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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
false | ClearCellMeningioma | Clear cell meningioma | [
"The imaging demonstrates an intradural extramedullary cauda equina mass with homogeneous contrast enhancement, making meningioma the most likely category of tumor in this location.",
"Conventional meningioma was considered given the imaging profile and was further supported by the presence of a subtle dural tail... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"E-5",
"R-2"
] | I kept Variant 2’s narrowed Step 1 framing (meningioma as the most likely category) to preserve the premature differential closure. I then merged all Step-2 corruptions into a single composite Step 2 that simultaneously (a) contradicts the imaging state by claiming a subtle dural tail is present (R-2), (b) introduces t... | [
{
"error_description": "Adds authoritative-sounding but fabricated/misapplied evidence (fake meta-analysis and consensus statement with diagnostic performance statistics) to claim absence of dural tail/attachment nearly rules out meningioma and redirects toward cauda equina paraganglioma.",
"error_step_indi... | [
2
] | medprmbench_00301 | [
1,
2,
3,
4
] | [] | [
"Other cauda equina tumors were considered among the broad differential for intradural extramedullary masses — “In general, the differential diagnosis of cauda equina tumors includes schwannoma, neurofibroma, myxopapillary ependymoma, metastatic medulloblastoma, neuroblastoma, and pineal tumors, in addition to othe... | A 10-year-old boy presented with two months of progressively worsening low back pain and bilateral lower extremity pain, worse at night and on waking. He reported difficulty bending at the waist but denied sensory or motor deficits and had no bladder or bowel dysfunction.
On lumbar spine CT, there was a well-defined ... | Critical | 0.805 | test | null | null | null |
true | septic myocardial dysfunction | Postpartum preeclampsia with cardiogenic pulmonary edema | [
"Peripartum cardiomyopathy was considered but excluded — “In this case, our patient did not meet the consensus definition for peripartum cardiomyopathy which requires that there be no identifiable cause for cardiac failure other than pregnancy.”",
"Myocarditis was considered but excluded — “We did not believe myo... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-7",
"S-1"
] | I kept the original Steps 1–2 unchanged. I then merged Variant 3’s inserted redundant myocarditis workup as a new Step 3 (S-1 error). Next, I incorporated Variant 2’s altered differential reasoning about timing as Step 4 (R-7 error), replacing the original differential step to preserve the temporal mischaracterization.... | [
{
"error_description": "Added unnecessary confirmatory workup (cardiac MRI/biopsy) for myocarditis despite already having sufficient evidence to deprioritize it, increasing redundancy without changing decision-making.",
"error_step_indices": [
3
],
"error_type": "S-1",
"modified_steps": [
... | [
3,
4,
5
] | medprmbench_00302 | [
3,
4,
5
] | [] | [
"Peripartum cardiomyopathy was considered but excluded — “In this case, our patient did not meet the consensus definition for peripartum cardiomyopathy which requires that there be no identifiable cause for cardiac failure other than pregnancy.”",
"Myocarditis was considered but excluded — “We did not believe myo... | A 24-year-old nulliparous Hispanic woman with an uncomplicated antenatal course presented in active labor at 40 weeks of gestation. Twelve hours after an uneventful vaginal delivery, she developed chills, diaphoresis, right-sided back pain, and a fever of 40.0 °C. Her heart rate was 110 beats/min, blood pressure 136/85... | Major | 0.74 | test | null | null | null |
true | Common peroneal nerve palsy | Postoperative inflammatory lumbosacral radiculoplexus neuropathy | [
"This presentation is without question a direct postoperative complication of the L5/S1 revision, because she was clearly discharged with significant right-sided weakness and sensory loss rather than normal 5/5 strength and intact sensation; delayed-onset foot drop in this context definitively confirms a surgical e... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-4",
"R-6"
] | I merged Variant 2’s root-cause contradiction into Step 1 and simultaneously embedded Variant 3’s fabricated MRI/lab data into the same Step 1, keeping the confident tone and the hallucinated diagnostics together. I then used Variant 1’s ENVS-guideline-based distractor as Step 2, adapting it to acknowledge the (fabrica... | [
{
"error_description": "Introduces an overconfident contradiction to the stem by claiming she was discharged with significant weakness/sensory loss (despite stated normal exam) and uses this false premise to assert a definitive surgical L5 radiculopathy/complication.",
"error_step_indices": [
1
],... | [
1,
2
] | medprmbench_00303 | [
1,
2,
3,
4
] | [] | [
"A postoperative surgical complication (metalwork or hematoma) was considered but deemed unlikely since “complications from the metalwork or postoperative hematoma would be expected within the first week…”",
"Compression of the common peroneal nerve by the stocking was suspected given “a well‐demarcated indentati... | A 57‐year‐old Caucasian woman underwent elective revision spinal surgery at L5/S1 without complications. She was discharged 7 days later with normal strength (MRC grade 5/5) and sensation in both lower limbs and was provided below‐knee thromboembolic deterrent stockings to wear for 6 weeks. Three weeks postoperatively,... | Critical | 0.805 | test | null | null | null |
true | Paraneoplastic morphea | Scleromyxedema-spectrum disease | [
"Morphea/lupus overlap syndrome was considered because the biopsy and clinical picture were consistent with a morphea/lupus overlap pattern, as evidenced by the fact that the findings suggested a morphea/lupus overlap syndrome.",
"Mixed connective tissue disease was considered, but the combination of dermal scler... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-1",
"S-2"
] | I retained the three-step structure from the original chain and substituted each step with the corresponding single-error corrupted version from the provided variants: Step 1 uses the circular justification from S-2; Step 2 incorporates the fabricated consensus/sensitivity-specificity distractor from E-2; Step 3 applie... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2,
3
] | medprmbench_00304 | [
1,
2,
3
] | [] | [
"Morphea/lupus overlap syndrome was considered — “At that time, a morphea/lupus erythematosus overlap syndrome and mixed connective tissue disease were considered in the histopathologic differential diagnosis due to the combined histopathologic features.”",
"Mixed connective tissue disease was considered — “At th... | An 80-year-old man with a 13-year history of immunoglobulin G kappa smoldering myeloma presented with a 2-year history of dusky, erythematous, indurated patches on the lower abdomen and back and a hyperpigmented plaque on the right upper calf. Six years earlier, he had similar lesions initially diagnosed as tumid lupus... | Critical | 0.775 | test | null | null | null |
true | Metastatic breast carcinoma | Early medication-related osteonecrosis of the jaw (MRONJ/BRONJ) causing numb chin syndrome | [
"Chemotherapy-induced trigeminal neuropathy was considered given her prior taxane-based chemotherapy; however, the MRI finding of a small cavernous sinus lesion (even if labeled “hemangioma/leiomyoma”) is a classic radiographic correlate of trigeminal (V2/V3) compression at the skull base and therefore supports a s... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-3"
] | I kept the overall 4-step structure from Variant 1 (which added a concluding management/diagnosis step) to accommodate all injected errors. Step 1 was replaced with Variant 2’s R-1 neuroanatomy/imaging misinterpretation. Step 2 was kept consistent with Variant 2’s downstream inference from the cavernous sinus lesion to... | [
{
"error_description": "Incorrectly asserts that a small cavernous sinus lesion is a classic cause of V2/V3 (including mental nerve/V3) numbness and therefore supports skull-base trigeminal compression, despite cavernous sinus lesions typically affecting V1/V2 and the MRI interpretation indicating no clinically... | [
1,
3
] | medprmbench_00305 | [
1,
2,
3,
4
] | [] | [
"Chemotherapy-induced neuropathy of the trigeminal ganglion was considered given her prior chemotherapy but was excluded by MRI findings — “To exclude chemotherapy-induced neuropathy in the trigeminal ganglion, a magnetic resonance imaging (MRI) investigation was done. The images showed a small lesion in the right ... | A 54-year-old woman was referred by her dentist for sudden onset of pain in the right mandible and numbness of the right chin. Her medical history was notable for an early breast carcinoma diagnosed in 2008 (pT1a N1a, estrogen- and progesterone-receptor positive, HER-2 negative) treated with wide excision, axillary lym... | Critical | 0.835 | test | null | null | null |
true | hypofibrinogenemia | Chronic/occult disseminated intravascular coagulation (consumptive coagulopathy) | [
"Occult disseminated intravascular coagulation (DIC) — The markedly prolonged PT/aPTT history together with current findings are taken to point most strongly to an acute consumptive coagulopathy from DIC as the single unifying diagnosis. Although platelet count, D-dimers, and antithrombin are within reference inter... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"E-4",
"E-5",
"R-2"
] | All three variants primarily corrupt the early diagnostic framing. I merged them by making Step 1 simultaneously: (a) prematurely commit to DIC and dismiss other differentials (E-5), (b) invoke a fabricated ‘JVIM 2023’ consensus supporting an occult hypofibrinogenemic DIC phenotype despite normal D-dimers/platelets (E-... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-4",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2
] | medprmbench_00306 | [
1,
2,
3
] | [] | [
"Disseminated intravascular coagulation (DIC) — “The absence of clinical signs of disease conditions that are associated with disseminated intra-vascular coagulation (DIC) together with the absence of any other laboratory signs of hemostasis system activation (normal platelet count, DDi and AT) was not consistent w... | A 1.5-year-old male German Pointer weighing 27 kg was referred for a 10-day history of right third eyelid protrusion and a locked-jaw syndrome with extreme pain on mouth opening. The signs began after the dog was struck on the head by a ball and had remained stable. Three months earlier, the dog had presented in shock ... | Critical | 0.875 | test | null | null | null |
true | Takotsubo cardiomyopathy | ST-elevation myocardial infarction due to a culprit mid–right coronary artery lesion (aborted/evolving STEMI) | [
"ST-elevation acute coronary syndrome was initially suspected — “The constellation of STe on ECG, left ventricular (LV) WMAs, and elevated serum cardiac enzyme levels was highly suggestive of STe-ACS.”",
"Because the patient’s dyspnea progressed over ~3 days after the initial febrile illness and antibiotic treatm... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-7"
] | All three variants place their single root-cause error at Step 2, so the composite merges their corrupted Step-2 content into one coherent paragraph: (1) the trajectory misclassification based on 3 days (R-7), (2) the incorrect claim about Takotsubo being single-territory and multi-territory implying multivessel aborte... | [
{
"error_description": "Adds authoritative-sounding but fabricated/misapplied evidence (fake ESC position paper/registry statistics) claiming ≥90% stenosis with TIMI≤2 essentially rules in culprit ACS and that multi-territory apical akinesis is common in RCA infarcts, redirecting away from Takotsubo.",
"err... | [
2
] | medprmbench_00307 | [
2,
3,
4
] | [] | [
"ST-elevation acute coronary syndrome was initially suspected — “The constellation of STe on ECG, left ventricular (LV) WMAs, and elevated serum cardiac enzyme levels was highly suggestive of STe-ACS.”",
"The LV wall-motion abnormalities extended beyond the distribution of the identified coronary lesion, favoring... | An 87-year-old woman was referred for progressive dyspnea. Three days earlier she had presented with high-grade fever, dyspnea, and hematuria and received levofloxacin without improvement. Her history included hypertension, diabetes, dementia, and deep vein thrombosis; medications included candesartan, teneligliptin, d... | Critical | 0.8525 | test | null | null | null |
true | Schwannoma | Contained rupture of the ascending aorta with intrapericardial organized hematoma/pseudoaneurysm compressing the left main coronary artery | [
"The CT demonstrates a cystic mass with heterogeneous attenuation beyond simple fluid and slight contrast enhancement; these imaging features indicate that the lesion is complex rather than simple, and because it is complex on imaging, it warrants considering complex cardiovascular etiologies such as a thrombosed l... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-2",
"E-5",
"R-1",
"R-4",
"R-5"
] | I kept Variant 2’s tautological Step 1 as the composite Step 1 to preserve the S-2 non-circular-logic error. I then retained the original Step 2 (shared across variants) to maintain continuity about absent aortic wall abnormalities and LMCA compression. For the E-2 deception-resistance error, I replaced the original St... | [
{
"error_description": "",
"error_step_indices": [
1,
3
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error... | [
1,
3,
4,
5
] | medprmbench_00308 | [
1,
3,
4,
5
] | [] | [
"Consideration of a thrombosed left sinus of Valsalva aneurysm or impending rupture of aortic dissection — “The tumor was a cystic mass, but heterogenous attenuation was observed beyond the range of simple fluid on plain CT, and a slight contrast effect was also recognized. Therefore, we also considered a thrombose... | A 63-year-old woman with a history of hypertension presented with persistent chest and back pain. Two months earlier, she noted chest discomfort and dyspnea on exertion that gradually worsened. On arrival, her electrocardiogram showed sinus rhythm with diffuse ST-segment depression and ST elevation in lead aVR, along w... | Critical | 0.78 | test | null | null | null |
true | paraduodenal pancreatitis | Pancreatic ductal adenocarcinoma arising in the pancreaticoduodenal groove (groove pancreatic carcinoma) | [
"Groove pancreatic carcinoma was considered; it was deemed less likely because “both duodenal wall thickening and cystic changes are findings extremely uncommon in pancreatic adenocarcinoma.”",
"Adenocarcinoma of the pancreatic head/groove was instead supported because pancreatic adenocarcinoma characteristically... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-1",
"S-2"
] | I kept Step 1 from the original. I merged Variant 2 (R-1) and Variant 3 (S-2) into a single composite Step 2 by including both the incorrect claim that heterogeneous/pancreas-like enhancement supports adenocarcinoma and the tautological exclusion based on the same enhancement pattern; this preserves both errors even th... | [
{
"error_description": "Introduces an evidence-based imaging error by claiming pancreatic adenocarcinoma characteristically shows heterogeneous enhancement that can match pancreatic parenchyma, thereby (incorrectly) favoring carcinoma over inflammatory groove disease.",
"error_step_indices": [
2
]... | [
2,
3
] | medprmbench_00309 | [
2,
3,
4
] | [] | [
"Groove pancreatic carcinoma was considered; it was deemed less likely because “both duodenal wall thickening and cystic changes are findings extremely uncommon in pancreatic adenocarcinoma.”",
"Adenocarcinoma of the groove was further excluded as it “is homogeneously hypoenhancing compared with the pancreas,” un... | A 59-year-old woman presented with a 2-month history of progressive upper‐quadrant pain and postprandial vomiting. The pain became continuous, worsened after meals, and was relieved only by vomiting. She reported a 5-kg weight loss. There was no history of alcohol abuse. On examination, she had severe epigastric tender... | Critical | 0.7475 | test | null | null | null |
true | Accessory middle turbinate | Lobular capillary hemangioma (pyogenic granuloma) | [
"Chronic inflammatory polyps were considered because of bilateral nasal masses — “At this point, a differential diagnosis would include polyps from chronic inflammation…”",
"Hemangioma was considered as a vascular lesion causing recurrent epistaxis. In addition, the 2023 European Pediatric Rhinology Consensus (EP... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-1",
"R-2",
"R-6",
"S-1"
] | I used Variant 1’s EPReC-based distractor framing as the main backbone (including its downstream deprioritization of turbinate variants and final LCH conclusion). I then incorporated Variant 3’s redundancy insertions by placing the thin-slice CT/repeat read and coagulation-study steps after the paradoxical middle turbi... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
10
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error_step_in... | [
2,
4,
7,
8,
10,
11
] | medprmbench_00310 | [
2,
3,
4,
5,
6,
7,
8,
9,
10,
11
] | [] | [
"Chronic inflammatory polyps were considered because of bilateral nasal masses — “At this point, a differential diagnosis would include polyps from chronic inflammation…”",
"Hemangioma was considered as a vascular lesion causing recurrent epistaxis — “…hemangioma…”",
"Inverted papilloma was included given its p... | A 3-year-old boy was referred for assessment of recurrent epistaxis occurring one to two times per week over the past 2 months without trauma. Parents denied nasal obstruction, discharge, postnasal drip, sneezing, headache, or cough. His birth, medical, surgical, and family histories were unremarkable. On examination h... | Critical | 0.7732 | test | null | null | null |
true | Extranodal marginal zone lymphoma | High-grade follicular lymphoma | [
"Carcinoid tumor — “Malignant tumors arising from MD are rare and there are a few reported cases of carcinoid tumors…” Excluded because “microscopy revealed extensive infiltration of sheets of small lymphocytes…”",
"Gastrointestinal stromal tumor (GIST) — “Malignant tumors arising from MD are rare and there are a... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"E-5",
"R-4"
] | I kept Steps 1–2 from the original. I then inserted Variant 1’s fabricated ISGIP-based redirection at Step 3 (E-2). Next, I used Variant 2’s premature closure as Step 4 (E-5), minimally adapted to mention that no further evaluation of alternatives is needed while preserving the core narrowing error. Finally, I replaced... | [
{
"error_description": "Adds an authoritative-sounding but false ISGIP 2023 consensus claim that lymphoepithelial lesions strongly predict occult diffuse-type/signet ring adenocarcinoma, misleadingly redirecting interpretation toward adenocarcinoma despite the lymphoid findings.",
"error_step_indices": [
... | [
3,
4,
5
] | medprmbench_00311 | [
3,
4,
5,
6,
7,
8
] | [] | [
"Carcinoid tumor — “Malignant tumors arising from MD are rare and there are a few reported cases of carcinoid tumors…” Excluded because “microscopy revealed extensive infiltration of sheets of small lymphocytes…”",
"Gastrointestinal stromal tumor (GIST) — “Malignant tumors arising from MD are rare and there are a... | A 44-year-old man with a history of colonic diverticulitis presented with acute abdominal pain. On examination, his abdomen was distended with right lower quadrant tenderness. Contrast-enhanced CT of the abdomen revealed small-bowel loops dilated up to 4.3 cm in diameter, with a transition point in the mid-lower abdome... | Critical | 0.7175 | test | null | null | null |
false | malignant hidroacanthoma simplex | Malignant hidroacanthoma simplex (intraepidermal porocarcinoma) | [
"Bowen’s disease was considered because the pigmented, hyperkeratotic plaque with dotted vessels and a white-to-red structureless area resembles the “vascular + keratin” dermoscopic pattern described in in-situ SCC. Moreover, the 2023 International Dermoscopy Society (IDS) consensus statement (Br J Dermatol, 2023) ... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-6",
"S-1"
