course lasted 10 days, during which she received multiple outpatient steroid injections. One week b... | Critical | 1 | test | null | null | null |
true | Diabetic papillopathy | Non-arteritic anterior ischemic optic neuropathy (NA-AION) | [
"Infectious/inflammatory optic neuropathies are considered in the differential of disc swelling with hemorrhages and acute vision loss.",
"Central retinal vein occlusion is considered given hemorrhages and edema.",
"Idiopathic intracranial hypertension is considered as a cause of optic disc swelling.",
"Hyper... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-2",
"R-3"
] | I kept the overall differential structure from the original while importing each variant’s corrupted component at its respective step: (1) I used Variant 2’s hypertensive-retinopathy step that implicitly asserts markedly elevated blood pressure, creating the intended step-consistency contradiction (root at composite St... | [
{
"error_description": "",
"error_step_indices": [
5
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
4,
8
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error... | [
4,
5,
7,
8,
9
] | medprmbench_00263 | [
1,
2,
3,
4,
5,
6,
7,
8,
9,
10
] | [] | [
"Infectious/inflammatory optic neuropathies considered — “Although the differential diagnosis of DP includes a variety of entities such as infectious/inflammatory optic neuropathies…”",
"Central retinal vein occlusion considered — “Although the differential diagnosis of DP includes…central retinal vein occlusion…... | A 60-year-old woman with poorly controlled type 2 diabetes mellitus (last HbA1c, 10.9%) presented with a 3-day history of acute visual loss in the right eye. She was taking oral hypoglycemic agents. Visual acuity was 6/360 in the right eye and intraocular pressures were 15 mmHg bilaterally. She was phakic and had a nor... | Critical | 0.91 | test | null | null | null |
false | mesenteric lymphangioma | Mesenteric cyst (small-bowel mesenteric lymphangioma) | [
"Acute intussusception was initially considered given the acute abdominal pain and intermittent palpable mass—“one case of acute intussusception.”",
"Mesenteric lipoma was suggested among intra-abdominal tumors due to the presence of a mass on imaging—“three cases of abdominal tumors (mesenteric lipoma, duodenal ... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-1",
"S-1"
] | Used the S-1 variant’s expanded structure by inserting the two redundant workup steps immediately after the initial mesenteric lipoma consideration, preserving their wording as the simplicity error. Replaced the original peritoneal abscess exclusion step with the R-1 corrupted version that (incorrectly) favors abscess ... | [
{
"error_description": "Prerequisite Sensitivity: the chain jumps to diagnosing a mesenteric cyst/lymphangioma from nonenhancing cystic imaging without first completing the prerequisite localization/differentiation step to confirm the lesion is truly mesenteric (vs duplication/omental/ovarian/other cyst) based ... | [
3,
4,
9,
11
] | medprmbench_00264 | [
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15
] | [] | [
"Acute intussusception was initially considered given the acute abdominal pain and intermittent palpable mass—“one case of acute intussusception.”",
"Mesenteric lipoma was suggested among intra-abdominal tumors due to the presence of a mass on imaging—“three cases of abdominal tumors (mesenteric lipoma, duodenal ... | A 71-year-old woman presented with a one-week history of periumbilical abdominal pain accompanied by fever, diarrhea, and passage of blood per rectum. She had no history of trauma. Her medical history was notable only for a recent urinary tract infection; she had no known chronic gastrointestinal or systemic illnesses.... | Major | 0.6017 | test | null | null | null |
false | Paralepistopsis acromelalga intoxication | Paralepistopsis acromelalga intoxication | [
"Autoimmune diseases — considered because erythromelalgia can be secondary to autoimmune disorders: “The differential diagnoses of acute and severe pain on the extremities, which appear as erythromelalgia, are numerous and include autoimmune diseases…”; excluded because “No other concomitant symptoms, including gas... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-4",
"S-1"
] | I used the expanded step structure from the S-1 variant (adding the redundant infection/toxin testing steps) and replaced the infectious-disease assessment with the R-4 overconfident, fact-contradicting claim of fever/hemodynamic instability, carrying that false premise forward into later infectious-framing exclusions.... | [
{
"error_description": "Prerequisite Sensitivity: The chain jumps to paralepistopsis acromelalga intoxication without first completing the prerequisite confirmation step (confirming ingestion and/or identifying the mushroom species), making the conclusion depend on an unverified prerequisite.",
"error_step_... | [
2,
3,
4,
7
] | medprmbench_00265 | [
2,
3,
4,
5,
6,
7,
8
] | [] | [
"Autoimmune diseases — considered because erythromelalgia can be secondary to autoimmune disorders: “The differential diagnoses of acute and severe pain on the extremities, which appear as erythromelalgia, are numerous and include autoimmune diseases…”; excluded because “No other concomitant symptoms, including gas... | A 62-year-old woman with well-controlled type 2 diabetes mellitus presented with a 2-day history of burning sensation and numbness in both hands and feet. The symptoms were exacerbated by standing and weight-bearing during walking and by warm stimulation such as bathing. She denied fever, gastrointestinal symptoms, or ... | Critical | 0.7612 | test | null | null | null |
true | foreign-body reaction | Prosthetic aorto–bi-iliac vascular graft infection | [
"Diffuse increased FDG uptake (SUVmax 5.4) along the aorta–bi-iliac graft region two months after surgery most strongly suggests an early postoperative prosthetic vascular graft infection because any increased uptake at this stage is unlikely to be benign.",
"Alternative explanations such as an infected haematoma... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-1",
"R-5",
"R-7",
"S-1"
] | I used Variant 1 as the backbone to preserve the E-1 omission/jump-to-infection framing (placing it in composite step 1 and maintaining the infection conclusion in the final step). I then incorporated Variant 2’s timing-based claims by rewriting the postoperative/foreign-body interpretation into a two-month resolution ... | [
{
"error_description": "",
"error_step_indices": [
1,
5,
6
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
5,
6
],
"error_type": "R-7",
"modified_steps": null
},
{
"error_descriptio... | [
1,
3,
4,
5,
6,
7
] | medprmbench_00266 | [
1,
2,
3,
4,
5,
6,
7
] | [] | [
"Prosthetic vascular graft infection — “focal increased FDG uptake in the region of any of the vascular grafts, with intensity higher than that of surrounding tissues, was defined as an infectious process.”",
"Infected haematoma adjacent to the graft — “Two false positive PET/CT results were related to FDG uptake... | A 64-year-old man underwent left radical nephrectomy, splenectomy, and aorta–bi-iliac grafting two months ago for renal cell carcinoma and infrarenal abdominal aortic aneurysm. He was referred for FDG-PET/CT for cancer restaging. He had no fever, local pain, or bacteraemia. Laboratory tests, including erythrocyte sedim... | Critical | 0.91 | test | null | null | null |
false | thymoma-associated multiorgan autoimmunity | Thymoma-associated multiorgan autoimmunity (TAMA) | [
"Lichen planus — “Given the clinical presentation, a diagnosis of lichen planus was favored versus lichen planus-like GVHD in the setting of TAMA.”",
"Lichen planus–like GVHD — “Given the clinical presentation, a diagnosis of lichen planus was favored versus lichen planus-like GVHD in the setting of TAMA.”",
"S... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-3",
"R-6"
] | I kept Steps 1–3 aligned with the original/variant language. To integrate E-1 and R-6, I replaced the original Step 4 (morphea differential) with Variant 1’s premature jump to TAMA (omitting explicit morphea evaluation) while also incorporating Variant 3’s fabricated ANA/anti–Scl-70 serologies into that same step, pres... | [
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
4,
5
] | medprmbench_00267 | [
4,
5
] | [] | [
"Lichen planus — “Given the clinical presentation, a diagnosis of lichen planus was favored versus lichen planus-like GVHD in the setting of TAMA.”",