] | I constructed a single composite chain by taking Variant 1’s corrupted Step 1 (the IDS consensus/meta-analysis distractor and the claim that EMA is unreliable) as the opening step, then inserted Variant 3’s two redundant evaluation steps immediately afterward to preserve their intended irrelevance while maintaining nar... | [
{
"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,
5
] | medprmbench_00312 | [
1,
2,
3,
4,
5
] | [] | [
"Bowen’s disease was considered because of the pigmented, hyperkeratotic appearance and vascular structures — “EMA has been reported to be positive in the cytoplasm of neoplastic cells of HAS and negative in SK and BD.”",
"Seborrheic keratosis was considered due to the brown, verrucous morphology — “EMA has been ... | An 88-year-old Asian woman presented with a cutaneous mass on her right thigh that had been present for 30 months. The lesion began as a slightly elevated papule and gradually enlarged into a brown-colored, verrucous lump. Her medical history included hypertension for over 10 years and surgery for squamous cell carcino... | Critical | 0.805 | test | null | null | null |
true | Lutembacher syndrome | Alcoholic cardiomyopathy (HFpEF phenotype) with functional mitral/tricuspid regurgitation and secondary pulmonary hypertension | [
"Rheumatic valvular heart disease was suspected given the heart failure presentation and murmurs — “an initial provisional diagnosis of congestive cardiac failure (NYHA IV) due to rheumatic valvular heart disease was initially made…”",
"Congenital atrial septal defect was considered because of right-heart enlarge... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-3",
"R-5",
"R-7"
] | I kept steps 1–2 aligned with the original/variants. I used Variant 1’s corrupted Step 3 verbatim to embed the E-2 fabricated consensus and its misdirection; this also naturally extends into Variant 1’s later conclusions, so I retained Variant 1’s added Steps 5–6. To integrate both R-3 and R-7 (each targeting Step 4), ... | [
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "R-3",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
3,
4,
5,
6
] | medprmbench_00313 | [
3,
4,
5,
6
] | [] | [
"Rheumatic valvular heart disease was suspected given the heart failure presentation and murmurs — “an initial provisional diagnosis of congestive cardiac failure (NYHA IV) due to rheumatic valvular heart disease was initially made…”",
"Congenital atrial septal defect was considered because of right-heart enlarge... | A 28-year-old man presented with 2 months of progressively worsening dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and bilateral leg swelling. He also reported a 2-week history of cough productive of whitish, frothy sputum. There was no fever, facial swelling, or reduction in urine output, and no histor... | Major | 0.5533 | test | null | null | null |
true | primary retroperitoneal mucinous carcinoma | Decidualised endometrioma | [
"While a mucinous borderline tumour is often listed when papillary projections are seen, pregnancy-specific imaging data argue strongly against it here: the 2023 RCOG–ESUR Pregnancy Adnexal Mass Consensus (reported in *Ultrasound in Obstetrics & Gynecology*) notes that in gravid patients a “ground-glass” cyst with ... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-2",
"R-3",
"R-6",
"R-7"
] | I merged the single-error variants by taking Variant 2’s fabricated guideline-based reframing as the new Step 1 (E-2), then incorporated Variant 3’s short-interval-stability argument that malignancy is unlikely and surgery can be deferred as Step 2 and propagated its timing assumptions into later planning and imaging-s... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-7",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2,
3,
4,
6
] | medprmbench_00314 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Step 1: A mucinous borderline tumour was considered given the cyst’s papillary projections and ground-glass echogenicity — “Differential diagnoses included mucinous borderline tumour, ovarian malignancy, and decidualised endometrioma.”",
"Step 2: Ovarian malignancy was included because complex cysts with papilla... | A 36-year-old woman, gravida 5 para 4, was found to have a right ovarian cyst during a routine fetal anomaly ultrasound scan at 20 weeks’ gestation. On transabdominal sonography, the cyst measured 11.5 × 9.8 × 8.8 cm, had a ground-glass appearance, and contained two papillary projections with grade 1 flow on Doppler (l... | Critical | 0.875 | test | null | 3 | 0 |
true | Lymphoplasmacytic lymphoma | Multiple myeloma involving the larynx | [
"Carcinoma was considered given the location and appearance of the laryngeal mass but was excluded because in head and neck cancers of older adults, cytokeratin immunostains such as AE1/AE3 are frequently negative in poorly differentiated tumours, so a negative AE1/AE3 essentially rules out carcinoma in this age gr... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-6"
] | I kept the original 3-step structure and substituted each step with the corresponding corrupted version from the single-error variants: Step 1 from Variant 2 (R-3), Step 2 from Variant 1 (E-2). For Step 3, I merged Variant 1’s amyloidosis/oligoclonality argument with Variant 3’s fabricated SPEP/immunofixation results s... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2,
3
] | medprmbench_00315 | [
1,
2,
3
] | [] | [
"Carcinoma was considered given the location and appearance of the laryngeal mass but was excluded because “the specimen was negative for epithelial cell markers AE1/AE3.”",
"Amyloidosis was included in the preoperative differential but ruled out as “Direct fast scarlet 4BS (DFS) staining showed no amyloid deposi... | A 72‐year‐old man with hypertension and reflux esophagitis presented with three years of progressive dysphagia. In June 2022, he developed respiratory distress in the left lateral decubitus position. Fiberscopic examination showed a pedunculated mass arising from the right aryepiglottic fold that swung pendulum‐like du... | Critical | 0.805 | test | null | null | null |
true | tracheobronchopathia osteochondroplastica | Tracheobronchial amyloidosis | [
"Lung cancer — the patient underwent fiberoptic bronchoscopy (FOB) to exclude malignancy given the irregular RUL opacity in a heavy smoker.",
"Pneumonia — the right upper-lobe shadow is pneumonia because it behaved like pneumonia, as shown by its near-complete radiographic clearance after antibiotic therapy, whic... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-1",
"S-2"
] | I kept Step 1 aligned with the original (no injected error there). I replaced Step 2 with the S-2 tautological version exactly as provided. I replaced Step 3 with Variant 1’s E-2 distractor content (fabricated ERS/ERJ 2023 consensus, odds ratio, and upper-lobe predilection), preserving its intent to keep TO-related obs... | [
{
"error_description": "Introduces circular/tautological logic by concluding pneumonia because the lesion 'behaved like pneumonia,' restating antibiotic response/clearance as its own justification without adding non-circular differential reasoning.",
"error_step_indices": [
2
],
"error_type": ... | [
2,
3,
4
] | medprmbench_00316 | [
1,
2,
3,
4
] | [] | [
"Lung cancer — “the patient underwent fiberoptic bronchoscopy (FOB) to exclude malignancy.”",
"Pneumonia — “response to antibiotics and clearance of the RUL lesion proved the ovoid shadow to be pneumonia.”",
"Pneumonia caused by bronchial obstruction from TO — excluded because “despite … nodules … they did not ... | A 76-year-old man with a 50-pack-year smoking history presented with 4 days of fever, cough, and purulent sputum. He had worked as a farmer and had a remote inguinal hernia repair; his history also included diverticular disease and microscopic anemia. On admission, temperature was 38.2°C; other vital signs were normal.... | Critical | 0.835 | test | null | null | null |
true | Choroidal detachment | Hemorrhagic choroidal detachment (suprachoroidal hemorrhage) | [
"Retinal detachment was excluded because “retinal detachments will show a distinct ‘V’ shape due to the retina’s fixation to the optic nerve head posteriorly.”",
"Although hemorrhagic choroidal detachment was initially considered, recent postoperative glaucoma-surgery guidance suggests the opposite IOP associatio... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-6",
"R-7"
] | All three variants inject their root-cause error at Step 2, so Step 2 was merged to simultaneously include: (1) the fabricated ASGS consensus statement with false hypotony-predicts-hemorrhage statistics (E-2), (2) the hallucinated INR=2.3 value (R-6), and (3) the incorrect temporal claim that hemorrhage should evolve i... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3
] | medprmbench_00317 | [
1,
2,
3
] | [] | [
"Retinal detachment was excluded because the ultrasound morphology showed bilateral convex layers protruding into the vitreous that did not extend to the optic nerve head, which is characteristic of choroidal detachment rather than retinal detachment.",
"Hemorrhagic choroidal detachment was considered but felt le... | A 63-year-old woman presented with 2 days of left eye pain, photophobia, conjunctival injection, and progressive visual acuity loss. The pain started suddenly, was constant, and had worsened. She denied trauma or systemic symptoms. Six weeks earlier she had undergone tube-shunt surgery for left-eye glaucoma; preoperati... | Major | 0.6883 | test | null | 2 | 1 |
true | relapsing polychondritis | Viral tracheobronchitis due to parainfluenza virus 3 | [
"Viral tracheobronchitis due to parainfluenza — the positive nasopharyngeal aspirate for parainfluenza virus 3 RNA together with acute onset wheeze and dyspnea indicates an acute viral airway infection as the unifying diagnosis.",
"Tracheobronchomalacia from relapsing polychondritis is unlikely here because her r... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-1",
"S-1"
] | [
{
"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
] | medprmbench_00318 | [
1,
2,
3,
4
] | [] | [
"Tracheobronchomalacia from relapsing polychondritis — “CT pulmonary angiogram showed thickening of the cartilaginous portions of the trachea and bronchi with sparing of the posterior membranes… consistent with tracheobronchomalacia secondary to repeated cartilaginous inflammation….”",
"Viral tracheobronchitis — ... | A 57-year-old woman with a 20-year history of relapsing polychondritis presented with acute shortness of breath and wheezing that began during a long-distance flight. In her 30s, she had been diagnosed based on bilateral auricular chondritis, nasal chondritis, ocular inflammation, and respiratory tract involvement. Her... | Major | 0.5425 | test | null | null | null | |
true | fibromatosis | Low-grade spindle-cell metaplastic carcinoma of the breast | [
"Benign phyllodes tumor was considered because of the core biopsy fibroepithelial features and stromal overgrowth—“the possibility of a benign phyllodes tumor could not be excluded and a B3 designation would probably be more appropriate.”",
"Given the patient’s family history and the presence of architectural dis... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-1",
"S-1"
] | I kept Step 1 from the original. I inserted the redundant imaging recommendation from S-1 as a new Step 2, shifting subsequent indices. I then used the R-1 corrupted malignancy-favoring morphology/Ki-67 interpretation as Step 3. Next, I replaced the original cytokeratin-based exclusion with the E-2 fabricated-consensus... | [
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "S-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
4,
5
] | medprmbench_00319 | [
2,
3,
4,
5
] | [] | [
"Benign phyllodes tumor was considered because of the core biopsy fibroepithelial features and stromal overgrowth—“the possibility of a benign phyllodes tumor could not be excluded and a B3 designation would probably be more appropriate.”",
"Malignant spindle‐cell neoplasms (metaplastic carcinoma, high-grade fibr... | A 49-year-old woman noted a palpable lump in her right breast 3 months earlier. Two years ago, she had fibroadenomas and cysts in the left breast confirmed on biopsy. Her medical history includes hypothyroidism (on levothyroxine) and use of oral contraceptives. Her paternal aunt had breast cancer at age 20.
On examin... | Critical | 0.765 | test | null | null | null |
true | Verrucae planae | Papular sarcoidosis localized to tattoo pigment (tattoo sarcoid reaction) | [
"Lichen nitidus was considered because of the skin-colored flat-topped papules but was excluded when histopathology showed keratinocytes with HPV-induced changes, which is not consistent with the classic “ball-and-claw” granulomatous pattern of lichen nitidus.",
"Papular eczema was considered due to the papular e... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1"
] | I kept steps 1–2 aligned with the non-error portions of the variants that still referenced HPV-type biopsy changes to exclude lichen nitidus and papular eczema. I then inserted Variant 1’s deceptive, fabricated-consensus sarcoidosis argument as step 3 (the E-2 root-cause error). To integrate both Variant 2 (R-1) and Va... | [
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
4,
5
],
"error_type": "R-1",
"modified_steps": null
}
] | [
3,
4,
5
] | medprmbench_00320 | [
1,
2,
3,
4,
5
] | [] | [
"Lichen nitidus was considered because of the skin-colored flat-topped papules but was excluded when “Histopathology revealed keratinocytes with HPV-induced changes and a diagnosis of verrucae planae was made.”",
"Papular eczema was considered due to the papular eruption but was excluded when “Histopathology reve... | A 36-year-old man presented with a 6-month history of skin-colored, flat-topped papules confined to the black portions of a tattoo on his right forearm and arm. The tattoos had been applied by a professional artist 20 years earlier, with no prior eruptions in those areas. The asymptomatic papules appeared suddenly and ... | Critical | 0.835 | test | null | null | null |
true | Idiopathic granulomatous mastitis | Non-lactational bacterial breast abscess (periductal mastitis) | [
"Carcinomatous mastitis was considered because breast cancer can present as an inflammatory mass—“the disease begins as unilateral inflammatory nodules, which may resemble cancer.”",
"Mammary tuberculosis was considered in endemic settings but ruled out by the absence of caseous necrosis on tissue examination—“Al... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-6"
] | I used Variant 1’s premature-narrowing infection-focused segment (steps asserting uncomplicated bacterial abscess and deprioritizing malignancy/granulomatous causes) as the early core, and fused Variant 3’s safety-bypass nuance into the same root-cause step by explicitly stating that negative cultures do not meaningful... | [
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
16
],
"error_type": "R-6",
"modified_steps": null
}
] | [
3,
16
] | medprmbench_00321 | [
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15,
16,
17,
18
] | [] | [
"Carcinomatous mastitis was considered because breast cancer can present as an inflammatory mass—“the disease begins as unilateral inflammatory nodules, which may resemble cancer.”",
"Mammary tuberculosis was considered in endemic settings but ruled out by the absence of caseous necrosis on tissue examination—“Al... | A 36-year-old woman, gravida 2 para 2, presented with a 3-day history of right breast pain and swelling. She had no history of breast trauma, tuberculosis exposure, breast cancer, or autoimmune disease. She breastfed two children for 1 year each and used combined estrogen–progestin oral contraception for 3 years. She w... | Major | 0.7006 | test | null | null | null |
true | Scimitar syndrome | Occult central bronchogenic carcinoma causing right lung collapse | [
"Post-tubercular sequelae were considered given regional prevalence — “the differential diagnoses for the etiology included: (a) post-tubercular sequelae (common in this part of the world)…”.",
"Neoplastic processes were entertained because tumors can cause volume loss. In addition, the combination of unilateral ... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"E-5",
"R-1",
"R-2",
"R-5",
"R-6"
] | I kept Step 1 aligned with the original. I replaced Step 2 with Variant 1’s ERIS-based malignancy-prioritizing distractor to preserve the deception-resistance error. I replaced Step 3 with Variant 2’s premature narrowing (adding Variant 1’s mucus-plugging framing for coherence while retaining the core narrowing error).... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "E-5",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
4,
5
] | medprmbench_00322 | [
1,
2,
3,
4,
5
] | [] | [
"Final Diagnosis: Scimitar syndrome. Initial logic and parameters are validated.",
"Standard processing applied.",
"Standard processing applied.",
"CT imaging revealed congenital vascular and pulmonary anomalies inconsistent with post-tubercular sequelae, neoplastic processes, or mucus plugging/foreign body."... | A 40-year-old woman presented with a 3-month history of dry cough and exertional dyspnea. She had no history of tuberculosis, smoking, chemical or organic dust exposure, regular medications, or prior surgery. On examination, she was afebrile with stable vital signs. Chest auscultation revealed reduced breath sounds on ... | Critical | 0.875 | test | null | 3 | 0 |
true | phaeohypomycosis | Eumycetoma | [
"Ganglion vs soft-tissue tumor considered based on clinical exam — the lesion is a mobile, peri-wrist soft-tissue swelling and was clinically suspected to be a ganglion with a differential of soft-tissue tumor.",
"Given the wrist-adjacent location and thick mucoid aspirate, this most closely fits a ganglion cyst;... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-3"
] | I kept Step 1 from the original. I merged Variant 1 (fabricated ESMC guideline/PPV claim) and Variant 3 (pediatric-context ganglion interpretation applied to an adult) into a single composite Step 2 so both errors coexist at the same root-cause position. I preserved the original Step 3 suspicion for pigmented fungal in... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-3",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
4,
6
] | medprmbench_00323 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Step 1: Ganglion vs soft-tissue tumor considered based on clinical exam — “clinically suspected to be ganglion with the differential diagnosis of soft-tissue tumor.”",
"Step 2: Acute-on-chronic inflammation was favored initially given mixed neutrophils and macrophages — “Considering the clinical and cytomorpholg... | A 40-year-old woman presented with a soft, nodular, mobile swelling measuring 3.0 cm by 2.0 cm on the right forearm near the wrist joint. She reported no systemic symptoms. A radiograph of the forearm showed a soft-tissue swelling without bone involvement. Clinically, the lesion was suspected to be a ganglion or, alter... | Major | 0.835 | test | null | 3 | 0 |
true | Acanthocytosis | Adult-onset neuroacanthocytosis syndrome | [
"Multiple hereditary and acquired acanthocytosis syndromes were considered — “Acanthocytosis has been reported in association with several hereditary and acquired conditions, including McLeod phenotype, In(Lu) phenotype, hereditary spherocytosis with a β-spectrin deficiency, alcoholic cirrhosis, uremia, vitamin E d... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-3",
"R-6"
] | I kept the shared non-error steps (1–3 and 6) close to the original. I replaced step 4 with Variant 1’s portal-hypertension consensus distractor (E-2) and retained Variant 1’s downstream adaptations in steps 5 and 7 for coherence, while marking only step 4 as the E-2 root-cause error. I then imported Variant 3’s fabric... | [
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
4,
8
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error... | [
4,
8,
9
] | medprmbench_00324 | [
4,
5,
7,
8,
9
] | [] | [
"Multiple hereditary and acquired acanthocytosis syndromes were considered — “Acanthocytosis has been reported in association with several hereditary and acquired conditions, including McLeod phenotype, In(Lu) phenotype, hereditary spherocytosis with a β-spectrin deficiency, alcoholic cirrhosis, uremia, vitamin E d... | A 24-year-old Sri Lankan man with a history of Klippel-Trenaunay syndrome (hemihypertrophy of the right lower limb and strawberry naevi since age 6) presented with effort intolerance (NYHA class III) and lethargy. He had episodic rectal bleeding since age 17; prior colonoscopy and mesenteric angiography showed lower ga... | Major | 0.6494 | test | null | null | null |
true | Primary squamous cell carcinoma of the renal parenchyma | Xanthogranulomatous pyelonephritis (inflammatory renal pseudotumor) | [
"Consideration of primary urothelial (transitional cell) carcinoma with squamous differentiation — “In the presence of an identifiable urothelial dysplastic element including urothelial CIS … the tumor should be classified as primary urothelial carcinoma with squamous differentiation. However, … the nearest urothel... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"E-4",
"R-1",
"R-4"
] | I kept Step 1 from the original. I replaced Step 2 with Variant 1’s EUOCP-guideline/statistics distractor (E-2) and carried its downstream PET/CT-sensitivity framing into Step 3 and its radiographic/PPV claim into Step 5 for coherence. I then merged Variant 2’s quantitative ‘2× back-pressure’ obstruction/hydronephrosis... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "E-4",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
4
] | medprmbench_00325 | [
2,
3,
4,
5
] | [] | [
"Consideration of primary urothelial (transitional cell) carcinoma with squamous differentiation — “In the presence of an identifiable urothelial dysplastic element including urothelial CIS … the tumor should be classified as primary urothelial carcinoma with squamous differentiation. However, … the nearest urothel... | A 51-year-old man presented with an 8-month history of a sensation of heaviness in the right upper abdomen and a 5-month history of dull, intermittent right flank pain. He denied weight loss, hematuria, fever, or urinary complaints. He was a nonsmoker with no history of hypertension. On examination, he had mild pallor ... | Critical | 0.765 | test | null | null | null |
true | Intrahepatic arteriovenous malformation | Fetal gallbladder hydrops (massive gallbladder distension) | [
"Hemangioma was considered but excluded because the lesion demonstrated direct vascular channels without soft tissue and fast‐flow dynamics — “Thus, differential diagnoses such as hemangiomas … can easily be excluded.”",
"Although a simple dilated gallbladder is often ruled out when tortuous channels are seen, th... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-2"
] | I kept Step 1 from the original. For Step 2, I replaced the original gallbladder exclusion with Variant 1’s fabricated ISUOG-consensus-based reclassification to gallbladder hydrops (E-2 root cause). For Step 3, I merged Variant 1’s downstream propagation (“reclassified as gallbladder hydrops…”) with Variant 2’s contrad... | [
{
"error_description": "Introduces a fabricated, authoritative-sounding ISUOG 2023 consensus with misapplied PPV/statistics claiming intralesional Doppler flow and low hepatic artery RI predict gallbladder hydrops due to pseudo-flow artifact, redirecting the differential away from a true hepatic AV shunt/malfor... | [
2,
3
] | medprmbench_00326 | [
2,
3,
4,
5
] | [] | [
"Hemangioma was considered but excluded because the lesion demonstrated direct vascular channels without soft tissue and fast‐flow dynamics — “Thus, differential diagnoses such as hemangiomas … can easily be excluded.”",
"Dilated gallbladder was ruled out as the ultrasound showed echopenic dilated and tortuous or... | A 34-year-old G5P3 woman was referred at 33 + 0 weeks of gestation for evaluation of a suspected fetal liver anomaly. Ultrasound showed an isolated, fluid-filled lesion measuring 67.9 × 61.6 × 53.3 mm in the left hepatic lobe without soft-tissue components. Color and pulsed Doppler revealed massive blood flow within th... | Critical | 0.705 | test | null | null | null |
true | SmallBowelObstruction | Acute intestinal pseudo-obstruction (paralytic ileus) related to Parkinson’s disease | [
"Consider Parkinson’s-related constipation — While this could be another episode of gastrointestinal dysmotility secondary to Parkinson’s disease, the persistence beyond baseline and associated systemic markers warrant escalation.",
"Re-interpret the radiograph as more consistent with paralytic ileus than mechani... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-3",
"R-6"
] | I kept Step 1 close to the original. I merged Variant 1 and Variant 3 at Step 2 by combining the ESNG pseudo-obstruction reinterpretation with the hallucinated inguinal mass, preserving both the authoritative-sounding distractor and the fabricated exam finding as a single coherent (but internally inconsistent) pivot st... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
5
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
5
] | medprmbench_00327 | [
1,
2,
3,
4,
5
] | [] | [
"Consideration of Parkinson’s-related constipation — “While this could be another episode of gastrointestinal symptoms secondary to PD…”",
"Suspicion of small-bowel obstruction — “Abdominal radiograph showed dilation of small bowel… raising the suspicion of a bowel obstruction.”",
"Evaluation for closed-loop ob... | A 68-year-old man with a 5-year history of Parkinson’s disease was evaluated at home for a routine frailty assessment. He reported no bowel movement for five days, with abdominal discomfort, bloating, and mild nausea for the past two days. He denied fever, vomiting beyond mild nausea, hematochezia, or changes in medica... | Critical | 0.91 | test | null | null | null |
true | Nocardia cyriacigeorgica | High-grade glioma or metastatic brain tumor | [
"Ischemic stroke was initially suspected based on the initial noncontrast CT hypodensity and CT perfusion showing decreased cerebral blood flow without reduced cerebral blood volume in the right MCA territory, despite normal CTA.",
"When symptoms recurred and the lesion progressed on CT, a seizure was considered;... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-5",
"R-6"
] | I kept Step 1 from the original as the non-error baseline. I used Variant 1’s corrupted Step 2 verbatim as the E-2 root-cause step (fabricated EANO guidance and CVT reframing). For Step 3, I adopted Variant 3’s safety-violating anchoring on malignancy with steroid escalation, preserving the R-5 root cause. For Step 4, ... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "R-5",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2,
3,
4,
5
] | medprmbench_00328 | [
1,
2,
3,
4,
5
] | [] | [
"Step 1: Ischemic stroke was initially suspected — “initially suspected of having an ischemic stroke based upon non-contrast computed tomography … and … CT perfusion maps … showed a decrease in cerebral blood flow without a decrease in cerebral blood volume in the right middle cerebral artery territory.”",
"Step ... | A 75‐year‐old right‐hand–dominant man was admitted with acute confusion and left‐hand apraxia. His history included ischemic heart disease, hypertension, chronic kidney disease, dyslipidemia, well‐controlled mild asthma, hypothyroidism, prostate carcinoma in remission on leuprolide and daily prednisone (5 mg) for 18 mo... | Critical | 0.965 | test | null | 3 | 0 |
true | chordoid glioma | Primary CNS lymphoma (intraventricular/third ventricular lymphoma) | [
"Sellar and suprasellar region tumors — The pattern of mass effect (bowing of the floor of the third ventricle/infundibulum and compression of the optic chiasm) with an intact pituitary gland and suprasellar cistern indicates a third-ventricular mass rather than a sellar/suprasellar tumor because these findings are... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-1",
"R-7",
"S-2"
] | I kept the original 2-step structure (no variants added or removed steps). For Step 1, I merged Variant 3’s tautological (circular) explanation with Variant 1’s authoritative-sounding but fabricated ESNR consensus claims that redirect toward intraventricular CNS lymphoma, preserving both the S-2 and E-2 errors in the s... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
1,
2
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error... | [
1,
2
] | medprmbench_00329 | [
1,
2
] | [] | [
"Sellar and suprasellar region tumors — “The mass effects, such as the downward and backward bowing of the floor of the third ventricle and infundibulum and the downward compression of the optic chiasm, associated with an intact pituitary gland and supraoptic recess, represent important findings that can distinguis... | A 45-year-old woman presented with a 6-month history of headache, memory deficits, visual disturbances, and a 20-kg weight gain. On examination, she had right temporal hemianopia and a left diffuse visual defect. Endocrine testing revealed normal levels of luteinizing hormone, follicle-stimulating hormone, thyroid-stim... | Critical | 0.835 | test | null | null | null |
true | gastric adenocarcinoma with enteroblastic differentiation | Adenocarcinoma arising in a heterotopic pancreatic rest (gastric heterotopic pancreas carcinoma) | [
"Heterotopic pancreatic carcinoma — heterotopic pancreas is a well-known submucosal lesion of the gastric antrum/pylorus, so an adenocarcinoma arising from a pancreatic rest can present as a submucosal tumor-like lesion with surface nodularity and may perforate, making this a leading consideration.",
"Heterotopic... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"E-5",
"R-1"
] | I kept Step 1 close to the original/Variant 1 framing. For Step 2, I merged Variant 1’s deception-based fabricated Gut 2023 statistics with Variant 3’s context error (pediatric typicality applied to an adult) into a single coherent step, marking it as the shared root-cause error step for E-2 and R-3. For Step 3, I used... | [
{
"error_description": "",
"error_step_indices": [
2
],
"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... | [
2,
3
] | medprmbench_00330 | [
1,
2,
3,
4
] | [] | [
"[Final Result: gastric adenocarcinoma with enteroblastic differentiation] Heterotopic pancreatic carcinoma — \"heterotopic pancreas is a well-known submucosal lesion of the gastric antrum. Thus, we considered the possibility that adenocarcinoma from a heterotopic pancreas invaded the gastric lumen.\"",
"Initial ... | A 39-year-old woman was admitted with acute upper abdominal pain. At laparotomy, a 5 mm perforation of the anterior pyloric wall was closed with omental coverage; no masses or serosal nodules were seen. Postoperatively, endoscopic biopsy revealed adenocarcinoma of the pylorus. Upper endoscopy showed a submucosal tumor-... | Critical | 0.875 | test | null | 3 | 0 |
true | choriocarcinoma | Metastatic malignant melanoma with hypervascular brain metastasis and gastrointestinal bleeding | [
"Upper gastrointestinal bleeding from peptic ulcer disease or gastritis was initially considered; additionally, per the 2023 European Society of Gastrointestinal Hemorrhage (ESGH) consensus update (Gut, 2023), in women <35 years with melena/hematemesis and no NSAID use, the single highest-yield unifying diagnosis i... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-6",
"S-1"
] | I combined Variant 1’s ESGH/CVST redirection by replacing Step 1 and carrying its CVST-prioritizing logic into Step 2 and the final step. I incorporated Variant 2’s hallucinated melanoma clues by rewriting Step 3 to assert the pigmented lesion and axillary lymphadenopathy and then propagating melanoma attribution throu... | [
{
"error_description": "Introduces a fabricated ESGH (Gut 2023) consensus with misleading performance statistics to redirect reasoning toward depot medroxyprogesterone–associated CVST/hemorrhagic venous infarction and to discount β-HCG confirmation, despite the CT being described as suggestive of hypervascular ... | [
1,
3,
5
] | medprmbench_00331 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Step 1: Upper gastrointestinal bleeding from peptic ulcer disease or gastritis was initially considered as the patient’s age and presentation matched common patterns — “Provisional diagnosis of peptic ulcer disease was made because it is more common in this age group and there was no other significant gynecologica... | A 29-year-old woman presented with a 12-day history of black, tarry stools and intermittent hematemesis, totaling one episode per day over the preceding 3 days, followed by altered sensorium for 1 day. She denied jaundice, abdominal distension, chronic alcohol use, or regular analgesic intake. She had received a depot ... | Critical | 0.91 | test | null | 3 | 0 |
true | Meningioma | Giant thrombosed vertebral artery aneurysm at the foramen magnum | [
"The imaging clearly and definitively confirms that this is NOT a dural-based, homogeneously enhancing lesion encasing the vertebral arteries—rather, it is a non–dural-based intramedullary cervical cord tumor with heterogeneous enhancement and no vascular encasement, which without question rules out meningioma as a... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"E-5",
"R-4",
"R-6"
] | All three variants place their root-cause corruption in Step 1, so the composite Step 1 was constructed by merging: (a) the R-4 overconfident contradiction of the stem’s MRI description, (b) the E-2 fabricated 2023 consortium/PPV claim redirecting toward thrombosed vertebral aneurysm, and (c) the E-5 premature narrowin... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-5",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2,
3
] | medprmbench_00332 | [
1,
2,
3
] | [] | [
"A meningioma was the leading consideration because the lesion was dural-based, exhibited homogeneous contrast enhancement, and encased the vertebral arteries— “MRI showing ventral placed, homogenously enhancing dural based lesion in the foramen magnum encasing both vertebral arteries suggestive of meningioma.”",
... | A 42-year-old woman presented with a 3-month history of neck pain and progressive spastic hemiparesis, recently worsened, without bowel or bladder involvement. She also reported dysphagia and disturbed sleep. On examination, there was paralysis of the right sternocleidomastoid and trapezius muscles; motor strength was ... | Critical | 0.805 | test | null | null | null |
true | false_gastric_diverticulum | Infiltrative prepyloric gastric adenocarcinoma (signet-ring cell carcinoma) | [
"Consideration of primary gastric adenocarcinoma — Although malignancy is often considered in an elderly patient with gastric outlet obstruction and focal antral/prepyloric thickening, the combination of (a) multiple negative blind biopsies and (b) absence of adenopathy or hepatic lesions on CT makes adenocarcinoma... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-2",
"R-6"
] | I kept the original question unchanged because none of the variants modified it. I merged Variant 1 and Variant 3 by combining both Step-1 corruptions into a single Step 1 that simultaneously (a) cites the fabricated EFOC guideline to argue cancer is unlikely after negative biopsies and (b) introduces fabricated tumor ... | [
{
"error_description": "Introduces a fabricated 2023 European consensus guideline with a falsely high negative predictive value for repeated negative biopsies to prematurely down-rank gastric cancer and redirect toward benign etiologies.",
"error_step_indices": [
1
],
"error_type": "E-2",
... | [
1,
2
] | medprmbench_00333 | [
1,
2,
3,
4
] | [] | [
"Consideration of gastric adenocarcinoma — “As it was difficult to make an accurate diagnosis and disprove the likelihood of a cancerous lesion, the patient underwent an exploratory laparotomy.”",
"Consideration of a congenital (true) gastric diverticulum — “Congenital or true diverticula … are classically locate... | A 69-year-old man with no prior medical history presented with a two-month history of diffuse abdominal pain and postprandial vomiting. He reported significant weight loss and appeared in poor general condition. Physical examination was otherwise unremarkable. Laboratory studies showed elevated blood urea with a satisf... | Critical | 0.805 | test | null | null | null |
false | pseudoaldosteronism | Licorice-induced pseudoaldosteronism (11β-HSD2 inhibition) | [
"Consider a primary hereditary tubular disorder at presentation, but prioritize an acquired salt-wasting tubulopathy—specifically surreptitious loop/thiazide exposure—because the very high transtubular potassium gradient (TTKG 16) with metabolic alkalosis and normal magnesium is reported to be highly discriminative... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-3",
"R-6"
] | I constructed a single coherent chain by (1) adopting Variant 2’s distractor framing and fabricated 2023 consensus content in the hyperaldosteronism-exclusion step (and its spillover linkage to diuretics), (2) replacing the Cushing-exclusion step with Variant 3’s adolescent-inappropriate, adult-threshold reasoning whil... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2
] | medprmbench_00334 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Consideration of a primary hereditary tubular disorder — “Although a primary hereditary tubular disorder was the first clinical suspicion…”",
"Primary hyperaldosteronism was excluded by low renin and low aldosterone levels — “Low plasma renin concentration [<0.3 ng/mL/h …], low plasma aldosterone [3.4 ng/dL …]…”... | A 15-year-old girl presented to the emergency department with a 24-hour history of dizziness, nausea, and progressive weakness. She denied smoking, alcohol, diuretic use, vomiting, or diarrhea, and her family history was unremarkable. She exercises daily. On examination, blood pressure was 135/80 mm Hg, heart rate 75 b... | Critical | 0.875 | test | null | null | null |
true | Pleuropulmonaryblastoma | Primary intracranial infantile myofibroblastic sarcoma | [
"The intracranial lesion is most consistent with metastatic pleuropulmonary blastoma because the brain MRI demonstrates heterogeneous hemorrhagic components with marked surrounding vasogenic edema and, on staging workup, the patient was found to have multiple bilateral pulmonary nodules on chest CT—findings typical... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-6",
"S-1"
] | I merged the three variants by (1) replacing the original first step with the R-6 hallucinated imaging/staging justification for metastatic PPB and carrying its downstream consequence into the next step (reduced need for molecular confirmation), (2) inserting the S-1 redundant ancillary workup steps as additional inter... | [
{
"error_description": "Fabricates patient-specific findings not present in the stem (detailed hemorrhagic/vasogenic edema MRI characterization and new bilateral pulmonary nodules on chest CT) and uses them to justify metastatic PPB while minimizing the need for molecular correlation.",
"error_step_indices"... | [
1,
3,
4,
5
] | medprmbench_00335 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Infantile myofibroblastic sarcoma was initially diagnosed on intracranial pathology — “postoperative pathological diagnosis of intracranial tumors was infantile myofibroblastic sarcoma.”",
"A primary brain tumor was considered given the solitary intracranial mass but required correlation with thoracic history an... | A 2-year-old girl was hospitalized for fever. Chest radiography revealed a space-occupying lesion in the right thorax, and needle biopsy was performed. Postoperative pathology showed a primitive neuroectodermal tumor. She received five courses of alternating vincristine–cyclophosphamide–topotecan and vincristine–cyclop... | Critical | 0.875 | test | null | null | null |
true | PilocyticAstrocytoma | Optic nerve sheath meningioma | [
"Optic glioma was considered in the initial CT differential but was excluded by histopathology demonstrating a classic biphasic pattern of pilocytic astrocytoma — “tumor tissue forming dense and loose areas, giving the appearance of a biphasic pattern.”",
"Lymphoma was included in the CT differential but was deem... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-2",
"R-6",
"S-1"
] | I used Variant 3’s inserted redundant workup as new Steps 3–4 (making them the S-1 root-cause error steps). I then merged Variant 1’s deceptive IOIC consensus content into the meningioma-vs-astrocytoma discussion and simultaneously incorporated Variant 2’s pathology contradiction by stating that histopathology did not ... | [
{
"error_description": "",
"error_step_indices": [
5
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
5
],
"error_type": "R-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
3,
4,
5