"Lichen planus–like GVHD — “Given the clinical presentation, a diagnosis of lichen planus was favored versus lichen planus-like GVHD in the setting of TAMA.”",
"S... | A 52-year-old woman presented with a generalized pruritic rash. Her history included malignant thymoma status post multiple resections, secondary myasthenia gravis, Good’s syndrome treated with monthly subcutaneous immunoglobulin, and T-cell large granular lymphocytic leukemia. She suffered recurrent pulmonary infectio... | Major | 0.595 | test | null | null | null |
false | Odontogenic carcinosarcoma | Odontogenic carcinosarcoma | [
"Considered benign ameloblastoma because of a painless mandibular mass — “Slow‐growing nature of AB typically presents as a painless mass”; excluded after biopsy revealed “prominent cellular atypia, nuclear pleomorphism, and numerous mitotic figures.”",
"The MRI findings are definitively benign and completely nor... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-4",
"R-6"
] | I kept Step 1 from the original. I merged Variant 1’s prerequisite-skipping jump-to-OCS into Step 2 while also incorporating Variant 2’s overconfident, stem-contradicting MRI claims into the same Step 2, preserving both errors simultaneously. To maintain narrative coherence with the introduced (false) imaging stance, I... | [
{
"error_description": "Prerequisite Sensitivity: the chain prematurely jumps to odontogenic carcinosarcoma at Step 2 without first completing the necessary differential workup (notably fully ruling out key competing biphasic odontogenic entities such as ameloblastic fibrosarcoma) before committing to the final... | [
2,
5
] | medprmbench_00268 | [
2,
3,
4,
5
] | [] | [
"Considered benign ameloblastoma because of a painless mandibular mass — “Slow‐growing nature of AB typically presents as a painless mass”; excluded after biopsy revealed “prominent cellular atypia, nuclear pleomorphism, and numerous mitotic figures.”",
"Considered ameloblastic carcinoma given cortical perforatio... | A 60-year-old man presented with a 6-month history of painless swelling on the right side of his face, associated with progressive facial asymmetry. His medical history was noncontributory. On examination, there was a large, purple, fluctuant mass overlying the right posterior mandibular body and ramus without cranial ... | Critical | 0.805 | test | null | null | null |
true | Metformin-associated encephalopathy | Methanol intoxication | [
"Uremic encephalopathy was considered because ESRD and the lentiform fork sign can occur in metabolic acidosis from uremia — “The lentiform fork sign is nonspecific and nondiagnostic, and it has wide differential diagnosis which includes uremic encephalopathy with metabolic acidosis, owing to deranged neurotransmis... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-5",
"R-6"
] | I kept Step 1 close to the original. For Step 2, I merged Variant 1’s unsupported conclusion of methanol as most likely (E-1) with Variant 2’s incorrect evidence-based claims about osmolar gap/severe anion-gap acidosis requirements (R-1), preserving both errors simultaneously by presenting an internally inconsistent bu... | [
{
"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... | [
1,
2,
3,
4,
5
] | medprmbench_00269 | [
1,
2,
3,
4,
5
] | [] | [
"Final Diagnosis: Metformin-associated encephalopathy. Initial logic and parameters are validated.",
"Standard processing applied.",
"Standard processing applied.",
"Standard processing applied.",
"Metformin-associated encephalopathy was considered due to prolonged metformin use in ESRD and risk of accumula... | A 63-year-old man with type 2 diabetes mellitus, hypertension, and a remote cerebrovascular accident with minimal residual weakness has been on twice-weekly maintenance hemodialysis for 2 years. He presented with a 1-month history of decreased speech output and difficulty walking, and over the preceding 2 weeks he deve... | Major | 0.86 | test | null | 3 | 0 |
true | Amoebiasis | Obstructing right-sided colonic adenocarcinoma with hepatic metastases | [
"Perforated peptic ulcer disease was considered — “The general surgeon was consulted for a differential diagnosis, including perforated peptic ulcer disease and a neoplasm.”",
"The imaging pattern of irregular right-sided colonic wall thickening with luminal narrowing and omental nodularity plus hypodense nonenha... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-5",
"R-1",
"R-3"
] | I used Variant 1’s Step 2 structure (CT deemed sufficient for definitive metastatic colon cancer) as the backbone to preserve the prerequisite-skipping error (E-1), and merged Variant 3’s added immunocompromised-host heuristic into the same Step 2 to also embed the contextual applicability error (R-3). I then replaced ... | [
{
"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_00270 | [
2,
3,
4
] | [] | [
"Perforated peptic ulcer disease was considered — “The general surgeon was consulted for a differential diagnosis, including perforated peptic ulcer disease and a neoplasm.”",
"Obstructing right-sided colonic carcinoma with liver metastases was considered — “After reviewing the clinical data and radiological imag... | A 54-year-old man presented with a 10-day history of diffuse, dull, nonradiating abdominal pain, high-grade fever, and three to four daily episodes of bloody diarrhea. He had traveled to Pakistan and over the preceding three months noted looser, more frequent stools but no prior history of diarrhea. His medical history... | Critical | 0.8225 | test | null | null | null |
false | Buschke-Lowenstein Tumor | Buschke-Lowenstein tumor (giant condyloma acuminatum) | [
"Squamous cell carcinoma was considered because of lymphadenopathy and invasive-appearing features but was excluded by histology showing no malignant cells — “…without signs of malignancy, the inguinal adenopathies are therefore of infectious origin and not metastatic.”",
"Secondary syphilis was considered due to... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-1",
"R-1",
"S-1"
] | I kept Step 1 and the infectious-mimic exclusion steps (TB, LGV, Donovanosis, amebiasis) aligned with the original/S-1 structure, inserted the two redundant testing steps from S-1 as Steps 3–4, replaced Step 2 with the R-1 corrupted syphilis-serology rationale, and replaced the final diagnostic confirmation step with t... | [
{
"error_description": "Jumps to diagnosing Buschke-Lowenstein tumor without the prerequisite confirmatory step at the decision point (biopsy/histology demonstrating HPV-related changes such as koilocytosis and excluding malignancy as the basis for confirmation).",
"error_step_indices": [
9
],
... | [
2,
3,
4,
9
] | medprmbench_00271 | [
2,
3,
4,
5,
6,
7,
8,
9
] | [] | [
"Squamous cell carcinoma was considered because of lymphadenopathy and invasive-appearing features but was excluded by histology showing no malignant cells — “…without signs of malignancy, the inguinal adenopathies are therefore of infectious origin and not metastatic.”",
"Secondary syphilis was considered due to... | A 50-year-old man with a history of recurrent urethritis and multiple sexual partners presented with a 10-year history of progressive swelling of the penis. On examination, there was a massive, grayish-pink, papillomatous, irregular, cauliflower-like lesion of the penis, multiple tender inguinal lymphadenopathies, and ... | Major | 0.5356 | test | null | null | null |
true | inflammatory pseudotumor | Adverse local tissue reaction (ALTR) from metal wear debris (metallosis-related pseudotumor) | [
"Sarcoma was considered given the long‐standing implant and aggressive-appearing osteolysis with a large mass, raising concern for an implant-associated malignancy versus another chronic process.",
"Given the low-grade fever, leukocytosis, elevated CRP, and the presence of a skin fistula, the process is best expl... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-2",
"R-5",
"R-6",
"R-7"
] | I kept the overall 5-step structure from the variants. Step 2 was replaced with Variant 1’s infection-skipping logic and also incorporated Variant 3’s improper reassurance from negative FNA and deferral of urgent PJI management, preserving the prerequisite omission (E-1). Steps 3–5 were aligned to Variant 3’s time-cour... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-5",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
4,
5
] | medprmbench_00272 | [
1,
2,
3,
4,
5
] | [] | [
"Sarcoma was considered given long‐standing implant and aggressive osteolysis — “clinical diagnosis of implant-induced sarcoma or chronic inflammatory mass was made.”",