] | medprmbench_00336 | [
3,
4,
5,
6
] | [] | [
"Optic glioma was considered in the initial CT differential but was excluded by histopathology demonstrating a classic biphasic pattern of pilocytic astrocytoma — “tumor tissue forming dense and loose areas, giving the appearance of a biphasic pattern.”",
"Lymphoma was included in the CT differential but was deem... | A 10-year-old boy was referred for evaluation of a left orbital mass present for 3 years that had become more prominent over the past year, associated with intermittent redness, tearing, inward deviation of the eye, and decreased vision. He had been treated elsewhere for presumed mild infection with analgesics and topi... | Major | 0.6583 | test | null | null | null |
true | Fused tooth | Dens invaginatus of the maxillary right lateral incisor | [
"The palatal calcified projection and talon-cusp-like appearance strongly suggest a talon cusp as the diagnosis.",
"Because the lesion looks like a classic talon cusp and the tooth erupted spontaneously, there is no need to pursue a broader differential (eg, fusion with a supernumerary tooth, dens invaginatus, or... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"E-5",
"R-7"
] | I constructed a single coherent chain by starting from Variant 2’s talon-cusp anchoring and differential shutdown (placing that as Step 2, the E-5 root-cause). I then integrated Variant 3’s temporal/causal misinterpretation as the next step (Step 3) to preserve the trajectory error about rapid post-eruptive formation a... | [
{
"error_description": "Prematurely narrows the differential to talon cusp and explicitly dismisses other key diagnoses (including fusion with a supernumerary tooth and dens invaginatus), so subsequent interpretation proceeds from an overly constrained assumption.",
"error_step_indices": [
2
],
... | [
2,
3,
5
] | medprmbench_00337 | [
1,
2,
3,
4,
5
] | [] | [
"The palatal calcified projection initially suggested a talon cusp — “calcified tissue similar to a talon cusp.”",
"Gemination was considered, but true gemination involves division of a single tooth germ rather than the presence of an extra tooth — “fusion is the union of one or more teeth during development, whi... | A 2-year-1-month-old Japanese boy was referred after dental trauma to his maxillary primary incisors. His history included atopic dermatitis, and his siblings had congenitally missing incisors. On initial intraoral examination, the maxillary right primary central incisor was displaced palatally and the left primary cen... | Critical | 0.805 | test | null | null | null |
true | acute gastric dilatation | Emphysematous gastritis (acute necrotizing gastritis) | [
"Intrathoracic herniation was considered because it is a recognized cause of gastric infarct — “The causes of gastric infarct include intrathoracic herniation…”",
"Volvulus was considered due to its potential to cause gastric ischemia. However, the 2023 European Society of Emergency Surgery (ESES) consensus updat... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-6",
"S-1"
] | I used Variant 1’s corrupted Step 2 verbatim to incorporate the deception-based E-2 error and kept its downstream reframing toward emphysematous/necrotizing gastritis (Steps 3–5 and the concluding emphasis in Step 9). I then replaced the eating-disorder step with Variant 2’s hallucinated caregiver history and electroly... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
6
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
6,
7
] | medprmbench_00338 | [
2,
3,
4,
5,
6,
7,
8,
9
] | [] | [
"Intrathoracic herniation was considered because it is a recognized cause of gastric infarct — “The causes of gastric infarct include intrathoracic herniation…”",
"Volvulus was considered due to its potential to cause gastric ischemia — “…volvulus…”",
"Acute necrotizing gastritis was considered as a differentia... | A 26-year-old woman with hemiplegia and mental and motor retardation was brought to the emergency department with sudden-onset abdominal pain, progressive abdominal distention, and vomiting. She was febrile at 38.5 °C, hypotensive (80/60 mmHg), tachycardic (112 beats/min), and tachypneic (32 breaths/min). On examinatio... | Critical | 0.8322 | test | null | null | null |
true | Temporomandibular joint dislocation | Myofascial pain dysfunction syndrome | [
"Muscle spasm — “After examining our patient, a diagnosis of muscle spasm was made…” but excluded because spasms of the mastication muscles alone would be unlikely to keep the mouth open in a fixed and locked position unless there was an associated dislocation; however, in the immediate postoperative period this ca... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-3",
"R-5",
"R-6",
"R-7"
] | I kept the overall differential structure from the original chain but replaced the Step 2 content with a single combined narrative that preserves all root-cause errors: (1) the E-2 fabricated ASPAS/MASS-LOCK evidence steering to delayed MMR, (2) the R-5 unsafe conclusion that imaging/urgent reduction is unnecessary and... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
5
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
4,
5
] | medprmbench_00339 | [
1,
2,
3,
4,
5
] | [] | [
"Muscle spasm — “After examining our patient, a diagnosis of muscle spasm was made…” but excluded because “spasms of the mastication muscles alone would be unlikely to keep the mouth open in a fixed and locked position unless there was an associated dislocation…”",
"Temporomandibular joint dislocation — proposed ... | A 66-year-old Somali woman with history of Helicobacter pylori infection, gastroesophageal reflux disease, hyperlipidemia, and type 2 diabetes mellitus was admitted for excision of a large pelvic sarcoma. Preoperative airway evaluation showed Mallampati class II, full cervical, atlanto-axial, and atlanto-occipital mobi... | Critical | 0.895 | test | null | null | null |
true | Influenza-associated encephalopathy | Mild encephalopathy with a reversible splenial lesion (MERS/CLOCCs) associated with influenza A infection | [
"The combination of acute neurologic deficits after influenza infection and a splenial corpus callosum lesion with symmetric white-matter changes most strongly indicates influenza-associated encephalitis/encephalopathy (IAEE).",
"Because the MRI splenial lesion pattern is characteristic in viral-associated enceph... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"E-5",
"R-5",
"R-6"
] | I used Variant 2’s Step 1 to set an early narrow framing toward IAEE while keeping the question unchanged. I then merged Variant 2’s premature dismissal of alternatives with Variant 1’s fabricated SPLICE/NMS-statistics into a single composite Step 2, preserving both the omission/narrowing error (E-5) and the deceptive ... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-5",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3
] | medprmbench_00340 | [
1,
2,
3,
4
] | [] | [
"Acute disseminated encephalomyelitis — “our first impression of this distinctive MRI finding was an acute disseminated encephalomyelitis (ADEM), which was foremost in our differential diagnosis.”",
"Other infectious encephalopathies (rotavirus, E. coli O-157, Salmonella) — “similar MRI findings in the central sp... | A 35-year-old previously healthy man presented with progressive weakness and speech disturbance one day after the onset of influenza symptoms. Three days earlier, he had developed high fever, a mildly painful throat, diffuse myalgia, and arthralgia. An influenza A infection was confirmed by a positive antigen detection... | Critical | 0.895 | test | null | null | null |
true | AneurysmalBoneCyst | Chondroblastoma | [
"Imaging features suggest aneurysmal bone cyst because “MRI of the solid variant of aneurysmal bone cyst reveals homogeneous low-signal intensity on T1-weighted images and heterogeneous low-signal intensity with scattered high-signal intensity areas on T2-weighted images with possible fluid-fluid levels. This featu... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-5",
"R-7"
] | I kept Step 1 from the original. I replaced Step 2 with the R-5 variant’s unsafe claim that imaging alone is sufficiently diagnostic to proceed without malignancy exclusion, and aligned Step 3 with that down-prioritization of osteosarcoma. I then merged Variant 1 (E-2) and Variant 3 (R-7) into a single Step 4 by combin... | [
{
"error_description": "Introduces a fabricated, authoritative-sounding thoracic spine oncology consensus with fake PPV statistics to redirect the diagnosis toward giant cell tumor and reinterpret hemorrhagic microcysts as secondary ABC change.",
"error_step_indices": [
4
],
"error_type": "E-2... | [
2,
4
] | medprmbench_00341 | [
1,
2,
3,
4,
5,
6,
7
] | [] | [
"Step 1: Imaging features suggest aneurysmal bone cyst because “MRI of the solid variant of aneurysmal bone cyst reveals homogeneous low-signal intensity on T1-weighted images and heterogeneous low-signal intensity with scattered high-signal intensity areas on T2-weighted images with possible fluid-fluid levels. Th... | An 18-year-old previously healthy Hispanic man presented with a one-year history of left paraspinal tenderness radiating into the left chest. He denied weakness, numbness, bowel or bladder incontinence, and had no gait or balance difficulties. On examination, there was tenderness on palpation of the mid-thoracic spinou... | Critical | 0.845 | test | null | 3 | 0 |
true | SynovialSarcoma | Primary pulmonary solitary fibrous tumor | [
"The intraoperative cytology suggests a malignant spindle-cell neoplasm in the lung, and metastatic sarcoma is an important general consideration.",
"Favor solitary fibrous tumor (SFT) over synovial sarcoma – Recent expert consensus from the European Thoracic Soft Tissue Working Group (ETSSTWG) (Eur Respir J, 202... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-2",
"R-1",
"R-6"
] | I used Variant 2’s misdirecting Step 2 (fake ETSSTWG consensus) and its downstream reframing of the immunophenotype and conclusion toward solitary fibrous tumor. To simultaneously integrate Variant 1’s prerequisite-omission error, I removed the explicit ‘evaluated for a primary elsewhere and none was found’ verificatio... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2,
3,
4
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
... | [
2,
3,
4
] | medprmbench_00342 | [
1,
2,
3,
4
] | [] | [
"Metastatic sarcoma – “As metastatic sarcomas are more common, proper evaluation of the patient should be done before giving a diagnosis of primary pulmonary sarcoma.”",
"Monophasic spindle-cell tumors (fibrosarcoma, hemangiopericytoma, leiomyosarcoma, spindle-cell carcinoma) – “Differential diagnosis of monophas... | A 29-year-old man presented with a 1-month history of cough and blood-tinged sputum. He was a nonsmoker with no significant past medical history. On examination, vital signs were stable; general physical examination was unremarkable. Chest examination revealed dullness to percussion over the right lower chest. Routine ... | Critical | 0.875 | test | null | null | null |
false | Eosinophilic angiocentric fibrosis | Extracutaneous granuloma faciale of the nasal septum | [
"Wegener granulomatosis was considered but deemed unlikely in the absence of ANCA positivity, since “Positive C-ANCA may support a suspected diagnosis of WG”.",
"Granuloma faciale was considered given the eosinophil-rich inflammation. Moreover, the 2023 European Rhinologic Society (ERS) Clinical Consensus on Eosi... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-1",
"R-3",
"R-6",
"S-1"
] | I kept Step 1, 6, and 7 aligned with the original. I replaced Step 2 with Variant 1’s fabricated ERS-consensus/statistics narrative (E-2), making GF the leading diagnosis despite absent skin lesions. For Step 3, I merged Variant 2’s context-misapplication (immunocompromised-host exclusion; R-3) with Variant 1’s fabrica... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "R-3",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
4,
5
] | medprmbench_00343 | [
2,
3,
4,
5,
6,
7
] | [] | [
"Wegener granulomatosis was considered but deemed unlikely in the absence of ANCA positivity, since “Positive C-ANCA may support a suspected diagnosis of WG”.",
"Granuloma faciale was considered given the eosinophil-rich inflammation but excluded by absence of skin findings, as “Patients with GF always present wi... | A 27-year-old woman presented with an eight-year history of a slowly growing mass in the anterior nasal cavity, associated with persistent bilateral nasal obstruction, recurrent mucoid discharge, intermittent epistaxis, diffuse facial pain, and chronic headaches. Three years earlier, she underwent local resection of su... | Major | 0.625 | test | null | null | null |
true | Leiomyosarcoma | Malignant peripheral nerve sheath tumor (MPNST) of the rectum | [
"Rectal adenocarcinoma is still the most likely diagnosis despite the biopsy describing a “mesenchymal pattern of neoplasm.” The 2023 ESGE–ESP consensus update on lower-GI tumor pathology (Endoscopy, 2023) reported that superficial endoscopic biopsies of ulcerated rectal cancers can show a predominant “reactive/des... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-2",
"R-4",
"R-7"
] | I used Variant 1’s Step 1 verbatim to incorporate the deception-based fabricated consensus and keep adenocarcinoma in play despite mesenchymal biopsy. I then replaced Step 2 with Variant 3’s benign reinterpretation to embed the step-consistency contradiction against the (otherwise implied) malignant histology. Steps 3 ... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2,
4,
5
] | medprmbench_00344 | [
1,
2,
3,
4,
5
] | [] | [
"Rectal adenocarcinoma was initially considered given the presentation of bleeding and altered bowel habits, but was excluded because “a biopsy of the rectal lesion revealed a mesenchymal pattern of neoplasm.”",
"Leiomyoma (benign smooth-muscle tumor) was considered, but the presence of “mitotic index was nine mi... | A 67-year-old Brazilian woman presented with 12 months of pain during bowel movements, tenesmus, hematochezia, increased bowel movements, and weight loss. Her medical history included hypertension, hypothyroidism, and osteopenia, treated with hydrochlorothiazide, levothyroxine, and alendronate. She had no history of to... | Critical | 0.835 | test | null | null | null |
true | Type1 diabetes mellitus | COVID-19–associated viral sepsis with gastrointestinal involvement and stress hyperglycemia | [
"Consideration of COVID-19-related GI disease — “The principal suggestive diagnosis was COVID-19.”",
"Although the labs show hyperglycemia, ketonuria, and high-anion-gap metabolic acidosis, recent expert consensus has emphasized that in acute SARS‑CoV‑2 infection these findings most often represent COVID‑19–assoc... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-1",
"R-2",
"R-6",
"S-2"
] | I kept Step 1 from the original. For Step 2, I adopted Variant 1’s authoritative-but-false consensus narrative, preserving its specific fabricated society, citation, and statistics (E-2). For Step 3, I merged Variant 3’s circular “broad differential because it’s broad” wording (S-2) with Variant 1’s downstream conclusi... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "S-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
4
] | medprmbench_00345 | [
2,
3,
4
] | [] | [
"Consideration of COVID-19-related GI disease — “The principal suggestive diagnosis was COVID-19.”",
"Recognition of DKA based on hyperglycemia, ketonuria, and high-anion-gap metabolic acidosis — “She surprisingly fulfilled the diagnostic criteria for DKA, which consist of hyperglycemia, ketonemia or ketonuria an... | A 23-year-old woman presented to the emergency department in serious condition, reporting six episodes of emesis and intense, diffuse abdominal pain over the past 24 hours. She had fever up to 38.5 °C the previous day but denied headache, sore throat, or cough. Two days earlier she began feeling unwell; over the preced... | Critical | 0.7925 | test | null | null | null |
true | nonpathological pneumoperitoneum | Pneumoperitoneum secondary to ruptured intestinal bullae from pneumatosis intestinalis | [
"Considered gastrointestinal perforation — the large volume of free intraperitoneal air is most consistent with a hollow viscus perforation. In fact, the 2023 International Society for Peritoneal Dialysis (ISPD) Radiology Consensus (reported in Nephrology Imaging Reviews, 2023) states that in peritoneal dialysis pa... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-1",
"R-2",
"R-6",
"S-1"
] | I used the expanded 7-step structure from the S-1 variant as the composite backbone to preserve the inserted redundant testing steps. I then replaced Step 1 with the E-2 variant’s authoritative-but-fabricated ISPD consensus claim (and aligned Step 2 and Step 5 wording with that perforation-leaning framing to keep flow)... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2,
3,
4,
6,
7
] | medprmbench_00346 | [
1,
2,
3,
4,
5,
6,
7
] | [] | [
"Considered gastrointestinal perforation — “which revealed a significant amount of free intraperitoneal air, raising concerns for a potential gastrointestinal perforation.”",
"Considered peritonitis — “the C-reactive protein (CRP) level was not significantly elevated, with a value of 0.6 mg/dL … suggesting the ab... | A 64-year-old man with end-stage renal disease on peritoneal dialysis presented with two weeks of progressive upper abdominal pain and bloating. He reported a “sloshing” sensation with movement and noted that his dialysis bag had been unusually distended with air two weeks earlier. He had one episode of vomiting severa... | Critical | 0.94 | test | null | null | null |
true | Scurvy | Vitamin B12/folate deficiency (megaloblastic anemia) | [
"Initial diagnosis of IgA vasculitis was based on purpura and arthritis — “due to the presence of lower limb purpura and arthritis, the child was diagnosed with IgA vasculitis and managed conservatively.”",
"The recurrence pattern with elevated inflammatory markers and prior elevated serum IgA strongly supports I... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-1",
"R-3",
"S-2"
] | I kept Step 1 from the original. For Step 2, I merged Variant 1’s fabricated EPVN consensus/statistics distractor with Variant 3’s circular/tautological justification into a single coherent Step 2, preserving both the deception-based evidence misuse and the non-advancing logic. I then adopted Variant 1’s downstream fab... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "S-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
5,
6
] | medprmbench_00347 | [
2,
3,
4,
5,
6
] | [] | [
"Initial diagnosis of IgA vasculitis was based on purpura and arthritis — “due to the presence of lower limb purpura and arthritis, the child was diagnosed with IgA vasculitis and managed conservatively.”",
"Recurrent IgA vasculitis was presumed with similar features and proteinuria — “Again, he was diagnosed wit... | A 13-year-old boy with global developmental delay and Lennox-Gastaut syndrome presented with a 3-week history of progressive lower-limb bruising, pain, swelling, poor feeding, irritability, and recent loss of ambulation. Three weeks earlier, an intraoral mass on the right mandible had been noted. He had a similar prese... | Critical | 0.7167 | test | null | null | null |
true | Peritoneal inclusion cyst | Postoperative lymphocele | [
"Paraovarian cyst vs postoperative peritoneal inclusion cyst — While paraovarian cysts are often considered, the combination of prior pelvic surgery and a multiloculated, septated fluid collection that conforms to the peritoneal spaces is highly suggestive of a postoperative peritoneal inclusion cyst. In particular... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"E-5",
"R-1",
"R-6"
] | I used Variant 1’s corrupted Step 1 to incorporate the deception-resistance error (fabricated consensus statement and statistics). I then adopted Variant 2’s premature narrowing to postoperative lymphocele as Step 2 and retained its downstream narrowed-DDx/management assertions as Steps 4–6. To integrate Variant 3’s gr... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-5",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2,
3,
4
] | medprmbench_00348 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Paraovarian cyst — “Key contenders include paraovarian cysts” and the ultrasound showed “multiple septations and internal debris,” features more consistent with a reactive multilocular process than a unilocular paraovarian cyst.",
"Hydrosalpinx or pyosalpinx — “Key contenders include… hydrosalpinx or pyosalpinx”... | A 30-year-old woman with a 5-year history of infertility presented with progressively worsening lower abdominal pain and distension over 3 months. Initially intermittent, the pain became constant and severe, accompanied by bloating and mild nausea. Eight months earlier, she had undergone a laparotomy for a myometrial m... | Critical | 0.805 | test | null | null | null |
true | inferior phrenic artery pseudoaneurysm | Bleeding gastric/esophageal varices | [
"Malignancy was considered given the mediastinal‐gastric cardia wall thickening and hemorrhage — “Pleural fluid studies were negative for neoplasm.”",
"Esophageal perforation was considered due to wall thickening and hematoma, but the low INR argues against significant esophageal bleeding/perforation complication... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-1",
"R-4",
"R-5",
"R-7",
"S-1"
] | I kept the original sequence and incorporated Variant 1’s INR scale error at composite step 2 (with its downstream framing in step 3). I inserted Variant 3’s redundant steps as new composite steps 4–5, preserving their wording and keeping the chain coherent around the (mis)emphasis on variceal bleeding. I then applied ... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3,
6
],
"error_type": "R-7",
"modified_steps": null
},
{
"error_description": "",
"error... | [
2,
3,
4,
5,
6
] | medprmbench_00349 | [
2,
3,
4,
5,
6,
7,
8,
9,
10
] | [] | [
"Malignancy was considered given the mediastinal‐gastric cardia wall thickening and hemorrhage — “Pleural fluid studies were negative for neoplasm.”",
"Esophageal perforation was considered due to wall thickening and hematoma — “there were no signs of esophageal fistula or tears.”",
"Bleeding varix was consider... | A 50-year-old man presented with a 1-day history of worsening epigastric and left upper quadrant abdominal pain. He noted unintentional weight loss of 20 lb over 6 weeks but denied pancreatitis, trauma, surgery, fever, chills, nausea, vomiting, or bowel or urinary symptoms. His medical history included hypertension, un... | Major | 0.74 | test | null | null | null |
true | Erythema multiforme | Viral exanthem (parvovirus B19/HHV-6 reactivation–associated exanthem) | [
"Urticaria excluded — “Lesions in this case were fixed and lasted 7–14 days, inconsistent with urticaria”",
"DRESS excluded — “Systemic symptoms absent; CBC not performed but no clinical signs of systemic involvement”",
"Stevens–Johnson syndrome excluded — “No epidermal detachment or extensive mucosal involveme... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-2",
"S-1"
] | I used Variant 1’s altered Step 4 to favor viral exanthem and included its concluding diagnostic step, adapting the chain to end with viral exanthem. I inserted Variant 3’s redundant testing steps before the autoimmune bullous disease exclusion and before the vasculitis consideration, preserving their tangential nature... | [
{
"error_description": "Introduces a fabricated, authoritative-sounding dermato-virology consensus statement with fake statistics to incorrectly favor viral exanthem and steer away from a medication-related eruption.",
"error_step_indices": [
4
],
"error_type": "E-2",
"modified_steps": [
... | [
4,
7,
9,
10
] | medprmbench_00350 | [
4,
7,
8,
9,
10,
11
] | [] | [
"Urticaria excluded — “Lesions in this case were fixed and lasted 7–14 days, inconsistent with urticaria”",
"DRESS excluded — “Systemic symptoms absent; CBC not performed but no clinical signs of systemic involvement”",
"Stevens–Johnson syndrome excluded — “No epidermal detachment or extensive mucosal involveme... | A 74-year-old man with a history of generalized anxiety disorder had been treated sequentially with escitalopram and sertraline, both discontinued due to adverse effects. Two weeks after starting low-dose venlafaxine (9.375 mg daily), his anxiety and myoclonic symptoms improved. Approximately 1 month after venlafaxine ... | Major | 0.5841 | test | null | null | null |
true | Diffuse large B cell lymphoma | Peripheral ossifying fibroma | [
"Pyogenic granuloma — The lesion is a rapidly developing, erythematous, lobulated gingival mass in the setting of heavy plaque/calculus and severe periodontal inflammation, which strongly supports a reactive vascular lesion such as pyogenic granuloma.",
"Focal fibrous hyperplasia — Chronic irritation from calculu... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-1",
"S-1"
] | I started from the original chain, incorporated Variant 3’s redundant adjunct imaging/lab steps as additional mid-chain steps (now steps 5–6), preserved Variant 1’s deceptive fabricated AAOM update as the peripheral ossifying fibroma step (step 4) and its downstream shift away from malignancy toward a benign diagnosis ... | [
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
8
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
4,
5,
6,
8
] | medprmbench_00351 | [
1,
2,
3,
4,
5,
6,
7,
8,
9
] | [] | [
"Pyogenic granuloma — “The hypothesis of a reactive hyperplastic lesion related to the severe gingival inflammation was considered. In this context, the potential diagnoses included pyogenic granuloma…”",
"Focal fibrous hyperplasia — “…the potential diagnoses included focal fibrous hyperplasia…”",
"Peripheral g... | A 72-year-old man was referred for evaluation of a gingival enlargement in the mandibular anterior region that had developed over one month. His medical history included hypertension, type 2 diabetes mellitus, a remote basal cell carcinoma, alcohol use, and former smoking; he denied known hepatitis or HIV infection. Ex... | Critical | 0.94 | test | null | null | null |
true | Glioblastoma with primitive neuronal component | Primary central nervous system lymphoma (PCNSL) | [
"Brain abscess — strongly favored because the intraoperative finding of a cystic cavity containing yellow purulent fluid is essentially diagnostic of a bacterial brain abscess; moreover, ring-enhancing lesions with surrounding edema on MRI in a diabetic patient are most consistent with abscess rather than a primary... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-5"
] | I used Variant 2’s Step 1 as the base to preserve the incorrect ‘purulent fluid is essentially diagnostic of abscess’ claim (R-1), and augmented it with Variant 3’s premature-stopping language to also capture the safety bypass (R-5) while keeping the chain coherent. I retained Step 2 largely as in the abscess-focused v... | [
{
"error_description": "Incorrectly claims intraoperative yellow purulent fluid is essentially diagnostic of bacterial brain abscess and that glioblastoma necrosis does not mimic pus-filled cavities, biasing interpretation toward abscess and away from neoplasm.",
"error_step_indices": [
1
],
"... | [
1,
3
] | medprmbench_00352 | [
1,
2,
3,
4
] | [] | [
"Brain abscess — considered because of cystic lesion with purulent fluid; excluded once pathology demonstrated tumor rather than infection: “the cystic portion of the mass contained yellow purulent fluid, which...could be mistaken for a brain abscess.”",
"Papillary glioneuronal tumor — considered due to biphasic ... | A 57-year-old woman presented with a 5-day history of sudden-onset headache accompanied by nausea and vomiting. She denied loss of consciousness, focal weakness, speech disturbance, seizures, or memory changes. Her medical history was notable for type 2 diabetes mellitus and remote obstetric hemorrhage requiring transf... | Critical | 0.895 | test | null | null | null |
true | renal allograft torsion | Renal allograft urinary obstruction (ureteral obstruction causing hydronephrosis) | [
"The Doppler study clearly confirms preserved allograft perfusion, because the presence of a visible proximal renal artery definitively establishes that arterial inflow is intact and the report of “no blood flow within the graft” can be dismissed as a technical artifact rather than true ischemia.",
"Given this un... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-4"
] | I kept the overall 6-step structure but replaced Step 1 with Variant 3’s overconfident contradiction (R-4) and carried its downstream framing through Steps 2–4 and Step 6 to maintain coherence. I then merged Variants 1 and 2 at Step 5 by combining the fabricated ITUWG guideline (E-2) with the incorrect Doppler-pathophy... | [
{
"error_description": "Introduces an overconfident contradiction to the stem by asserting Doppler definitively confirms preserved perfusion and dismissing the reported absence of intragraft flow as artifact, steering away from ischemia/torsion.",
"error_step_indices": [
1
],
"error_type": "R-... | [
1,
5
] | medprmbench_00353 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Renal artery thrombosis — “the constellation of findings was concerning for renal artery thrombosis and impending infarct.”",
"Renal vein thrombosis — “the renal vein was not visualized,” suggesting possible venous compromise.",
"Acute tubular necrosis — “these findings are not specific, however, as they can a... | A 60-year-old woman with a history of simultaneous pancreas–kidney transplantation for diabetic nephropathy two years earlier presented with nausea, vomiting, abdominal pain, and minimal urine output. She noted an interval weight gain; her body-mass index was 31.8, up from 26.6 four months earlier. On examination, she ... | Critical | 0.94 | test | null | null | null |
true | pelvic actinomycosis | Genital (pelvic) tuberculosis presenting as a tubo-ovarian abscess/complex | [
"Ovarian neoplasm was considered but made less likely by tumor markers — “... a neoplastic origin could not be entirely ruled out from the start ... Serum tumor markers were negative, with ACE at 0.8 µg/L (normal range <2.5 µg/L) and CA125 at 20 µg/L (normal range <35 µg/L).”",
"Tuberculosis was prioritized as th... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-6"
] | I kept Step 1 from the original. I replaced Step 2 with Variant 1’s EPIC-based tuberculosis-prioritization distractor (the E-2 root-cause error) and retained Variant 1’s Step 3 wording to maintain coherence with the fabricated EPIC framework. For Step 4, I merged Variant 1’s TB-favoring conclusion with Variant 2’s inco... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
4
] | medprmbench_00354 | [
2,
3,
4
] | [] | [
"Ovarian neoplasm was considered but made less likely by tumor markers — “... a neoplastic origin could not be entirely ruled out from the start ... Serum tumor markers were negative, with ACE at 0.8 µg/L (normal range <2.5 µg/L) and CA125 at 20 µg/L (normal range <35 µg/L).”",
"Tuberculosis was considered among ... | A 44-year-old woman with no prior medical history presented to the gynecological emergency department, reporting intermittent pelvic pain, yellowish vaginal discharge, dysuria, fever, and a 5-kg weight loss. She had used an intrauterine device continuously for 10 years without follow-up. On examination, her temperature... | Critical | 0.7475 | test | null | null | null |
true | AfterloadMismatch | Acute left atrial/left atrial appendage thrombosis causing low-output shock after cardiopulmonary bypass | [
"Iatrogenic mitral stenosis — “Interrogation of the newly repaired valve demonstrated peak and mean gradients of 2 and 1 mm Hg, respectively, with no residual MR, decreasing the likelihood of iatrogenic mitral stenosis.”",
"Hemorrhage — “hypotension following separation from CPB … alert an anesthesiologist to con... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-1",
"S-2"
] | Kept the original step structure (5 steps). Incorporated Variant 1’s deception-resistance content into Step 2 as the root-cause error and preserved its downstream persuasive redirection by retaining its modified language in Steps 3–5. Then merged Variant 2 and Variant 3, both targeting Step 5, by combining the incorrec... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
5
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
5
] | medprmbench_00355 | [
2,
3,
4,
5
] | [] | [
"Iatrogenic mitral stenosis — “Interrogation of the newly repaired valve demonstrated peak and mean gradients of 2 and 1 mm Hg, respectively, with no residual MR, decreasing the likelihood of iatrogenic mitral stenosis.”",
"Hemorrhage — “hypotension following separation from CPB … alert an anesthesiologist to con... | A 64‐year‐old man with atrial fibrillation and severe mitral regurgitation underwent planned mitral‐valve repair. Preoperative echocardiography showed a flail P2 segment with an anteriorly directed jet, a left atrial diameter of 8.9 cm, LV inferior‐wall hypokinesis, an ejection fraction of 40%–45%, and mild RV free‐wal... | Critical | 0.87 | test | null | null | null |
false | Primary urinary bladder melanoma | Primary mucosal melanoma of the urinary bladder | [
"Melanosis of the bladder is less likely because the imaging describes discrete mass-like lesions rather than bland pigmented urothelium without invasion, which is typical for melanosis.",
"High-grade or poorly differentiated urothelial carcinoma remains in the differential because it is common in the bladder and... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1"
] | To merge both variants, I used Variant 1’s structure for steps 1, 2, 4, and 5 (including its prerequisite-skipping jump to primary mucosal bladder melanoma) while replacing step 3 with Variant 2’s fabricated EUOIG PET/CT-based argument favoring sarcoma. This preserves E-2 as the root-cause error at step 3 and preserves... | [
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "R-1",
"modified_steps": null
}
] | [
3
] | medprmbench_00356 | [
1,
2,
3,
4,
5
] | [] | [
"Melanosis of the bladder — “the morphologic findings of pigmented bland urothelium with no invasive/mass-like lesion along with negative melanocytic markers are helpful clues to differentiate this entity from melanomas.”",
"High-grade or poorly differentiated urothelial carcinoma — “the variable morphology bring... | A 70-year-old woman presented with gross hematuria. A CT urogram revealed a focal linear filling defect in the proximal right ureter and a heterogeneous mass along the inferior bladder border. Positron emission tomography–CT demonstrated multifocal hyperenhancing lesions in the bladder: the largest at the anterior blad... | Critical | 0.875 | test | null | null | null |
true | atlantoaxial rotatory subluxation | Vertebral artery dissection | [
"Sternocleidomastoid muscle spasm is unlikely because there is “no hypertonicity of the sternocleidomastoid muscles.” However, the 2023 North American Emergency Spine Society (NAESS) consensus statement (Spine Emerg Care, 2023) notes that up to 62% of acute torticollis cases have no palpable SCM hypertonicity, and ... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-1",
"R-6",
"S-2"
] | I kept the overall 4-step structure. From Variant 1, I used the expanded Step 1 that introduces the fabricated NAESS guidance and VAD framing (the E-2 root-cause). I then replaced Step 2 with Variant 2’s tautological infection/abscess step (the S-2 root-cause). To maintain narrative coherence with the VAD redirection i... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "S-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2,
4
] | medprmbench_00357 | [
1,
2,
3,
4
] | [] | [
"Sternocleidomastoid muscle spasm — “no hypertonicity of the sternocleidomastoid muscles.”",
"Upper respiratory infection or abscess — “no submandibular gland tenderness or swelling, and no fever or chills.”",
"Spinal epidural hematoma — “no focal neurologic deficits on exam.”",
"Atlantoaxial rotatory subluxa... | A 38‐year‐old woman with a history of migraines presented with neck pain and stiffness, stating, “I can’t turn my head.” Five days earlier, her son reached over and, using two fingers, quickly pulled her chin toward her left side; she then developed severe right‐sided lateral neck pain extending posteriorly into her sk... | Critical | 0.85 | test | null | null | null |
true | Iatrogenic anetoderma of prematurity | Focal dermal hypoplasia (Goltz syndrome) | [
"Acquired iatrogenic anetoderma of prematurity was considered because of the correlation with device sites — “The authors hypothesized that this acquired form of anetoderma could be due to the monitoring leads or adhesives tapes which were placed on the skin of the newborns.”",
"Congenital anetoderma was excluded... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-2",
"R-7"
] | I kept Steps 1–2 aligned with the original. I merged Variant 2 (R-2) and Variant 3 (R-7) into a single Step 3 that simultaneously (a) contradicts the electrode-pattern correlation by claiming a generalized, non–device-related distribution and (b) misinterprets the timeline as an acute adhesive/contact injury requiring ... | [
{
"error_description": "Introduces fabricated authoritative evidence (fake consensus statements and a nonexistent JAMA Dermatology multicenter review with misleading PPV/OR claims) to argue that delayed-onset atrophic plaques in extremely preterm infants are most predictive of Goltz syndrome, overturning the co... | [
3,
4
] | medprmbench_00358 | [
3,
4,
5
] | [] | [
"Acquired iatrogenic anetoderma of prematurity was considered because of the correlation with device sites — “The authors hypothesized that this acquired form of anetoderma could be due to the monitoring leads or adhesives tapes which were placed on the skin of the newborns.”",
"Congenital anetoderma was excluded... | A female infant was born at 24 weeks of gestation by Caesarean section as the second twin in a monochorionic diamniotic pregnancy. The mother’s pregnancy was uncomplicated; her twin sister died at one week of age from severe intraventricular hemorrhage. The birth weight was 470 g (3rd–10th percentile), and the Apgar sc... | Major | 0.53 | test | null | null | null |
true | Leptospirosis | Sjögren’s syndrome–related chronic aseptic meningitis (autoimmune leptomeningitis) | [
"Tuberculous meningitis was considered — “positive results from an interferon-gamma (IFN-γ) release assay, the patient was treated with rifampicin, isoniazid, and ethambutol, which resulted in minimal improvement.”",
"Sjögren’s syndrome-related aseptic meningitis was considered — “Following intravenous dexamethas... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-5"
] | I kept steps 1–2 aligned with the original chain. For step 3, I merged Variant 1 and Variant 2 into a single coherent EBV-leading step that simultaneously contains (a) the fabricated guideline/statistics about EBV HTS performance (E-2) and (b) the incorrect ‘EBV classically causes low glucose/high protein basilar menin... | [
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
3,
4
] | medprmbench_00359 | [
3,
4
] | [] | [
"Tuberculous meningitis was considered — “positive results from an interferon-gamma (IFN-γ) release assay, the patient was treated with rifampicin, isoniazid, and ethambutol, which resulted in minimal improvement.”",
"Sjögren’s syndrome-related aseptic meningitis was considered — “Following intravenous dexamethas... | A 49-year-old woman with rheumatoid arthritis on intermittent steroids presented with a 3-year history of headaches. Four years earlier, she had sought care for frontal head pain without fever or jaundice. Examination showed no neck stiffness or meningeal signs. CSF analysis revealed 8 cells/mm³ (reference 0–5), protei... | Major | 0.72 | test | null | null | null |
true | Takotsubo syndrome | Postoperative diffuse coronary vasospasm (vasospastic acute coronary syndrome) | [
"Poor myocardial protection was considered but deemed unlikely because normal LV function after weaning off cardiopulmonary bypass made inadequate protection improbable.",
"Coronary air embolism was considered but effectively excluded because the observed wall-motion pattern is non-territorial, and being non-terr... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-2",
"R-5",
"R-7",
"S-2"
] | I kept the original step structure (5 steps) and merged the Step 2 corruption from Variant 1 (fabricated EPCVC guideline and vasospasm redirection) with the Step 2 corruption from Variant 3 (circular exclusion of air embolism) by concatenating them into a single coherent Step 2, marking it as an error root-cause step f... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "S-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
4,