"Infection was considered due to low‐grade fever and elevated inflammatory markers — “The result of FNA before surgery ruled out infection and ma... | A 60-year-old man with a 20-year history of ankylosing spondylitis underwent bilateral total hip replacement two decades ago. Over the past 5 years, he noted progressive swelling of the left pelvis and a growing mass in the left thigh. He had one fine‐needle aspiration (FNA) biopsy at another institution, which showed ... | Critical | 0.91 | test | null | null | null |
false | AmnioticBandSequence | Intrinsic constriction band syndrome (Streeter-type) | [
"The combination of exencephaly with multiple facial clefts and edema most strongly points to a chromosomal syndrome such as trisomy 13/18, making that the most likely diagnosis.",
"Neural tube defects can accompany these chromosomal conditions, fitting with the exencephaly seen here.",
"Limb amputations and co... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-2",
"R-6"
] | I constructed a single 6-step chain by taking Variant 1’s erroneous Step 1 (chromosomal diagnosis without checking the normal karyotype) to preserve the E-1 prerequisite omission. I then kept Variant 1’s downstream framing in Steps 2–3 for coherence. Next, I inserted Variant 3’s fabricated MRI-based LBWC reclassificati... | [
{
"error_description": "Prerequisite Sensitivity: The chain jumps to a chromosomal diagnosis (trisomy 13/18, then trisomy 13) without first using the provided normal karyotype (46,XY) to rule out aneuploidy, and proceeds based on that unsupported assumption.",
"error_step_indices": [
1
],
"err... | [
1,
4,
5
] | medprmbench_00273 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Chromosomal syndromes — “the midline facial defects observed in this case, with labial and palatal clefts, have a differential diagnosis with trisomy 13 and trisomy 18, but the karyotype study was normal.”",
"Neural tube defect as isolated malformation — “Anomalies resulting from amniotic bands may simulate chro... | A male neonate was delivered at 36 weeks’ gestation by induced vaginal breech labor to a 29-year-old primigravida. Prenatal ultrasound at 19 weeks had shown exencephaly, midline facial clefts, and edema. Birth weight was 2230 g; Apgar scores were 8 and 9 at 1 and 5 minutes. Karyotype analysis on 20 cells was 46,XY. In ... | Critical | 0.805 | test | null | null | null |
false | Organophosphate-induced delayed neuropathy | Organophosphate-induced delayed neuropathy (OPIDN) | [
"Multiple sclerosis was considered because of spastic paraparesis but was excluded—there was absence of oligoclonal bands.",
"Given the myelopathic presentation with spastic paraparesis, neuromyelitis optica spectrum disorder is the most likely diagnosis.",
"Although the presentation could resemble a central my... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-2",
"R-4",
"R-6"
] | I kept Step 1 from the original. For Variant 1 (E-1), I replaced the original Step 2 with the premature NMOSD conclusion, omitting the antibody-based exclusion prerequisite. Variants 2 (R-2) and 3 (R-4) both corrupt Step 3 by contradicting the stem’s normal NCS; I merged them into a single Step 3 that simultaneously as... | [
{
"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
] | medprmbench_00274 | [
1,
2,
3,
4
] | [] | [
"Multiple sclerosis was considered because of spastic paraparesis but was excluded—“There was absence of oligoclonal bands.”",
"Neuromyelitis optica was considered because of myelopathic presentation but was excluded—“Serum aquaporin-4 or myelin oligodendrocyte globulin antibodies were absent.”",
"Peripheral ne... | A 16-year-old male ingested 100 mL of a 50% chlorpyrifos and 5% cypermethrin organophosphate mixture with suicidal intent. One hour later, he presented with altered sensorium, hypersalivation, hyperlacrimation, bradycardia, and miosis and was treated with gastric lavage, atropine, and pralidoxime. After 48 h he develop... | Critical | 0.805 | test | null | null | null |
true | spinal cerebrospinal fluid leak | Chiari malformation type I | [
"Chiari Malformation Type I was initially considered based on imaging — MRI showed cerebellar tonsillar descent >3 mm below the foramen magnum.",
"Failure of decompression surgery argued against Chiari Malformation as the cause — she underwent two suboccipital decompressions without headache relief.",
"Given th... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"R-1",
"R-6",
"R-7"
] | All three variants place their root-cause error at Step 3, so the composite Step 3 was constructed to simultaneously (a) prematurely conclude spinal CSF leak from orthostatic symptoms (E-1), (b) incorrectly argue that orthostatic headaches point to Chiari I rather than CSF leak (R-1), and (c) use chronicity to rule out... | [
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "R-7",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
3,
4
] | medprmbench_00275 | [
1,
2,
3,
4
] | [] | [
"Step 1: Chiari Malformation Type I was initially considered based on imaging — “MRI head demonstrated TD ... and she was diagnosed with CM.”",
"Step 2: Failure of decompression surgery argued against Chiari Malformation as the cause — “She received two suboccipital decompression surgeries resulting in no relief.... | A 25-year-old woman presented with a 10-year history of daily headaches. Her past medical history was notable for migraine. She reported that her headaches worsened upon standing and improved when she lay down. An MRI of the head demonstrated downward displacement of the cerebellar tonsils more than 3 mm below the fora... | Critical | 0.905 | test | null | 3 | 0 |
true | small cell lung cancer | Systemic sarcoidosis with gastrointestinal (ileal) involvement causing intestinal pseudo-obstruction | [
"Mechanical small bowel obstruction was considered but excluded because MR enterography shows asymmetrical small bowel wall thickening and adjacent mesenteric lymphadenopathy with no significant mechanical cause for intestinal obstruction, suggesting a functional/infiltrative process rather than a fixed obstructing... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-1",
"S-2"
] | I kept Step 1 from the variants/original (mechanical obstruction excluded) since it remained compatible. I merged all three Step-2 corruptions into a single coherent Step 2 by retaining the tautological 'paraneoplastic-appearing' justification (S-2), inserting the incorrect SCLC pseudo-obstruction mechanism via ectopic... | [
{
"error_description": "Introduces a fabricated, authoritative ERS consensus guideline with false specificity/PPV claims to misclassify a mediastinal-invasive right hilar mass as highly predictive of sarcoidosis, steering the reasoning toward systemic/GI sarcoidosis and propagating that conclusion to the final ... | [
2
] | medprmbench_00276 | [
1,
2,
3,
4
] | [] | [
"Mechanical small bowel obstruction was considered but excluded because “MR enterography … shows asymmetrical small bowel wall thickening … with no significant mechanical cause for intestinal obstruction.”",
"A paraneoplastic origin was suspected given the new hilar mass on chest imaging: “a contrast CT study of ... | A 55-year-old man presented with 3 days of nausea, vomiting, abdominal pain, and constipation, with milder similar episodes in preceding weeks. His history was notable for obesity, prediabetes, and a 30-pack-year smoking history. On examination, he was tachycardic; the abdomen was diffusely distended, mildly tender, wi... | Critical | 0.905 | test | null | null | null |
true | acute interstitial nephritis | Focal segmental glomerulosclerosis (FSGS-spectrum podocytopathy) with concurrent acute interstitial nephritis | [
"Multiple glomerular diseases considered — “Initial differential diagnosis included membranous nephropathy, minimal change disease, IgA nephropathy, focal segmental glomerulosclerosis, fibrillary glomerulonephritis, immunotactoid glomerulopathy, amyloidosis, light chain deposition disease, and myeloma kidney.”",
... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-1",
"S-1"
] | I used Variant 1’s corrupted Step 4 as the composite chain’s Step 4 (the deception-based redirection toward FSGS with fabricated evidence). I then incorporated Variant 3’s two inserted redundant steps immediately after that point (repeat protein quantification and broad secondary nephrotic workup), keeping the remainde... | [
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
5,
6
],
"error_type": "S-1",
"modified_steps": null
},
{