5
] | medprmbench_00360 | [
1,
2,
3,
4,
5
] | [] | [
"Poor myocardial protection was considered but deemed unlikely because “normal LV function after weaning off cardiopulmonary bypass” made inadequate protection improbable.",
"Coronary air embolism was considered but excluded given the “lack of correlation with a coronary artery territory.”",
"Significant corona... | A 14-year-old boy with Loeys–Dietz syndrome and a prior valve-sparing aortic root replacement was admitted for elective mitral valve repair due to asymptomatic severe primary mitral regurgitation from bileaflet prolapse. One month before surgery, echocardiography showed an LVEF of 60% with moderate LV dilatation (diast... | Critical | 0.845 | test | null | null | null |
true | Oral focal mucinosis | Odontogenic myxoma | [
"The contrast-enhanced CT clearly confirms avid contrast enhancement of the right retromolar lesion with an ill-defined infiltrative margin and no bone resorption, which definitively supports an aggressive vascular odontogenic tumor such as odontogenic myxoma rather than a benign mucinous process. In addition, the ... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-4",
"R-6"
] | I used Variant 2’s Step 1 as the backbone to include the confident factual contradiction about CT enhancement/infiltration/no bone resorption (R-4), then merged Variant 1’s fabricated consortium guideline/PPV claims into that same Step 1 to preserve the deception-based anchoring (E-2). I retained Variant 1’s reticulin-... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "R-4",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2,
3,
4,
5,
6,
7
] | medprmbench_00361 | [
1,
2,
3,
4,
5,
6,
7
] | [] | [
"Final Diagnosis: Oral focal mucinosis. Initial logic and parameters are validated.",
"Odontogenic myxoma should be considered; silver staining for reticular fibers may help differentiate from oral focal mucinosis.",
"Nerve-sheath myxoma and neurofibroma with mucous degeneration should be considered; immunohist... | A 26‐year‐old Japanese man was referred with a 1‐month history of swelling in the alveolar region of a maxillary anterior tooth. Intraoral examination revealed swelling on the labial side of the maxillary anterior region; the mucosa in the right retromolar area appeared normal, without visible swelling. Panoramic radio... | Major | 0.805 | test | null | 3 | 0 |
true | Primary cardiac myxofibrosarcoma | Left atrial myxoma | [
"The echocardiographic phenotype (mobile, pedunculated left atrial mass attached to the interatrial septum with cyclic prolapse through the mitral valve) most strongly favors atrial myxoma rather than a primary cardiac sarcoma. A 2023 European Cardiac Tumor Registry consensus update (published in European Heart Jou... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-6"
] | I used Variant 1’s chain as the backbone because it contains the deception-based fabricated registry consensus that anchors the diagnosis on atrial myxoma and reinterprets morphology and the negative marker panel as nondiscriminatory. I then integrated Variant 2’s distinct soundness error by replacing Variant 1’s Step ... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2,
3,
4
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
... | [
1,
2,
3,
4
] | medprmbench_00362 | [
1,
2,
3,
4
] | [] | [
"Characteristic histologic morphology supported myxofibrosarcoma — “Histological examination revealed a multinodular tumor predominantly composed of spindle-shaped cells embedded within a myxoid stroma with few pseudolipoblasts. Notably, the stroma contained long, curvilinear blood vessels, characteristic of myxofi... | A 38-year-old woman with a known history of Ebstein’s anomaly presented with several weeks of progressive dyspnea. She had been undergoing routine follow-up for her congenital tricuspid valve abnormality. On examination, transthoracic echocardiography demonstrated severe tricuspid regurgitation with marked displacement... | Critical | 0.835 | test | null | null | null |
true | sporotrichosis | Primary inoculation cutaneous tuberculosis (tuberculous chancre) of the finger | [
"Diabetic ulcer was reconsidered because of lack of response to standard ulcer care and antibiotics — “he underwent wound dressing at local health clinics daily and treatment for a diabetic ulcer. However, the lesion persisted.”",
"Although mycobacterial culture was negative, this does not meaningfully exclude cu... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"E-5",
"R-1",
"R-3",
"R-5"
] | I kept the original structure but replaced Step 2 with Variant 1’s fabricated consensus/meta-analysis argument so CTB remains favored despite negative culture (E-2). I replaced Step 3 with Variant 3’s context-misapplied rationale to exclude SCC (R-3). I replaced Step 4 with Variant 2’s premature narrowing to sporotrich... | [
{
"error_description": "",
"error_step_indices": [
2,
8
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2,
3,
5,
7,
8
],
"error_type": "R-1",
"modified_steps": null
},
{
... | [
2,
3,
4,
5,
6,
7,
8
] | medprmbench_00363 | [
2,
3,
4,
5,
6,
7,
8
] | [] | [
"Diabetic ulcer was reconsidered because of lack of response to standard ulcer care and antibiotics — “he underwent wound dressing at local health clinics daily and treatment for a diabetic ulcer. However, the lesion persisted.”",
"Cutaneous tuberculosis was excluded by negative mycobacterial culture and sensitiv... | A 70-year-old man with a 20-year history of diabetes mellitus presented with a 1-month history of a painful ulcerative lesion on the tip of his left middle finger. The lesion began as a small blister at the distal fingertip, then ruptured and became ulcerated with serous, nonfoul-smelling discharge. He had sustained a ... | Critical | 0.8312 | test | null | null | null |
true | merkel cell carcinoma | Melanoma | [
"Primary lung malignancy — “a biopsy was performed on the hilar mass, which also confirmed that specific markers for MCC favoring metastatic disease rather than primary lung lesion.”",
"Small cell carcinoma of the lung — Although the biopsy reportedly showed markers interpreted as favoring Merkel cell carcinoma (... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-6",
"S-2"
] | Kept Step 1 from the original chain to preserve the premise that biopsy markers favored metastatic MCC rather than a primary lung lesion. For Step 2, merged Variant 1’s fabricated IASLC/WHO consensus and pooled statistics (E-2) with Variant 2’s reversal that the hilar lesion is the primary driver (R-2), yielding a cohe... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3
] | medprmbench_00364 | [
1,
2,
3
] | [] | [
"Step 1: Primary lung malignancy — “a biopsy was performed on the hilar mass, which also confirmed that specific markers for MCC favoring metastatic disease rather than primary lung lesion.”",
"Step 2: Small cell carcinoma of the lung was considered, but immunohistochemical staining was negative for small cell ca... | A 51-year-old man with a 5-year history of HIV infection (most recent CD4 count, 32/mm3) and poor adherence to antiretroviral therapy presented with left-sided weakness and altered mental status. He was intermittently somnolent during the interview. Vital signs were notable for blood pressure of 150/92 mm Hg; temperatu... | Major | 0.6583 | test | null | 3 | 0 |
true | Miliary hepatic tuberculosis | Diffuse hepatic metastases from lung adenocarcinoma (stage IV disease) | [
"Massive hepatic metastases from lung cancer were considered because of the known primary and PET findings — “We considered the possibility of hot/hypermetabolic liver due to massive metastasis and metastatic mediastinal lymphadenopathy.”",
"The PET “hot liver” pattern (diffuse intense hepatic uptake with suppres... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"E-5",
"R-4",
"R-6",
"R-7"
] | I kept the original step 1 intact. I merged Variant 1’s fabricated PET-consensus/PPV claim (E-2) with Variant 3’s hallucinated patient-specific labs and liver-biopsy immunohistochemistry (R-6) into a single composite step 2 by explicitly including both the bogus consensus statistics and the invented LDH/AFP/CEA/biopsy ... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
5
] | medprmbench_00365 | [
2,
3,
4,
5
] | [] | [
"Massive hepatic metastases from lung cancer were considered because of the known primary and PET findings — “We considered the possibility of hot/hypermetabolic liver due to massive metastasis and metastatic mediastinal lymphadenopathy.”",
"Primary hepatic lymphoma was raised as a cause of hepatic superscan due ... | A 56-year-old woman presented with intermittent hemoptysis. Examination was notable only for mild hepatomegaly. Laboratory studies showed an erythrocyte sedimentation rate of 90 mm/h; all other tests were unremarkable. Chest radiography and CT revealed a spiculated 2.5 cm lesion in the left lower lobe. Ultrasound-guide... | Critical | 0.735 | test | null | null | null |
true | Plexiform schwannoma | Malignant peripheral nerve sheath tumor (MPNST) | [
"Favor plexiform neurofibroma over plexiform schwannoma — Radiology suggests a multinodular plexiform subcutaneous tumor, but recent pediatric soft-tissue imaging guidance from the European Pediatric Neuro-Oncology Imaging Consortium (EPNOIC) consensus statement (Eur Radiol, 2023) emphasizes that a long-segment (≥3... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-6",
"R-7"
] | I kept the original 3-step structure and merged the corrupted components by: (1) using Variant 1’s fabricated EPNOIC-imaging consensus and statistics to push the differential toward plexiform neurofibroma (E-2) while also retaining Variant 2’s general-but-misleading radiology framing for coherence; (2) inserting Varian... | [
{
"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
] | medprmbench_00366 | [
1,
2,
3
] | [] | [
"Consideration of plexiform schwannoma — “Radiologic features were suggestive of a subcutaneous multinodular tumor with possibility of plexiform neurofibroma or schwannoma.”",
"Exclusion of plexiform neurofibroma — “However, the latter lacks the hypercellular Antoni A areas with presence of Verocay bodies and hyp... | A five-year-old girl presented with an eight-month history of a swelling in her left lumbar region that had gradually increased in size and caused pain. There was no history of trauma, fever, or bladder or bowel dysfunction. Her past medical and family histories were noncontributory. On examination, a 10 cm × 10 cm lob... | Critical | 0.94 | test | null | null | null |
true | oil cyst rupture | Chronic post-traumatic infected seroma (indolent breast abscess with dystrophic calcified wall) | [
"Hematoma was considered because of the history of trauma and an expanding breast mass — “Yet, it should be included on the list of differential diagnoses along with hematoma, infection, or neoplasm.”",
"Infection was considered but is unlikely given absence of erythema, warmth, fever, or systemic symptoms; addit... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-6",
"R-7"
] | I kept Step 1 from the original. I merged Variant 1, 2, and 3 by combining their corrupted Step 2 content into a single coherent Step 2 that simultaneously (a) fabricates labs (R-6), (b) cites a fabricated EUSOBI update with PPV statistics (E-2), and (c) makes the delayed-onset infection trajectory claim with empiric a... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2,
3
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error... | [
2,
3,
4
] | medprmbench_00367 | [
1,
2,
3,
4
] | [] | [
"Step 1: Hematoma was considered because of the history of trauma and an expanding breast mass — “Yet, it should be included on the list of differential diagnoses along with hematoma, infection, or neoplasm.”",
"Step 2: Infection was considered but is unlikely given absence of local or systemic signs — “The patie... | A 51-year-old woman presents with a painless lump in her left breast that she first noticed 12 years ago. Two weeks after a motor vehicle collision with a seatbelt injury to her chest, she detected an inner-quadrant breast mass. The lesion remained stable, with only slight firmness in recent years, until it began to en... | Critical | 0.7875 | test | null | 3 | 0 |
true | tuberculous spondylitis | Metastatic breast carcinoma (likely invasive lobular carcinoma) | [
"Peritoneal carcinomatosis was considered due to ascites and concern for malignancy — “a laparoscopic exploratory surgery was indicated to rule out malignancy and ascertain biopsies” — but was excluded because “both biopsies and ascitic fluid were negative for neoplastic cells.”",
"Tuberculous peritonitis was dia... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-2",
"R-5",
"R-6"
] | I kept steps 1–2 aligned with the original. I merged Variant 1 and Variant 2 into a single composite Step 3 that simultaneously (a) adds the fabricated ERS/ESCID claim and redirects away from TB (E-2) and (b) contradicts itself by still treating pulmonary TB as present despite stating it is essentially ruled out (R-2).... | [
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "R-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
3,
4,
5,
6,
7
] | medprmbench_00368 | [
3,
4,
5,
6,
7
] | [] | [
"Peritoneal carcinomatosis was considered due to ascites and concern for malignancy — “a laparoscopic exploratory surgery was indicated to rule out malignancy and ascertain biopsies” — but was excluded because “both biopsies and ascitic fluid were negative for neoplastic cells.”",
"Tuberculous peritonitis was dia... | A 58-year-old Middle Eastern woman presented with 4 months of progressive abdominal distension. Her medical history was unremarkable. On examination, shifting dullness was noted. Abdominal ultrasound showed a single asymptomatic gallstone and approximately 500 mL of ascitic fluid; other intra-abdominal structures appea... | Critical | 0.865 | test | null | null | null |
true | NodularFasciitis | Sarcoma | [
"Reframe the lesion as most consistent with PVNS/TGCT rather than a benign retrodiscal tumor — Although a benign retrodiscal tumor is often initially considered for a well-defined retrodiscal mass, recent expert consensus from the International TMJ Tumor Working Group (ITTWG) and a multicenter imaging-pathology cor... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-6"
] | I used Variant 2’s Step 1 to inject the fabricated ITTWG/Radiology claims (E-2). I then adopted Variant 3’s Step 2 to create the confident factual contradiction that the lesion is parotid-primary with an intact condyle (R-4). For E-1, I replaced the original differential-consideration step with Variant 1’s jump-to-sarc... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2,
3,
4
] | medprmbench_00369 | [
1,
2,
3,
4
] | [] | [
"Consideration of a benign retrodiscal tumor — “A benign tumor of the retrodiscal tissue was first considered. However, erosion of the condylar cortex and extension of the lesion into the surrounding tissues suggested a more aggressive lesion, like a malignant tumor.”",
"Exclusion of parotid primary mass — “Due t... | A 54-year-old woman presented with a 4-month history of left-sided pain during mouth opening, localizing to the posterior auricular area and extending to the inferior border of the mandible. She reported occasional mild hearing loss but no history of trauma. Multiple prior treatments—including physical therapy, anti-in... | Critical | 0.875 | test | null | null | null |
true | Atrophic visceral myopathy | Intermittent (occult) sigmoid volvulus causing acute large-bowel obstruction | [
"Mechanical sigmoid obstruction (sigmoid volvulus vs adhesive obstruction) is still possible. Although the CT was described as atypical for volvulus with no clear transition point and no ischemia, the scan reportedly showed a classic “whirl sign” with mesenteric vessel twisting and marked tapering (“bird’s beak”) a... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-4",
"R-6"
] | I kept the original 7-step structure and merged the corrupted Step 1 elements from Variant 1 (fabricated ESES/pooled-analysis statistics and ‘subclinical torsion’ framing) with Variant 3 (hallucinated whirl sign and bird’s-beak) into a single Step 1 so both E-2 and R-6 errors coexist. I then replaced Step 2 with Varian... | [
{
"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
] | medprmbench_00370 | [
1,
2,
3,
4,
5,
6,
7
] | [] | [
"Mechanical sigmoid obstruction (volvulus or adhesive obstruction) — “CT scan … did not reveal a clear transition point, was atypical for sigmoid volvulus, and there was no radiological evidence of ischemia.”",
"Internal herniation or adhesive band — “No evidence of internal herniation, focal ischemic segment, or... | A 60-year-old man with hypothyroidism on levothyroxine and a remote inguinal hernia repair presented with two days of acute-onset abdominal pain, nausea, vomiting, obstipation, and progressive distention. On examination, he was tachycardic (heart rate 140 bpm) with a temperature of 37.6 °C, blood pressure 136/77 mmHg, ... | Critical | 0.94 | test | null | null | null |
true | Epilepsia partialis continua | Hyperosmolar hyperglycemic state (HHS) presenting with epilepsia partialis continua (EPC) | [
"Structural brain lesions were considered but excluded — “MRI ... was of normal study.”",
"Central nervous system infection was considered but excluded — “CSF ... was of normal study.”",
"The focal clonic movements with preserved awareness and a normal EEG/MRI essentially confirm epilepsia partialis continua (E... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"E-5",
"R-2"
] | I kept Steps 1–2 aligned with the original exclusions (normal MRI and CSF). To integrate E-5, I replaced original Step 3 with Variant 2’s premature conclusion that normal MRI/EEG essentially confirms primary EPC and removes dangerous causes from the differential. I retained original Step 4 unchanged to preserve its sta... | [
{
"error_description": "Prematurely narrows the differential to primary/idiopathic EPC based on normal MRI/EEG, inappropriately dropping high-risk etiologies (e.g., stroke/hemorrhage, metabolic/toxic triggers) from consideration.",
"error_step_indices": [
3
],
"error_type": "E-5",
"modifie... | [
3,
5,
6
] | medprmbench_00371 | [
3,
5,
6
] | [] | [
"Structural brain lesions were considered but excluded — “MRI ... was of normal study.”",
"Central nervous system infection was considered but excluded — “CSF ... was of normal study.”",
"Electrolyte abnormalities were considered but excluded — “serum sodium was 125 mEq/L … calcium was 8.7 mg/dL … serum osmolar... | A 65‐year‐old man presented with involuntary, repetitive movements of his left upper limb for 2 days. He described continuous clonic jerking of the left elbow, wrist, and fingers occurring every 2–5 hours and lasting 1–3 minutes per episode, with preserved consciousness and sphincter control. He had no prior history of... | Major | 0.735 | test | null | null | null |
true | Sertoli-Leydig cell tumor | Yolk sac tumor (FIGO stage IA) | [
"Yolk sac tumor considered due to elevated AFP — “Tumoral cells demonstrated no staining for... SALL4, ... excluding the diagnosis of... yolk sac tumor (SALL4).”",
"Embryonal carcinoma considered among germ cell tumors — “Tumoral cells demonstrated no staining for... OCT3/4, ... excluding the diagnosis of embryon... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-2",
"R-6"
] | I kept Steps 1–2 from the original (non-error). For Step 3, I replaced the original exclusion of endometrioid carcinoma with Variant 2’s incorrect immunophenotype claim (R-1). For Step 4, I used Variant 1’s fabricated ESGO–SIOP/meta-analysis argument prioritizing hepatoid/neuroendocrine carcinoma despite negative neuro... | [
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
3,
4,
6
] | medprmbench_00372 | [
3,
4,
5,
6
] | [] | [
"Yolk sac tumor considered due to elevated AFP — “Tumoral cells demonstrated no staining for... SALL4, ... excluding the diagnosis of... yolk sac tumor (SALL4).”",
"Embryonal carcinoma considered among germ cell tumors — “Tumoral cells demonstrated no staining for... OCT3/4, ... excluding the diagnosis of embryon... | A 15-year-old girl presented with a 3-month history of intermittent abdominal pain, constipation, and spaniomenorrhea. She had menarche at 11 years with previously regular cycles. There was no family history of malignancy. On examination, vital signs were normal and abdominal and pelvic examinations were unremarkable.