"error_description": "",
"error... | [
4,
5,
6,
8,
13
] | medprmbench_00277 | [
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15,
16
] | [] | [
"Multiple glomerular diseases considered — “Initial differential diagnosis included membranous nephropathy, minimal change disease, IgA nephropathy, focal segmental glomerulosclerosis, fibrillary glomerulonephritis, immunotactoid glomerulopathy, amyloidosis, light chain deposition disease, and myeloma kidney.”",
... | An 81-year-old Asian man with erectile dysfunction, CKD stage 3a (baseline creatinine 1.4 mg/dL, eGFR 47 mL/min/1.73 m2), hypertension, hyperlipidemia, coronary artery disease, gout on long-term allopurinol, and osteoarthritis presented with one month of generalized edema and a 9.1 kg weight gain. Two weeks before admi... | Major | 0.6381 | test | null | null | null |
true | Accessory insertion of biceps femoris tendon | Inflammatory iliotibial band bursitis with dynamic iliotibial band snapping (ITB friction/subluxation syndrome) | [
"Popliteus and semitendinosus/gracilis tendon pathologies were considered — snapping at the lateral knee can be caused by surrounding soft-tissue structures such as the popliteus and pes anserinus tendons, and MRI showing no tear or peritendinous edema makes an acute/degenerative tendon tear less likely.",
"Iliot... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-3",
"R-7"
] | I kept the original structure but replaced Step 2 with the E-2 distractor-heavy ITB-prioritization step. I replaced Step 3 with the R-3 contextual misapplication that favors an occult lateral meniscal tear despite negative MRI/localization, while explicitly retaining the conflicting IKSTC/MRI-claims from E-2 to preserv... | [
{
"error_description": "",
"error_step_indices": [
2,
7
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "R-3",
"modified_steps": null
},
{
"error_description": "",
"error... | [
2,
3,
6,
7
] | medprmbench_00278 | [
1,
2,
3,
4,
5,
6,
7
] | [] | [
"Popliteus and semitendinosus/gracilis tendon pathologies were considered — “snapping at the lateral knee can be caused by a variety of pathologies involving surrounding soft tissue structures such as the popliteus, semitendinosus and/or gracilis tendons” and MRI showed no tear or edema ruling out these tendon inju... | A 48-year-old man presented with a 2-year history of right lateral knee snapping and pain without antecedent trauma. He noted that the pain and snapping at the fibular head worsened with cycling and deep squats. On examination, there was no muscle atrophy; however, a visible and audible snapping occurred when the knee ... | Critical | 0.775 | test | null | null | null |
true | erythema dyschromicum perstans | Pigmented fixed drug eruption | [
"Lichen planus pigmentosus was considered but excluded — “In the case described, the fact that the condition has an insidious progression, with blue-grey, asymptomatic, relatively symmetrical macules without a reticular pattern on non-photoexposed areas, and the absence of flexural lesions supports the diagnosis of... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-3"
] | I kept the original structure and incorporated Variant 2’s changes to steps 3–5 and its added final diagnosis step (step 9). I then replaced step 6 with Variant 3’s erroneous prioritization of urticaria pigmentosa to include the contextual applicability error. Next, I replaced steps 7–8 with Variant 1’s fabricated Addi... | [
{
"error_description": "Adds fabricated, authoritative-sounding guideline/registry evidence claiming high sensitivity/PPV of oral blue-grey macules with melanophages for early autoimmune Addison’s disease, incorrectly prioritizing Addison’s disease and using this to deprioritize hemochromatosis.",
"error_st... | [
3,
6,
7
] | medprmbench_00279 | [
3,
4,
5,
6,
7,
8,
9
] | [] | [
"Lichen planus pigmentosus was considered but excluded — “In the case described, the fact that the condition has an insidious progression, with blue-grey, asymptomatic, relatively symmetrical macules without a reticular pattern on non-photoexposed areas, and the absence of flexural lesions supports the diagnosis of... | A 57-year-old Caucasian woman (phototype III) presented with a 5-year history of asymptomatic pigmented lesions on the oral mucosa and trunk. The lesions had progressively worsened over the first 12 months and were not preceded by any skin changes. New lesions on the trunk appeared over the past 4 months, increasing in... | Critical | 0.8622 | test | null | null | null |
true | PPP syndrome | ANCA-associated vasculitis presenting with vasculitic panniculitis and polyarthritis | [
"Infectious panniculitis was considered but ruled out given negative serologic tests— “Serologic tests excluded an infectious disease in the form of hepatitis, HIV, or tuberculosis.”",
"Vasculitic panniculitis is definitively confirmed here because antineutrophil cytoplasmic antibodies (ANCA) are clearly elevated... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-2",
"R-4"
] | I kept Step 1 from the original. I merged Variant 1 and Variant 3 into a single composite Step 2 by preserving both the overconfident false claim that ANCA is clearly elevated (R-4) and the fabricated 2023 ENDeC guideline/statistics about seronegativity supporting PG (E-2), even though they internally conflict—this mai... | [
{
"error_description": "Adds an authoritative-sounding but fabricated 2023 consensus guideline with fake diagnostic performance statistics claiming seronegativity strongly supports pyoderma gangrenosum/neutrophilic dermatosis, redirecting away from pancreatitis-driven PPP despite markedly elevated lipase.",
... | [
2,
4
] | medprmbench_00280 | [
2,
3,
4,
5
] | [] | [
"Infectious panniculitis was considered but ruled out given negative serologic tests— “Serologic tests excluded an infectious disease in the form of hepatitis, HIV, or tuberculosis.”",
"Vasculitic panniculitis was unlikely because autoantibodies were not elevated— “antineutrophil cytoplasmic antibodies, as an ind... | A 45-year-old Caucasian man with chronic nicotine dependence and no other comorbidities was admitted after a minor forestry injury to the left middle finger. He was diagnosed with phlegmon of the extensor tendons and reactive osteomyelitis of several fingers bilaterally, debrided surgically, and treated with clindamyci... | Critical | 0.735 | test | null | null | null |
true | lepromatous leprosy | Diabetic neuropathic arthropathy (Charcot-type) | [
"Rheumatoid arthritis or deforming polyarthritis was considered because of chronic joint pain and distal phalangeal atrophy. In addition, the combination of symmetric hand deformities, osteoporosis on radiographs, and chronic plantar ulcers aligns with seronegative juvenile idiopathic arthritis (JIA) complicated by... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-3"
] | I kept the original 3-step structure. Step 1 was replaced with Variant 1’s fabricated-consensus JIA reframing (E-2), making it the root error at step 1. Step 2 was replaced with Variant 2’s incorrect claim about nerve trunk thickening favoring diabetes (R-1) and then augmented with Variant 1’s vasculopathy cohort distr... | [
{
"error_description": "Injected fabricated authoritative-sounding rheumatology/neurology consensus and cohort evidence (EULAR–PReS 2023; Rheumatology 2022; IPNS 2024) with misleading PPV/specificity-style claims to redirect the reasoning away from leprosy toward seronegative polyarticular JIA with vasculopathi... | [
1,
2,
3
] | medprmbench_00281 | [
1,
2,
3
] | [] | [
"Rheumatoid arthritis or deforming polyarthritis was considered because of chronic joint pain and finger atrophy — “articular pain, atrophy of the fingers, and polymorphic cutaneous manifestations often evoke rheumatoid arthritis or deforming polyarthritis.”",
"Diabetic neuropathic ulcer was initially suspected d... | A 17-year-old farmer from Kankossa, Mauritania, presented with severe chronic arthralgia of both hands and bilateral perforating ulcers on the soles, evolving over 7 years. His symptoms began with hypopigmented maculopapular skin lesions and paresthesia at the finger and toe tips and on the plantar surfaces. He had see... | Critical | 0.835 | test | null | null | null |
true | Multiple sclerosis | Acute pontine ischemic stroke (PPRF infarction) | [
"Although bilateral PPRF or abducens nucleus lesions can produce bilateral horizontal gaze palsy, the combination of (a) normal visual evoked potentials, (b) AQP4/MOG seronegativity, and (c) an enhancing short-segment thoracic cord lesion is now considered highly predictive of seronegative neuromyelitis optica spec... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-3",
"R-5",
"R-7"
] | I constructed a single 4-step chain by taking Variant 1’s corrupted Step 1 (fabricated NMOSD guideline/statistics), Variant 2’s corrupted Step 2 (incorrect claim that bilateral MLF lesions abolish abduction and cause complete horizontal gaze palsy), and Variant 3’s corrupted Step 3 (time-course misread as hyperacute st... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-2",
"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_00282 | [
1,
2,
3,
4
] | [] | [
"Bilateral abducens nucleus lesions would produce similar gaze palsy, but lesions were localized to the PPRF — “lesions affecting the abducens nuclei will cause ipsilateral horizontal gaze palsy ... bilateral horizontal gaze palsy will be caused if lesion(s) involve both abducens nuclei.”",
"MLF lesions (internuc... | A 16-year-old Iranian girl presented with sudden-onset bilateral horizontal gaze palsy that developed overnight. She reported paresthesia in both feet beginning 2 months earlier, progressing over 2 weeks to her trunk at the level of the umbilicus, and a similar episode in both hands about 1 year prior. She had no signi... | Critical | 0.905 | test | null | null | null |
true | decompression retinopathy | Diabetic papillopathy with mild diabetic macular edema | [
"Diabetic retinopathy progression was suspected because postoperative hypotony after trabeculectomy can accelerate diabetic microvascular damage and break down the blood–retinal barrier, leading to microaneurysms with dye leakage, peripapillary flame-shaped hemorrhages, and optic disc edema; in insulin-dependent di... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-3"
] | All three variants place their single error in Step 1, so the composite Step 1 was constructed by merging the full set of diabetes-centered, surgery-stress/hypotony arguments (R-1 and R-3) with the fabricated meta-analysis and diagnostic statistics (E-2), while preserving the incorrect timing/FA claims about decompress... | [
{
"error_description": "Introduces an authoritative-sounding but fabricated 2023 AJO meta-analysis and false diagnostic performance statistics to steer interpretation of the postoperative hemorrhages/disc edema toward diabetic papillopathy with mild DME instead of decompression retinopathy, and carries that con... | [
1
] | medprmbench_00283 | [
1,
3
] | [] | [
"Decompression retinopathy was suspected because it presents after an acute lowering of IOP with retinal hemorrhages, optic disc edema, and macular changes — “Our patient had all the described characteristics of DR, including retinal hemorrhages, optic disc edema, macular edema, and decreased visual acuity.”",
"V... | A 54-year-old woman with primary open-angle glaucoma and poor adherence to topical therapy was referred for surgical management. She had a history of severe obesity (BMI 37 kg/m2) and well-controlled insulin-dependent diabetes. Preoperative best-corrected visual acuity was 20/20 in both eyes. Untreated IOPs were consis... | Major | 0.7183 | test | null | null | null |
true | Functional mitral regurgitation | Acute severe primary (degenerative) mitral regurgitation due to occult leaflet/chordal rupture | [
"Although the patient has known ischaemic cardiomyopathy, the combination of “disproportionate” severe MR (EROA 80 mm², regurgitant volume 76 mL) with giant left-atrial V waves (to 65 mmHg) is more consistent with an acute severe MR physiology rather than chronic functional MR. The 2023 European Acute MR Consensus ... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-3",
"S-1"
] | I used Variant 1’s reframing of the case (giant V waves/disproportionate MR implying acute primary degenerative MR and discounting tethering) as the composite Step 1, preserving the fabricated consensus/registry assertions and carrying that same EACMRS-based tethering unreliability claim into the final echo-interpretat... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2,
3
],
"error_type": "S-1",
"modified_steps": null
},
{
"error_description": "",
"error... | [
1,
2,
3,
4
] | medprmbench_00284 | [
1,
2,
3,
4,
5
] | [] | [
"Severe ischaemic cardiomyopathy was considered the primary cause of decompensation — “The differential diagnosis for intractable heart failure was attributed predominantly to the underlying severe ischaemic cardiomyopathy …”",
"Stage IV chronic kidney disease was thought to contribute to low output and end-organ... | A 63-year-old man with ischaemic cardiomyopathy and New York Heart Association class IV symptoms, on maximal medical therapy, was referred after 22 days in an intensive care unit for inability to wean from dobutamine support (INTERMACS III), with evidence of low cardiac output (acute on chronic kidney injury, hepatic d... | Critical | 0.775 | test | null | null | null |
true | bullous systemic lupus erythematosus | Bullous pemphigoid | [
"Bullous systemic lupus erythematosus was considered given underlying SLE manifestations (malar rash, discoid lesions, cytopenias, low complement, urinary abnormalities) and widespread tense vesicles and bullae — “Bullous systemic lupus erythematosus (BSLE) is a blistering disease characterized by tense subepiderma... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-1",
"S-2"
] | I kept the original step structure (5 steps) and merged the single-error variants by substituting the corrupted Step 2 from Variant 3 (tautological DH reasoning), the corrupted Step 3 from Variant 2 (incorrect SLE association for EBA), and the corrupted Step 4 from Variant 1 (fabricated pemphigoid consensus/statistics)... | [
{
"error_description": "Introduces tautological/circular logic by justifying dermatitis herpetiformis only by restating that pruritic vesicles indicate a disease defined by pruritic vesicles, without adding discriminating clinical reasoning.",
"error_step_indices": [
2
],
"error_type": "S-2",
... | [
2,
3,
4
] | medprmbench_00285 | [
1,
2,
3,
4,
5
] | [] | [
"Bullous systemic lupus erythematosus was considered given underlying SLE manifestations and widespread tense vesicles and bullae — “Bullous systemic lupus erythematosus (BSLE) is a blistering disease characterized by tense subepidermal fluid‐filled vesicles and bullae. The common sites of involvement include the f... | A 24-year-old Southeast Asian woman presented with a 2-month history of pruritic blisters and bullae initially on her hands that gradually involved her face and trunk. She also reported weight loss, myalgia, fatigue, intermittent fever, self-limiting epistaxis, and hair loss. She denied dyspnea, hematuria, decreased ur... | Critical | 0.835 | test | null | null | null |
true | Fraser syndrome | Congenital pulmonary lymphangiectasia causing non-immune hydrops fetalis (CPL-plus spectrum) | [
"Considered plexiform pulmonary arteriopathy but excluded because the overall picture is one of multisystem congenital malformation—i.e., it is not plexiform pulmonary arteriopathy because the findings represent congenital anomalies, and they are congenital anomalies because they do not fit plexiform pulmonary arte... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-3",
"S-2"
] | I used Variant 1’s overall diagnostic redirection (CPL/CPL-plus with fabricated guidance) as the backbone for steps 2–4, preserving its authoritative but misleading citations and concluding diagnosis. I replaced the original step 1 with Variant 3’s circular exclusion of plexiform pulmonary arteriopathy to integrate the... | [
{
"error_description": "Introduces circular/tautological logic by excluding plexiform pulmonary arteriopathy solely by restating that the case is congenital anomalies, and justifying congenital anomalies by saying they do not fit plexiform pulmonary arteriopathy, without adding discriminating evidence.",
"e... | [
1,
2
] | medprmbench_00286 | [
1,
2,
3,
4
] | [] | [
"Considered plexiform pulmonary arteriopathy but excluded because of multisystem congenital anomalies — “Plexiform pulmonary arteriopathy and lenz microphthalmia syndrome were also differential diagnoses for our case, but the presence of congenital malformations led us to exclude plexiform pulmonary arteriopathy.”"... | A 19-year-old gravida 2, para 1 woman, with no significant medical or surgical history and a nonconsanguineous marriage, attended routine prenatal visits.
20-week ultrasound showed hyperechogenic lungs, ascites, a normal right kidney, a three-vessel umbilical cord, and a normal sucking reflex.