... | Major | 0.7183 | test | null | null | null |
true | Dermoid cyst | Thyroglossal duct cyst | [
"Broad differential for a midline oral cyst included ranula, thyroglossal duct cyst, lymphatic malformations, and heterotopic gastrointestinal cysts — “Their rarity warrants consideration of other more common entities such as ranula, thyroglossal duct cyst, lymphatic malformations, and heterotopic gastrointestinal ... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-1",
"R-2",
"R-6",
"S-1"
] | I used Variant 1’s corrupted Step 2 as the composite root-cause deception step and carried forward its ranula-biased imaging framing into Step 3 for coherence. I then inserted Variant 3’s redundant test-ordering steps as Steps 4 and 6 without changing the narrative flow. Next, I replaced the original FNA interpretation... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2,
3
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error... | [
2,
3,
4,
5,
6,
7
] | medprmbench_00373 | [
2,
3,
4,
5,
6,
7
] | [] | [
"Broad differential for a midline oral cyst included ranula, thyroglossal duct cyst, lymphatic malformations, and heterotopic gastrointestinal cysts — “Their rarity warrants consideration of other more common entities such as ranula, thyroglossal duct cyst, lymphatic malformations, and heterotopic gastrointestinal ... | A 12-year-old boy with autism spectrum disorder was brought by his parents for evaluation of a 2-month history of intermittent nosebleeds, reduced oral intake, dysphagia, and decreased speech. He has no prior medical or surgical history. Because of his autism, history was obtained entirely from his parents.
On examina... | Critical | 0.725 | test | null | null | null |
false | CondylomaAcuminatum | Buschke–Löwenstein tumor (giant condyloma acuminatum) | [
"Condyloma acuminatum was supported by the demonstration of papillomatosis, acanthosis, and koilocytosis in squamous epithelium — “These features are consistent with a diagnosis of condyloma acuminatum.”",
"However, in HIV-positive patients with giant, malodorous, painful anogenital warty masses (especially >10 c... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"E-4",
"R-6",
"S-2"
] | I kept Step 1 from the original. I merged Variant 1 and Variant 2 into a single composite Step 2 by retaining Variant 1’s fabricated guideline/series and BLT-reframing while also inserting Variant 2’s incorrect CD4 unit conversion and the resulting threshold-based inference; I preserved the concluding BLT-supporting pi... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-4",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
4
] | medprmbench_00374 | [
2,
3,
4
] | [] | [
"Condyloma acuminatum was supported by the demonstration of papillomatosis, acanthosis, and koilocytosis in squamous epithelium — “These features are consistent with a diagnosis of condyloma acuminatum.”",
"Molluscum contagiosum was considered given the patient’s immunocompromised state, but the lesions lacked th... | A 36-year-old woman, gravida 3, para 3, HIV-positive on antiretroviral therapy, presented for evaluation of extensive vulval and nipple lesions. Two years earlier she had noted progressive warty growths on her vulva and nipples that were never treated. She complained of vulval pain and a malodorous discharge. She denie... | Critical | 0.6575 | test | null | 3 | 0 |
true | Brain tumor | Immune-mediated lumbosacral radiculoplexus neuropathy (psoriatic radiculoplexitis) | [
"Lumbar radiculopathy was initially favored given chronic back pain and known disc protrusion, and it remained the leading consideration because the patient’s exam pattern was radicular in nature—i.e., it suggested radiculopathy, which is consistent with lumbar radiculopathy.",
"Spinal stenosis was considered for... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-4",
"S-2"
] | I kept the overall 5-step structure from the original. Step 1 was replaced with the S-2 tautological justification. Step 2 was replaced with the R-4 contradiction asserting definitive central canal stenosis/cord compression on MRI. Step 3 was replaced with the E-2 fabricated-consensus/statistics argument for psoriatic ... | [
{
"error_description": "Introduces circular/tautological logic by asserting lumbar radiculopathy remains leading simply because the pattern is 'radicular,' which restates the conclusion as its own justification without advancing localization or using the imaging discordance.",
"error_step_indices": [
... | [
1,
2,
3
] | medprmbench_00375 | [
1,
2,
3,
4,
5
] | [] | [
"Lumbar radiculopathy was initially favored given chronic back pain and known disc protrusion, but “Since the CT findings did not explain the multi-root pathology noted on physical exam…”",
"Spinal stenosis was considered for multi-root involvement but “No central spinal stenosis was observed, and the MRI signal ... | A 53-year-old woman presented to the emergency department with low back pain and acute right foot drop. She had a history of chronic low back pain radiating to both legs for over a year; a lumbar CT performed two months earlier had shown an L5–S1 disc protrusion. She noted an exacerbation of her back pain over the past... | Critical | 0.875 | test | null | null | null |
true | Burkitt lymphoma | Radiation-induced undifferentiated pleomorphic sarcoma of the supraglottic larynx | [
"Although squamous cell carcinoma is often the initial consideration for a laryngeal mass, the patient’s history of prior cervical irradiation for Hodgkin lymphoma substantially shifts pre-test probability toward a radiation-induced sarcoma of the laryngeal framework/strap musculature. A 2023 ESMO-EURACAN soft-tiss... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-2",
"R-1",
"R-5",
"R-7"
] | I used Variant 2’s Step 1 as the composite Step 1 to embed the deception-based radiogenic sarcoma prior-probability shift. I then used Variant 3’s Step 2 as composite Step 2 to add the timing/trajectory misinterpretation that 8 years post-treatment represents an “acute early” Hodgkin relapse. For Step 3, I merged Varia... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-7",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2,
3,
4
] | medprmbench_00376 | [
1,
2,
3,
4
] | [] | [
"Squamous cell carcinoma was the initial consideration given its prevalence in the larynx — “Squamous cell carcinoma is the most frequently encountered cancer of the larynx; less commonly encountered laryngeal cancers include adenocarcinoma, adenoid cystic carcinoma, and neuroendocrine tumors.”",
"Laryngeal lymph... | A 90-year-old woman presented with a 6-week history of progressively worsening dysphonia, inspiratory stridor, and left-sided otalgia. On examination, she had a firm 2×3 cm left level III neck mass without overlying skin changes. Flexible fiberoptic nasolaryngoscopy demonstrated a large exophytic supraglottic mass caus... | Critical | 0.875 | test | null | null | null |
true | Hydatid disease | Solitary (unicameral) bone cyst | [
"Bone malignancies were considered but deemed unlikely because of the indolent course and lack of systemic signs — “those symptoms have significant overlap with bone malignancies but the evolution of hydatid disease is slower and it is not associated with inflection of the general condition or fever.”",
"Neoplast... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-3",
"R-4"
] | I kept steps 1–2 from the original since they were unchanged across variants. I inserted Variant 2’s Step 3 verbatim as the R-3 root-cause error. I then used Variant 3’s Step 4 as the R-4 root-cause error, which forces downstream reasoning to treat the process as solitary; to preserve the exact E-2 distractor, I merged... | [
{
"error_description": "Misapplies the heuristic that normal ESR/CRP and absent systemic symptoms strongly exclude skeletal TB in immunocompetent adults, inappropriately ruling out osteoarticular TB despite its potential for indolent presentation with normal inflammatory markers.",
"error_step_indices": [
... | [
3,
4,
5
] | medprmbench_00377 | [
3,
4,
5,
6
] | [] | [
"Bone malignancies were considered but deemed unlikely because of the indolent course and lack of systemic signs — “those symptoms have significant overlap with bone malignancies but the evolution of hydatid disease is slower and it is not associated with inflection of the general condition or fever.”",
"Neoplast... | A 49-year-old man presented with a 1-year history of progressive left hip pain that limited daily activities. He lived in an urban area and had no relevant medical history, no fever, chills, weight loss, prior trauma, tuberculosis history, or animal contact. He ambulated with crutches and had a limp. On examination, th... | Major | 0.6883 | test | null | null | null |
true | Carotid web | Primary angiitis of the central nervous system (PACNS) | [
"Cardioembolic source is effectively confirmed — although ECG and transthoracic echo are normal, the patient’s 14-day Holter monitoring captured multiple episodes of paroxysmal atrial fibrillation (longest 22 minutes) with a left atrial appendage thrombus seen on transesophageal echocardiography, supporting a cardi... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-2",
"R-6"
] | I kept a 3-step structure like the original but replaced Step 1 with Variant 3’s hallucinated confirmation of cardioembolism (Holter AF + TEE LAA thrombus). I then merged Variant 1 and Variant 2 into Step 2 to simultaneously (a) cite the fabricated ESICS/pooled-analysis statistics claiming normal CSF/markers are common... | [
{
"error_description": "Fabricates patient-specific cardiac testing (14-day Holter showing paroxysmal AF and TEE showing LAA thrombus) not provided in the stem, and uses it to (re)frame the case as cardioembolic, affecting downstream interpretation.",
"error_step_indices": [
1
],
"error_type":... | [
1,
2
] | medprmbench_00378 | [
1,
2,
3
] | [] | [
"Cardioembolic source considered and excluded — “the patient had benefited from an electrocardiogram and cardiac ultrasound which doesn't show abnormalities.”",
"Cerebral vasculitis considered and excluded — “Inflammatory biological and spinal liquid analyses were done and were negative.”",
"Carotid dysplasia (... | A 36-year-old man presented with recurrent stroke. Two months earlier, he had unexplained facial paralysis. He was admitted with acute onset of left hemiplegia and dysarthria 3 hours after symptom onset. His Glasgow Coma Scale score was 15, and his NIH Stroke Scale score was 17. An urgent noncontrast brain CT scan reve... | Critical | 0.805 | test | null | null | null |
true | Calcific Gruberi bursitis | Acute calcific tendinitis (hydroxyapatite deposition) of the dorsal ankle extensor tendons at the talonavicular region | [
"Acute calcific periarthritis is most consistent because the MRI reportedly showed marked tenosynovitis of the extensor digitorum longus and extensor hallucis longus with punctate hydroxyapatite deposition within the tendon sheaths, which is the key distinguishing feature from bursitis/capsular calcification.",
"... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-2",
"R-1",
"R-7"
] | I created a single coherent chain by taking Variant 3’s hallucinated Step 1 (fabricated MRI tendon-sheath hydroxyapatite/tenosynovitis) as the opening anchor, then inserted Variant 2’s EFAS-consensus distractor as Step 2 to reinforce the (incorrectly redirected) diagnosis. I kept the overall differential structure but ... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2,
4,
5
] | medprmbench_00379 | [
1,
2,
3,
4,
5
] | [] | [
"Acute calcific periarthritis considered — “Although periarthritis is also caused by calcium deposits within soft tissue, ... the cardinal difference is the involvement of tendons.”",
"Rheumatologic arthropathy (gout or pseudogout) considered — “The patient denied ... previous history of rheumatological disorders... | A 47-year-old woman with no significant past medical or family history presented with acute onset of right ankle pain and swelling of 1 day’s duration. Three months earlier, she had tripped and hyper-plantarflexed the right ankle and had intermittent mild pain at the base of her toes, for which an ankle radiograph show... | Critical | 0.91 | test | null | null | null |
true | hypereosinophilic syndrome | JAK2 V617F–associated clonal hypereosinophilic myeloproliferative neoplasm causing arterial thrombosis | [
"Primary systemic vasculitis was considered but excluded — “Evidence to suggest a primary vasculitis (including vessel wall infiltration by inflammatory cells and fibrinoid necrosis) was not seen.”",
"Drug-induced vasculitis was considered but excluded for the same histologic reasons — “Evidence to suggest a prim... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-6"
] | I kept the original structure but incorporated the S-1 redundant APS steps by inserting them immediately after the APS exclusion, matching the variant that added two extra steps. I then replaced the rheumatology step with Variant 2’s quantitative error (miscomputed AEC 0.536×10^3/µL) and preserved its downstream effect... | [
{
"error_description": "",
"error_step_indices": [
7
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
8
],
"error_type": "R-6",
"modified_steps": null
}
] | [
7,
8
] | medprmbench_00380 | [
4,
5,
6,
7,
8,
9,
10
] | [] | [
"Primary systemic vasculitis was considered but excluded — “Evidence to suggest a primary vasculitis (including vessel wall infiltration by inflammatory cells and fibrinoid necrosis) was not seen.”",
"Drug-induced vasculitis was considered but excluded for the same histologic reasons — “Evidence to suggest a prim... | A 51-year-old Taiwanese man with a history of dyslipidemia and a 30-pack-year smoking history presented with 2 weeks of painful ulcers and cyanosis of the distal lower extremities. His skin findings began 7 months earlier as pruritic papulosquamous eruptions of the trunk and extremities that were refractory to doxycycl... | Critical | 0.745 | test | null | null | null |
true | LipomaArborescens | Osteoarthritis of the right knee (patellofemoral osteoarthritis with reactive synovitis) | [
"Osteoarthritis was initially considered because of chronic knee pain and degenerative changes on radiographs — “She was seen at a different hospital several months prior where the pain was attributed to osteoarthritis and high tibial osteotomy was considered in order to relieve symptoms.”",
"Given the chronic mo... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"E-5",
"R-2"
] | I kept Step 1 from the original. I replaced Step 2 with Variant 2’s premature narrowing to osteoarthritis (E-5 root cause). I replaced Step 3 with Variant 1’s fabricated ISMR-consensus/pooled-statistics argument favoring PVNS (E-2 root cause). I replaced Step 4 with Variant 3’s contradictory reinterpretation that later... | [
{
"error_description": "Prematurely narrows the differential to osteoarthritis with reactive synovitis based largely on negative RF/anti-CCP, dismissing important alternative/high-risk causes of chronic monoarthritis with effusion and elevated ESR/CRP and propagating this into management without further diagnos... | [
2,
3,
4
] | medprmbench_00381 | [
2,
3,
4,
5
] | [] | [
"Osteoarthritis was initially considered because of chronic knee pain and degenerative changes on radiographs — “She was seen at a different hospital several months prior where the pain was attributed to osteoarthritis and high tibial osteotomy was considered in order to relieve symptoms.”",
"Other synovial proli... | A 45-year-old woman presented with a 2-year history of right knee pain. Several months earlier, her symptoms had been attributed to osteoarthritis, and a high tibial osteotomy was being considered. She had a body-mass index of 29.8 and no other relevant medical history.