At 25 weeks, ultrasound... | Critical | 0.775 | test | null | null | null |
true | Familial retinal arterial macroaneurysms | Bilateral Coats disease | [
"The combination of peripheral/midperipheral aneurysms, arterial beading, and capillary dropout in a child—together with congenital supravalvular pulmonary stenosis—most strongly supports an ALK1/ENG-related hereditary hemorrhagic telangiectasia (HHT) spectrum disorder with retinal arteriovenous malformations rathe... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-3"
] | I kept Variant 1’s corrupted Step 1 intact to preserve the deceptive, fabricated-registry redirection toward HHT (E-2). I then merged Variants 2 and 3 into a single composite Step 2 by including both incompatible epidemiologic claims (adult-onset unilateral Coats used to argue against pediatric bilateral disease, and s... | [
{
"error_description": "Introduces a fabricated authoritative-sounding registry and misleading diagnostic statistics to claim congenital outflow-tract stenosis plus Coats-like retinopathy strongly predicts HHT-spectrum retinal AVM, redirecting away from the correct retinal macroaneurysm/Coats-like framework.",
... | [
1,
2
] | medprmbench_00287 | [
1,
2,
3
] | [] | [
"Familial retinal arterial macroaneurysms was considered because it is “a rare autosomal recessive disease characterized by retinal arterial beading, aneurysm formation along the major arterial trunks, hemorrhage and exudation.”",
"Coats disease was considered given the “telangiectatic vessels, capillary non-perf... | A 7-year-old boy was referred for evaluation of intermittent exotropia in his left eye. His medical history was notable for mild supravalvular pulmonary stenosis discovered on echocardiography during a routine exam. Best-corrected visual acuity was 20/100 in the right eye and 3/200 in the left eye. Intraocular pressure... | Major | 0.73 | test | null | null | null |
true | desmoplastic fibroblastoma | Low-grade fibromyxoid sarcoma (LGFMS) | [
"Desmoid tumor is considered but can be excluded because desmoids are typically more cellular and show infiltrative, poorly circumscribed peripheral margins with more prominent internal vascularity than seen in this well-delineated lesion.",
"Although fibromyxoid sarcoma is often described as having more dominant... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"E-5",
"R-1",
"R-4",
"R-5",
"S-1"
] | I kept the original question unchanged (no variants modified it). I used Variant 1’s corrupted Step 2 verbatim to preserve the deceptive fabricated EMON/FIBRO-MRI evidence (E-2) and allowed that claim to continue influencing the later conclusion by adapting the final step to reference it. I inserted Variant 3’s redunda... | [
{
"error_description": "",
"error_step_indices": [
1,
2,
5
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
1,
2,
5
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_d... | [
1,
2,
3,
4,
5,
6
] | medprmbench_00288 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Desmoid tumor considered but excluded because “On the histological level, these are lesions of greater cellularity, vascular, and infiltrative on the periphery.”",
"Fibromyxoid sarcoma considered but excluded because “This is a key point for differentiating it from more aggressive lesions where the liquid signal... | A 76-year-old woman noted a slowly enlarging mass adjacent to her right lateral malleolus over 3 months, causing discomfort with shoes and walking. She denied trauma or infection. On examination, there was a firm, 4 cm retromalleolar mass without overlying skin changes or regional lymphadenopathy and no sensorimotor de... | Critical | 0.88 | test | null | null | null |
true | Miller Fisher syndrome | Dengue-associated brainstem encephalitis (dengue neuroinvasive syndrome) | [
"Although the triad of ophthalmoplegia, ataxia, and areflexia can suggest Miller Fisher syndrome (MFS), in the setting of confirmed acute dengue with severe thrombocytopenia and cranial neuropathies, the more likely unifying diagnosis is dengue-associated brainstem encephalitis/neuropathy syndrome, and the combinat... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-5"
] | Both variants place their single root-cause error in the initial reasoning step. To integrate them without weakening either, Step 1 was merged to simultaneously (a) present the fabricated 2023 consortium statement and misleading predictive values steering toward dengue brainstem encephalitis (E-2) and (b) assert the in... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "R-5",
"modified_steps": null
}
] | [
1
] | medprmbench_00289 | [
1,
2,
3,
4
] | [] | [
"The patient presents with the acute triad of ophthalmoplegia, ataxia, and areflexia, which are the hallmark signs of Miller Fisher syndrome (MFS). Although the patient has a positive Dengue NS1 antigen and RT-PCR, his neurological manifestations (especially the absence of sensory symptoms and limb weakness alongsi... | A 70-year-old Sri Lankan man with a 6-year history of well-controlled diabetes mellitus and hypertension presented with acute high-grade intermittent fever, headache, arthralgia, myalgia, and nausea without an apparent focus of infection. On day 2 of illness, he developed right eyelid ptosis and dysarthria. On day 3, h... | Critical | 0.835 | test | null | 2 | 1 |
false | pyogenic spondylodiscitis | Pyogenic spondylitis (infectious spondylodiscitis) at L4–L5 | [
"Because Enterobacter cloacae is a gut commensal that rarely causes true hematogenous vertebral infection, a positive blood culture in this setting more likely reflects transient bacteremia/contamination; the lumbar MRI marrow signal changes at L4–L5 are therefore most consistent with spinal metastasis from esophag... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-1",
"S-2"
] | I used Variant 2’s Step 1 to preserve the R-1 soundness error that downplays E. cloacae bacteremia and favors metastasis. I then inserted Variant 1’s guideline/cohort-based distractor as Step 2 to preserve the E-2 deception error, and adapted Step 3 to smoothly incorporate Variant 1’s “therefore” transition while also ... | [
{
"error_description": "Replaces correct evidence-based inference from positive Enterobacter cloacae blood cultures with the incorrect claim that E. cloacae rarely causes hematogenous vertebral infection and that positive cultures are more likely contamination, redirecting diagnosis toward metastatic spinal tum... | [
1,
2,
4
] | medprmbench_00290 | [
1,
2,
3,
4
] | [] | [
"Hematogenous spread most likely — “E. cloacae was detected in blood cultures and infected to distant lumbar spines, and we diagnosed pyogenic spondylitis due to hematogenous spread of bacteria.”",
"Direct infiltration excluded — “no direct damage to the prevertebral fascia was observed during salvage reconstruct... | A 70-year-old Japanese man presented with dysphagia and was diagnosed with T3N0M0 esophageal squamous cell carcinoma. His medical history included type 2 diabetes mellitus (HbA1c 6.6%), percutaneous coronary intervention, and radiotherapy for laryngeal cancer. He underwent two courses of 5-fluorouracil/docetaxel/cispla... | Critical | 0.835 | test | null | null | null |
true | Retrograde contrast reflux into the duodenum | Cystic-duct catheter–induced microperforation (spiral valve of Heister contrast extravasation artifact) | [
"The initial IOC streak of contrast just inferior to the cystic duct is most consistent with an occult duodenal fistula/iatrogenic duodenal injury from difficult dissection, and the absence of leak on methylene blue testing or repeat IOC can be attributed to temporary sealing (e.g., by clips, edema, or omental appo... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-5",
"R-6"
] | I used Variant 2’s corrupted Step 1 to inject the safety-awareness anchoring error (R-5). I then merged Variant 3’s hallucinated MRCP support for extrahepatic bile duct duplication with Variant 1’s fabricated SHBI/Annals evidence into a single composite Step 2 so both R-6 and E-2 root-cause errors coexist in the same s... | [
{
"error_description": "Bypasses the critical safety check that negative methylene blue testing and resolution on repeat IOC make duodenal injury/fistula less likely; instead, it prematurely anchors on an occult duodenal injury and explains away reassuring evaluations as temporary sealing.",
"error_step_ind... | [
1,
2
] | medprmbench_00291 | [
1,
2,
3,
4
] | [] | [
"Duodenal fistula was suspected given the IOC finding of a contrast jet suggesting bile leak, but it was excluded by negative leak testing and resolution on repeat imaging — “methylene blue leak test failed to demonstrate the leak and a repeat IOC revealed disappearance of the suspicious jet.”",
"Extrahepatic bil... | A 40-year-old man presented with right upper quadrant pain and fevers up to 38 °C. Laboratory studies showed a white-cell count of 17.9 × 10^9/L, C-reactive protein of 425 mg/L, and normal liver-function tests. Contrast-enhanced CT of the abdomen demonstrated acute cholecystitis with an 8 mm stone impacted at the gallb... | Critical | 0.895 | test | null | null | null |
true | calcific myonecrosis | Late-phase myositis ossificans | [
"Given that the mass has enlarged substantially over the past five months, this tempo is most consistent with an acute/aggressive soft-tissue malignancy (eg, synovial sarcoma or extraskeletal osteosarcoma), since calcific myonecrosis is a very delayed post-traumatic process that typically would not show noticeable ... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-6",
"R-7"
] | I kept the original 3-step structure but merged the corrupted content where each variant injected its single error. Step 1 was rewritten to simultaneously include (a) the trajectory/tempo mistake from R-7 (treating 5-month growth as incompatible with delayed post-traumatic disease and implying urgent malignancy) and (b... | [
{
"error_description": "Fabricated patient-specific data not in the stem (MRI showing heterogeneous enhancement/hemorrhage; unintentional 6-kg weight loss) and used it to steer reasoning toward malignant sarcoma.",
"error_step_indices": [
1
],
"error_type": "R-6",
"modified_steps": [
... | [
1,
2
] | medprmbench_00292 | [
1,
2,
3
] | [] | [
"Considered soft-tissue sarcomas (synovial sarcoma, epithelioid sarcoma, extraskeletal osteosarcoma) — “Synovial sarcoma, epithelioid sarcoma and extraskeletal osteosarcoma may radiographically resemble calcific myonecrosis; however, the calcific pattern in myonecrosis has a peripheral distribution with a central c... | A 68-year-old man presented with a progressive, painless swelling of his left leg. Forty years earlier, he had sustained ipsilateral tibial and fibular fractures treated with open reduction and internal fixation, followed by a postoperative left common peroneal nerve deficit. Two years ago, after a minor muscle strain ... | Critical | 0.805 | test | null | null | null |
true | mucormycosis | Herpes zoster ophthalmicus–associated orbital apex syndrome (zoster sine herpete) with VZV vasculopathy causing central retinal artery occlusion | [
"Conjunctivitis was initially considered — “was prescribed polymyxin for presumed conjunctivitis.”",
"Anaphylaxis was considered given the oropharyngeal edema and patient’s self‐report — “she believed she was having an allergic reaction; after using her EpiPen® without resolution, she came to the ED to be treated... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-6"
] | I kept steps 1–3 aligned with the original. I replaced step 4 and step 5 with Variant 2’s authoritative-sounding VZV/ANOS distractor content (E-2) to ensure the fabricated consensus statement and statistics are preserved and the diagnostic direction is redirected. For step 6, I merged Variant 3’s incorrect CST pathophy... | [
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
4,
5,
6
] | medprmbench_00293 | [
4,
5,
6
] | [] | [
"Conjunctivitis was initially considered — “was prescribed polymyxin for presumed conjunctivitis.”",
"Anaphylaxis was considered given the oropharyngeal edema and patient’s self‐report — “she believed she was having an allergic reaction; after using her EpiPen® without resolution, she came to the ED to be treated... | A 52-year-old woman with obesity and chronic prednisone use for presumed pulmonary fibrosis initially presented to an urgent care center two days earlier for a presumed conjunctivitis and was prescribed polymyxin. She then came to the emergency department complaining that her head felt swollen and that her throat was b... | Major | 0.765 | test | null | null | null |
true | Vismodegib-induced diarrhea | Crohn disease (ileocolitis) | [
"Broad differential diagnosis should prioritize infectious colitis (especially bacterial/viral) and inflammatory bowel disease, because in otherwise healthy outpatient adults on oral targeted therapy, chronic medication-induced colitis is uncommon and most chronic watery diarrhea is due to infection or IBD.",
"Ep... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-3"
] | I used Variant 3’s Step 1 to embed the contextual misprioritization (R-3). I kept Step 2 from the original/variants unchanged to preserve the baseline (non-error) statement about apoptosis. I replaced Step 3 with Variant 1’s distractor-laden argument (E-2). I then replaced Step 4 with Variant 2’s incorrect pathology cl... | [
{
"error_description": "Applies general outpatient chronic-diarrhea heuristics (infection/IBD most common; drug colitis uncommon) to a special oncology/targeted-therapy context with apoptotic injury, misprioritizing the differential and predisposing the conclusion toward IBD over medication-induced enterocoliti... | [
1,
3,
4
] | medprmbench_00294 | [
1,
3,
4,
5
] | [] | [
"Broad differential diagnosis including infection, ischemia, graft-versus-host disease, IBD, and drug effects — “The nonspecific histologic findings in this case yield a broad differential diagnosis of infectious causes (including viral infections), ischemia, graft-versus-host disease, inflammatory bowel disease (I... | A 66-year-old man with Gorlin syndrome and a 10-year history of daily vismodegib therapy (150 mg) for locally advanced and metastatic basal cell carcinoma presented with worsening watery diarrhea. Two years after starting vismodegib, he developed loose stools 2–3 times daily (Common Terminology Criteria for Adverse Eve... | Critical | 0.835 | test | null | null | null |
true | Nonrheumatic myocarditis | Acute rheumatic fever–associated carditis (hyperacute post-streptococcal carditis) | [
"Acute coronary syndrome — Elevated troponin with ischemic-appearing ST-segment depressions should be treated as ACS, and once ACS is assumed, alternative life-threatening diagnoses (eg, myocarditis) do not need to be prioritized in the differential.",
"Acute rheumatic fever (rheumatic carditis) — Despite the ver... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-2",
"R-5"
] | I kept the overall three-step structure from the original. For Step 1, I used Variant 3’s unsafe ACS anchoring language verbatim, making it the root-cause safety error. For Step 2, I merged Variant 1’s fabricated AHA/ACC statement and statistics with Variant 2’s subtle but direct 2–3 week timing shift, preserving both ... | [
{
"error_description": "Prematurely anchors on ACS and explicitly deprioritizes the critical safety check of considering myocarditis and other dangerous non-ACS causes of troponin elevation in a young patient.",
"error_step_indices": [
1
],
"error_type": "R-5",
"modified_steps": [
1
... | [
1,
2
] | medprmbench_00295 | [
1,
2,
3
] | [] | [
"Acute coronary syndrome — “Based on their evaluation, it was felt that the patient most likely had myocarditis and less likely acute coronary syndrome.”",
"Acute rheumatic fever — “Based on their evaluation and timing of chest pain just one day after the diagnosis of streptococcal pharyngitis, it was felt that t... | A 24-year-old man with no prior medical history presented with nonradiating central chest pain of a few hours’ duration. One day earlier, he had been diagnosed with group A streptococcal pharyngitis and started on amoxicillin 500 mg orally twice daily. On initial evaluation, his heart rate was 116 beats per minute; oth... | Critical | 1 | test | null | null | null |
true | acute renal allograft rejection | Immune checkpoint inhibitor–associated thromboinflammatory syndrome with transplant renal vein thrombosis | [
"Considered acute allograft rejection — Despite recent discontinuation of immunosuppression, the relatively stable graft function without a meaningful rise from baseline makes acute rejection less likely; the fever and graft tenderness are better explained by a vascular complication related to the known intragraft ... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-2",
"S-2"
] | I kept the question unchanged because no variant modified it. I combined Variant 2’s altered Step 1 (downplaying rejection by contradicting the creatinine rise) with Variant 3’s tautological Step 2. I then incorporated Variant 1’s fabricated ICITS anchoring as Step 3 and retained its concluding diagnostic Step 4 for co... | [
{
"error_description": "Step-consistency error: re-characterizes kidney function as relatively stable without a meaningful rise from baseline (despite creatinine 275 μmol/L vs baseline 150–180 μmol/L) and uses that altered state to downplay acute rejection.",
"error_step_indices": [
1
],
"erro... | [
1,
2,
3
] | medprmbench_00296 | [
1,
2,
3,
4
] | [] | [
"Considered acute allograft rejection — “Given the sudden decrease in kidney function in the context of recently discontinuing immunosuppression, starting immunotherapy, and the presence of graft-site tenderness, his presentation was felt to be most suspicious for acute allograft rejection…”",
"Considered renal v... | A 44-year-old man with end-stage kidney disease secondary to congenital oligomeganephronia underwent a living-donor kidney transplant 20 years earlier. Twenty-nine days before presentation, his maintenance immunosuppression (cyclosporine and prednisone) was stopped after an 8-cm clear cell carcinoma was diagnosed in th... | Critical | 0.775 | test | null | null | null |
true | subpleural pulmonary cysts | Intralobar pulmonary sequestration with secondary infection | [
"The CT pattern of diffuse peripheral, paraseptal, and subpleural cysts tracking along the fissures in a former extremely premature infant with chronic lung disease is most consistent with bronchopulmonary dysplasia (BPD)–related cystic/emphysematous change, so this can be taken as the unifying diagnosis without ne... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"E-5",
"R-6"
] | All three variants injected their root-cause error at Step 1, so I merged them into a single composite Step 1 that simultaneously (a) prematurely commits to BPD as the unifying diagnosis (E-5), (b) adds a fake 2023 radiology consensus with misleading statistics favoring CPAM (E-2), and (c) hallucinates a systemic arter... | [
{
"error_description": "Introduces a fabricated 2023 Pediatric Radiology/consensus statement with plausible-sounding but incorrect performance statistics to argue that subpleural, fissure-tracking cysts strongly predict CPAM and to add an authoritative-sounding CT-based argument against lymphangiectasia.",
... | [
1
] | medprmbench_00297 | [
1,
2
] | [] | [
"Congenital pulmonary airway malformation was less likely because “the cysts are generally localized to one lobe and seldom seen in subpleural area.”",
"Pulmonary lymphangiectasia was excluded since its CT findings typically include “intralobular and peribronchial thickening, patchy ground-glass opacification, pl... | A 10-month-old girl born at 29 weeks’ gestation with trisomy 21 and chronic lung disease of prematurity was transferred for otolaryngologic evaluation of persistent stridor. Ten days earlier she had developed a 4-day history of cough, rhinorrhea, tactile fever, and increased work of breathing. At the community hospital... | Critical | 0.805 | test | null | null | null |
true | Actinomycosis | Rhinocerebral mucormycosis (invasive fungal sinusitis) | [
"Fungal sinusitis was initially suspected because chronic sinus opacification and a mass-like lesion on CT can mimic invasive fungal disease — “Fungal sinusitis was suspected.”",
"Although sulfur granules can be seen in several infections, the presence of a focally hyperdense intranasal lesion in a diabetic patie... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1"
] | I used Variant 1’s corrupted Step 2 as the composite chain’s Step 2 to preserve the deceptive, authoritative-sounding but false ER-SBS consensus/statistics (E-2 root cause). To maintain coherence with that misdirection, I also kept Variant 1’s downstream adaptations in Steps 3–4 that deprioritize nocardiosis/botryomyco... | [
{
"error_description": "Introduces a fabricated ER-SBS 2023 consensus statement and false CT hyperdensity performance statistics to make mucormycosis appear highly likely in diabetics with unilateral hyperdense sinonasal lesions, redirecting the differential away from actinomycosis and propagating that misdirec... | [
2,
5
] | medprmbench_00298 | [
2,
3,
4,
5
] | [] | [
"Fungal sinusitis was initially suspected because chronic sinus opacification and a mass-like lesion on CT can mimic invasive fungal disease — “Fungal sinusitis was suspected.”",
"Nocardiosis was considered due to the potential for sulfur granules in sinus specimens, which resemble those found in actinomycosis — ... | A 55-year-old woman with a history of diabetes mellitus presented with a 3-month history of left-sided nasal obstruction, purulent nasal discharge, and facial pain that did not improve after multiple courses of oral antibiotics. She denied any recent dental procedures or facial trauma. Anterior rhinoscopic examination ... | Critical | 0.765 | test | null | null | null |
true | syphilis | Anabolic steroid–induced cholestatic liver injury (drug-induced liver injury) | [
"Medication-induced cholestasis is definitively confirmed by the history, as the patient clearly reports recent use of over-the-counter herbal supplements and analgesics; additionally, he later disclosed taking an over-the-counter bodybuilding supplement containing anabolic-androgenic steroids (e.g., stanozolol) fo... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-4",
"R-6"
] | I kept a single coherent 4-step chain while combining the corrupted content from all variants. Step 1 merges the R-4 contradiction (asserting definite OTC medication use) with the R-6 hallucinated anabolic-steroid supplement disclosure, preserving both as coexisting claims supporting drug-induced cholestasis. Step 2 in... | [
{
"error_description": "Overconfidently contradicts the stem by claiming the patient clearly used OTC herbal supplements/analgesics and that this definitively confirms drug-induced cholestasis, despite explicit denial; downstream reasoning deprioritizes syphilis.",
"error_step_indices": [
1
],
... | [
1,
2
] | medprmbench_00299 | [
1,
2,
3,
4
] | [] | [
"Medication-induced cholestasis was considered but excluded based on history — “He denied taking any medications including over-the-counter herbal supplements or analgesics.”",
"Acute viral hepatitis was considered but excluded after testing — “Hepatitis screen was negative for acute hepatitis A, B, or C infectio... | A 29-year-old man with no significant medical history presented with epigastric abdominal pain. He reported a 1-week history of tea-colored urine, pale stools, and diffuse pruritus that preceded the development of a new rash. He denied taking any medications, including over-the-counter herbal supplements or analgesics.... | Critical | 0.805 | test | null | 2 | 1 |
true | benign metastasizing leiomyoma | Pulmonary rheumatoid nodules | [
"Primary bronchogenic carcinoma was considered because “pulmonary nodules… are the most typical radiographic presentation of early lung cancer, and multiple pulmonary nodules of varying sizes may be the first sign of malignancy in a patient without a prior diagnosis” but was less likely given “this patient was not ... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-4",
"S-1"
] | I kept the full step expansion from the simplicity variant (adding PET-CT and tumor markers as new steps 3–4), then replaced the original metastasis consideration with the deception variant’s Step 2 including the fabricated IASLC/ERS consensus and carried its downstream wording into the leiomyosarcoma/BML and other dif... | [
{
"error_description": "Adds a fabricated, authoritative-sounding 2023 IASLC/ERS consensus statement with false PPV/likelihood statistics to strongly favor metastatic uterine sarcoma and effectively rule out benign metastasizing leiomyoma, misleading the differential.",
"error_step_indices": [
2
]... | [
2,
9
] | medprmbench_00300 | [
2,
3,
4,
5,
6,
7,
8,
9,
10
] | [] | [
"Primary bronchogenic carcinoma was considered because “pulmonary nodules… are the most typical radiographic presentation of early lung cancer, and multiple pulmonary nodules of varying sizes may be the first sign of malignancy in a patient without a prior diagnosis” but was less likely given “this patient was not ... | A 46-year-old woman presented for preoperative evaluation before a planned hysterectomy. She reported a 2-year history of dry cough and an unintentional 10-lb weight loss over the past year. Her medical history was unremarkable; she was a non-smoker with no history of cancer, recent travel, or significant occupational ... | Critical | 0.84 | test | null | null | null |
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