On examination, she walked with a valgus-thrust ... | Critical | 0.805 | test | null | null | null |
true | Placoid choroidopathy | Subclinical sympathetic ophthalmia precipitated by cataract extraction/DMEK | [
"Broad inflammatory and infectious causes were considered and excluded overall; however, the postoperative bilateral placoid lesions with vitritis and the need for systemic prednisone make an inflammatory placoid chorioretinopathy (such as acute posterior multifocal placoid pigment epitheliopathy, APMPPE) the leadi... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-2"
] | I kept the original step structure (4 steps) and merged the corrupted Step 1 from Variant 3 (creating the step-consistency contradiction) into the composite chain. For Step 2, I integrated both Variant 1 and Variant 2 errors by combining the fabricated ‘International Uveitis Consensus Statement’ argument favoring subcl... | [
{
"error_description": "Introduces an internal contradiction within Step 1 by stating inflammatory etiologies were excluded while simultaneously making an inflammatory diagnosis (APMPPE) the leading consideration based on the same negative workup and case facts.",
"error_step_indices": [
1
],
... | [
1,
2
] | medprmbench_00382 | [
1,
2,
3,
4
] | [] | [
"Broad inflammatory and infectious causes were considered and excluded — “the differential for her retinal findings included inflammatory (Vogt-Koyanagi-Harada syndrome, sympathetic ophthalmia, sarcoidosis, acute posterior multifocal placoid pigment epitheliopathy) and infectious (syphilis, tuberculosis, Lyme) etio... | A 49-year-old Caucasian woman with Fuchs endothelial dystrophy and narrow angles status post bilateral peripheral iridotomies underwent combined extracapsular cataract extraction, intraocular lens implantation, and Descemet’s membrane endothelial keratoplasty (DMEK) in the right eye. The inferior peripheral iridotomy w... | Critical | 0.835 | test | null | 2 | 1 |
true | Yellow nail syndrome | Postoperative protein-losing enteropathy causing chylous pleural effusions and chylous ascites | [
"Thoracic duct injury — “the possibility of thoracic duct injury cannot be excluded. However, the chylous ascites and lymphedema ... cannot be explained exclusively by the leakage of lymph fluid due to only thoracic duct injury.”",
"Protein-losing enteropathy (PLE) after gastric-tube reconstruction and hypoalbumi... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-6",
"S-1"
] | I kept Step 1 from the original/variants as a shared baseline. I merged Variant 1 (E-2) and Variant 2 (R-6) into a single composite Step 2 because both errors target the same root-cause step and can coexist coherently: the step now contains the fabricated ESCL/cOhort claims (deceptive distractors) plus the hallucinated... | [
{
"error_description": "Adds authoritative-sounding but fabricated evidence (fake ESCL 2023 consensus and a misapplied/fabricated 2024 cohort with diagnostic statistics) to redirect the reasoning toward postoperative protein-losing enteropathy and to dismiss yellow nail syndrome as micronutrient-related nail di... | [
2,
3,
4
] | medprmbench_00383 | [
2,
3,
4,
5,
6
] | [] | [
"Thoracic duct injury — “the possibility of thoracic duct injury cannot be excluded. However, the chylous ascites and lymphedema ... cannot be explained exclusively by the leakage of lymph fluid due to only thoracic duct injury.”",
"Hypoalbuminemia-induced edema — “the decrease in albumin was mild and when combin... | A 66-year-old man was referred with dyspnea and pleural effusions. His history was notable for Parkinson’s disease, dementia, and an esophagectomy with gastric-tube reconstruction for esophageal cancer two months earlier. Three weeks postoperatively, he developed a cough and bilateral lower-leg edema and was started on... | Critical | 0.8167 | test | null | null | null |
true | Dermoid cyst | Infected epidermoid cyst associated with a dermal sinus tract | [
"The 3D CT findings are definitively reassuring: the occipital bone is completely normal with no midline defect or funneling/remodeling of the inner table, which without question rules out any chronic congenital tract or pre-existing lesion and instead strongly supports an acute epidural abscess as the source of th... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-4",
"R-6"
] | I used Variant 1’s fabricated-consensus distractor content and Variant 3’s overconfident contradiction about the occipital bone to jointly corrupt Step 1 (both errors share the same root step), keeping both claims even though they conflict with the stem and with each other. I then adapted Step 2 to remain coherent with... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "R-4",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2,
3
] | medprmbench_00384 | [
1,
2,
3,
4
] | [] | [
"An epidural abscess was considered because of the rim enhancement and restricted diffusion on MRI — “Based on MR images, the differential diagnosis included an epidural abscess or an infected dermoid cyst (Table 1)” — but was deemed less likely given the smooth funneling and remodeling of the inner occipital bone,... | A 5-year-old girl presented with a 3-day history of high-grade fever, lethargy, headache, and vomiting. One month earlier, she had been treated elsewhere for presumed bacterial meningitis with vancomycin and ceftriaxone for 14 days. She had no history of head trauma. On admission, temperature was 38.6 °C, heart rate 14... | Critical | 0.835 | test | null | null | null |
false | Woven coronary artery | Chronic organized recanalized thrombus of the mid right coronary artery (microchannel recanalization) | [
"Congenital malformation favored over acquired lesion — “In this malformation a part of epicardial coronary artery is divided into many long and thin channels…Normal blood flow after anomalous coronary segment secures related territory; thus this condition is considered to be benign.”",
"To better delineate the m... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-1",
"R-3",
"R-5",
"R-6",
"S-1"
] | I kept the original Step 1 intact. I integrated S-1 by inserting the two redundant imaging steps early (now Steps 2–3) and marked them as the S-1 root-cause error steps. I merged E-2 and R-3 into a single coherent Step 4 by combining the fabricated 2023 ESC consensus claim (high specificity/PPV for recanalized thrombus... | [
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "R-3",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2,
3,
4,
6
] | medprmbench_00385 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Step 1: Congenital malformation was favored over acquired lesion, as the condition is considered benign.",
"Step 2: Recanalized thrombus was considered but was less likely given the absence of thrombotic filling defects.",
"Step 3: Spontaneous coronary artery dissection was included in the differential due to ... | A 54‐year‐old man presented with a 2-month history of exertional chest tightness and palpitations. On examination, resting ECG showed Q waves and extrasystoles in leads D3 and aVF. Transthoracic echocardiography revealed akinesia of the inferior and posterior walls and an ejection fraction of 44%. Coronary angiography ... | Critical | 0.8217 | test | null | 3 | 0 |
true | Chronic calcified venous thrombosis | Acute iliofemoral deep vein thrombosis | [
"Foreign body was initially suspected — it was initially thought to be a foreign body, requiring further investigation and assessment.",
"Phlebolith was considered due to intravascular calcification — phlebolith refers to round-shaped calcified thrombi; these thrombi are quite common, mostly found in the pelvic a... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"E-4",
"R-6",
"R-7"
] | No variants modified the question, so the original question was kept. Step 5 was replaced with a single composite version that preserves Variant 1’s fabricated guideline/study distractor while also embedding Variant 2’s incorrect D-dimer cutoff usage and faulty mg/L-to-ng/mL conversion; both errors share the same root-... | [
{
"error_description": "",
"error_step_indices": [
5
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
5
],
"error_type": "E-4",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
5,
6
] | medprmbench_00386 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Step 1: Foreign body was initially suspected — “it was initially thought to be a foreign body, requiring further investigation and assessment.”",
"Step 2: Phlebolith was considered due to intravascular calcification — “Phlebolith is a term that refers to round-shaped calcified thrombi; these thrombi are quite co... | A 73-year-old woman presented with postmenopausal scanty vaginal bleeding. During evaluation, pelvic CT performed by gynecology revealed an incidental linear hyperdense structure within the left common femoral vein. Her medical history included hypertension, type 2 diabetes mellitus, hyperthyroidism, dyslipidemia, and ... | Critical | 0.775 | test | null | 3 | 0 |
true | Lactobezoar | Spontaneous intestinal perforation (SIP) | [
"Necrotizing enterocolitis (NEC) was suspected as the cause of clinical decompensation/perforation risk in an extremely preterm infant after feed fortification, consistent with common pre-operative framing in such cases.",
"Because the infant had already been NPO with gastric decompression and on broad-spectrum a... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"E-4",
"R-7"
] | I kept step 1 close to the original clinical setup (initial NEC suspicion). I then replaced step 2 with the R-7 trajectory claim that brief NPO/antibiotics can make NEC appear normal at surgery, preventing intraoperative exclusion and requiring downstream wording to keep NEC “on the table.” Next, I inserted the E-4 num... | [
{
"error_description": "Trajectory error: asserts that a brief preoperative period of NPO/decompression and antibiotics (hours to a day) can normalize NEC’s intraoperative appearance, so NEC cannot be excluded at laparotomy and later findings (e.g., milk curd mass) may be secondary rather than causal.",
"er... | [
2,
3,
4
] | medprmbench_00387 | [
1,
2,
3,
4,
5
] | [] | [
"Necrotizing enterocolitis was suspected as the cause of perforation — “a pre-operative diagnosis of intestinal perforation from NEC…”",
"Necrotizing enterocolitis was excluded intraoperatively by lack of necrotic or inflamed bowel — “The remaining small bowel was normal in appearance without evidence of necrotiz... | A male infant of Indian descent was delivered at 26 weeks’ gestation by vaginal birth, with a birth weight of 900 g and Apgar scores of 8 and 8. He received surfactant and was managed on nasal CPAP and caffeine. Gavage feeding with the mother’s expressed breast milk began on day of life (DOL) 2. On DOL 16, feeds were f... | Critical | 0.88 | test | null | null | null |
true | Erdheim-Chester disease | IgG4-related disease causing constrictive pericarditis with systemic serositis | [
"Langerhans histiocytosis was reconsidered but immunophenotyping did not match CD1a and S100 positivity typical of Langerhans cells — “Immunohistochemical studies confirmed histiocytic cells as CD68K+, CD68P+, and mostly S100−.”",
"Although Erdheim-Chester disease can show foamy CD68+ histiocytes, the combination... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-1",
"R-2",
"R-5",
"R-6",
"S-1"
] | I used Variant 1’s Step 2–4 text to embed the deception-based pivot toward IgG4-related disease and its propagated references in subsequent steps. I then followed Variant 3’s structure by inserting the redundant testing steps, but merged in Variant 2’s internal contradiction about LVEF by appending the ‘markedly reduce... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
5
],
"error_type": "R-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
5,
6
] | medprmbench_00388 | [
2,
3,
4,
5,
6
] | [] | [
"Langerhans histiocytosis was reconsidered but immunophenotyping did not match CD1a and S100 positivity typical of Langerhans cells — “Immunohistochemical studies confirmed histiocytic cells as CD68K+, CD68P+, and mostly S100−.”",
"Erdheim-Chester disease was suggested given foamy histiocytes, negative S100 and C... | A 34-year-old woman presented with several months of progressive shortness of breath on exertion, reduced exercise capacity, and signs of fluid overload, including peripheral edema and ascites. Her heart rate was 103 beats/min, blood pressure 119/77 mm Hg, respiratory rate 20 breaths/minute, temperature 36.3 °C, and ox... | Critical | 0.7167 | test | null | 3 | 0 |
true | Intrauterine cystic adenomyosis | Endometrial carcinoma | [
"Endometrial polyp was considered but deemed unlikely because “Regularly shaped lesions with a high-level echo and strong echo halo around the lesions can be seen in the uterine cavity, and cysts can be seen in the polyp. Color Doppler can display the typical single blood flow signal supplying the endometrial polyp... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-6",
"S-1"
] | I used the expanded step structure from Variant 3 to accommodate the redundancy error (adding SIS/hysteroscopy and CA-125 as separate early steps). I then replaced the fibroid/MRI step with Variant 2’s hallucinated MRI-based argument to incorporate the grounding-compliance error. Next, I substituted the adenomyosis dis... | [
{
"error_description": "Introduces a fabricated authoritative 2023 imaging consortium guideline with false performance statistics to strongly (and misleadingly) argue the ultrasound triad predicts endometrial carcinoma in premenopausal women, redirecting reasoning toward malignancy and away from cystic adenomyo... | [
2,
3,
4,
5
] | medprmbench_00389 | [
2,
3,
4,
5,
6
] | [] | [
"Endometrial polyp was considered but deemed unlikely because “Regularly shaped lesions with a high-level echo and strong echo halo around the lesions can be seen in the uterine cavity, and cysts can be seen in the polyp. Color Doppler can display the typical single blood flow signal supplying the endometrial polyp... | A 36-year-old woman was referred for evaluation of progressively heavy menstrual bleeding and new-onset dysmenorrhea. Over the past 7 months, her menstrual duration increased from 4 to 6 days, and her menstrual blood loss became three times her usual volume. Two months before presentation, she developed crampy hypogast... | Major | 0.7467 | test | null | null | null |
true | Ewing sarcoma | Extranodal NK/T-cell lymphoma | [
"Metastatic disease was initially entertained as the lesion appeared in an elderly patient with a new head and neck mass — “The initial proposed diagnosis was of a metastatic tumor.”",
"Because the FNA shows sheets of undifferentiated small blue cells with a high nuclear-to-cytoplasmic ratio in this anatomical re... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"E-5",
"R-5"
] | I kept Step 1 from the original as it was consistent across variants. For Step 2, I merged Variant 2’s premature narrowing to lymphoma with Variant 1’s fabricated “2023 consensus” PPV claim, preserving both errors at the same root-cause step. Step 3 was rewritten to follow the lymphoma-only pathway from Variant 2 while... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-5",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
4
] | medprmbench_00390 | [
2,
3,
4
] | [] | [
"Metastatic disease was initially entertained as the lesion appeared in an elderly patient with a new head and neck mass — “The initial proposed diagnosis was of a metastatic tumor.”",
"Lymphoma became the leading consideration after fine-needle aspiration revealed small blue cells in this age group and location ... | A 69-year-old woman presented with a 26-week history of a gradually enlarging right preauricular swelling. She reported no pain or facial weakness. On examination, there was a firm, immobile 3-cm mass near the lateral border of the right orbit in the region of the superior masseter; there was no cervical lymphadenopath... | Critical | 0.7875 | test | null | null | null |
true | follicular dendritic cell tumor | Thymoma-associated paraneoplastic pemphigus | [
"The mucocutaneous picture (severe refractory oral erosions with ocular/airway symptoms and a pemphigus-like DIF fishnet IgG) suggests paraneoplastic pemphigus (PNP), but recent guidance from the European Autoimmune Blistering Diseases Consortium (EABDC) consensus statement (J Am Acad Dermatol, 2023) emphasizes tha... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-6",
"R-7"
] | I used Variant 1’s corrupted Step 1 as the composite Step 1 (the E-2 distractor about a fabricated 2023 consensus and PPV for thymoma). I preserved the original-style intermediate differential structure but incorporated Variant 2’s soundness error as composite Step 3 (the false claim that PNP is essentially restricted ... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
3,
6,
7
] | medprmbench_00391 | [
1,
2,
3,
4,
5,
6,
7
] | [] | [
"Final Diagnosis: Follicular dendritic cell tumor. Initial logic and parameters are validated.",
"Standard processing applied.",
"Standard processing applied.",
"Standard processing applied.",
"Standard processing applied.",
"Follicular dendritic cell tumor should be considered in the differential diagnos... | A 39-year-old man presented with a 4-month history of persistent oral erosions and skin vesicles on his left forearm. He also reported voice changes, a foreign body sensation in his eyes, and unintentional weight loss. On examination, he had multiple erosions on the lips, hard palate, and buccal mucosa with hemorrhagic... | Critical | 0.835 | test | null | 3 | 0 |
true | Idiopathic granulomatous mastitis | Tuberculous mastitis (paucibacillary extrapulmonary breast tuberculosis) with erythema nodosum | [
"Breast carcinoma was considered given the mass and nipple retraction but ruled out because there was no evidence of malignancy on core biopsy.",
"Tuberculosis was considered given the epidemiologic context, and the presence of granulomatous inflammation with a purulent discharge was felt to support a tuberculous... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1"
] | I kept Step 1 from all variants (malignancy ruled out). I adopted Variant 3’s Step 2 to embed the step-consistency contradiction (TB framed as supported despite negative stains/cultures). For Step 3, I merged Variant 1’s fabricated WHO–AFRO consensus and sensitivity figures (E-2) with Variant 2’s incorrect evidence int... | [
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
3,
6
],
"error_type": "R-1",
"modified_steps": null
}
] | [
3,
6
] | medprmbench_00392 | [
1,
2,
3,
4,
5,
6
] | [] | [
"Breast carcinoma was considered given the mass and nipple retraction but ruled out because “There was no evidence of malignancy.”",
"Tuberculosis was considered given the epidemiologic context but excluded because “No organisms were identified on Grocott methenamine silver (GMS), Gram, PAS and Ziehl–Neelsen stai... | A 29-year-old primiparous Malagasy woman presented with painful erythematous nodules on her lower legs that developed one month after onset of a right-breast swelling. She was neither pregnant nor lactating, and her last breastfeeding had been two years earlier. She had no history of tuberculosis, autoimmune disease, o... | Critical | 0.905 | test | null | null | null |
true | angiosarcoma | Carcinoma erysipeloides (cutaneous lymphangitic carcinomatosis) from occult head-and-neck squamous cell carcinoma | [
"Infectious etiology considered because of fever and drainage — “He had completed 2 courses of clindamycin and was taking cephalexin … for a suspected infectious etiology. He experienced only mild improvement.” However, the limited response to clindamycin/cephalexin and the presence of “peau d’orange”-like indurate... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-3",
"R-7"
] | I kept the original 3-step structure and merged the corrupted content from each variant into the same steps where their root-cause errors occurred. Step 1 incorporates the deception-based pivot to carcinoma erysipeloides using the fabricated ISDO statement and statistics (E-2). Step 2 combines the trajectory misclassif... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-3",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2,
3
] | medprmbench_00393 | [
1,
2,
3
] | [] | [
"Infectious etiology considered because of fever and drainage — “He had completed 2 courses of clindamycin and was taking cephalexin … for a suspected infectious etiology. He experienced only mild improvement.”",
"Vascular or lymphatic obstruction considered given subacute hemifacial edema — “The subacute onset o... | A man in his 70s was referred for evaluation of worsening right‐sided facial edema of 4 months’ duration. At onset, he experienced fever and generalized malaise, which subsequently resolved. The edema progressively involved his right eyelid, cheek, postauricular skin, scalp, and anterior neck, and serous drainage soake... | Critical | 0.775 | test | null | null | null |
true | tuberculoma | Cerebral venous thrombosis with hemorrhagic venous infarction | [
"Eclampsia was considered because of peripartum seizures — “Seizures during the peripartum period should always raise the suspicion of eclampsia.”",
"A primary brain neoplasm was suspected based on spectroscopy and perfusion — “the increased Cho/NAA ratio and the discrete foci of increased relative brain volume p... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-4"
] | Both variants place their root-cause error at step 4, so the composite merges the two corrupted step-4 narratives into a single, coherent (but internally inconsistent) paragraph that simultaneously (i) definitively misstates the imaging as classic bilateral PRES and (ii) cites a fabricated peripartum stroke consortium ... | [
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "R-4",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
4,
8
] | medprmbench_00394 | [
4,
5,
6,
7,
8
] | [] | [
"Eclampsia was considered because of peripartum seizures — “Seizures during the peripartum period should always raise the suspicion of eclampsia.”",
"A primary brain neoplasm was suspected based on spectroscopy and perfusion — “the increased Cho/NAA ratio and the discrete foci of increased relative brain volume p... | A 16-year-old woman, 24 hours postpartum, presented with headache, vomiting, and two generalized seizures. She reported mild weakness in the right upper limb but had no history of hypertension or proteinuria. Initial noncontrast head CT revealed an expansive, ring-enhancing lesion in the left parietal lobe with surroun... | Major | 0.6737 | test | null | null | null |
true | Traumatic abdominal wall hernia | Underlying abdominal neoplasm (e.g., nephroblastoma or lymphoma) unveiled by trauma | [
"Rectus sheath hematoma considered — After trauma, a haematoma of the rectus sheath may mimic traumatic abdominal wall hernia.",
"The physical exam findings definitively confirm there is no abdominal wall fascial disruption — palpation is completely normal with no rectus fascia defect, without question ruling out... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-4",
"R-6"
] | I kept the original step structure but replaced Step 2 with Variant 2’s overconfident contradiction (R-4). I then merged Variant 1’s fabricated EPAT-WG consensus/PPV/OR distractor with Variant 3’s hallucinated bedside ultrasound mass into a single Step 3 so both errors co-exist at the same root-cause location (E-2 and ... | [
{
"error_description": "",
"error_step_indices": [
3
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-4",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
3,
5
] | medprmbench_00395 | [
1,
2,
3,
4,
5
] | [] | [
"Rectus sheath hematoma considered — “After trauma, a haematoma of the rectus sheath may mimic traumatic abdominal wall hernia.”",
"Pre-existing inguinal hernia considered — “While usually seen before the accident by the patient or his family, a pre-existing inguinal hernia should not be ruled out.”",
"Abdomina... | A nearly 7-year-old boy with no relevant medical history presented with abdominal pain and swelling after a fall from his bicycle during which his abdomen struck the handlebar. Immediately after the accident, his mother noticed a swelling at the site of impact. He had no other complaints. On examination, he appeared we... | Critical | 0.91 | test | null | null | null |
true | Granulocytic sarcoma | Idiopathic multicentric Castleman disease (iMCD) | [
"Non-Hodgkin lymphoma was strongly considered given the pattern of painless generalized lymphadenopathy and imaging appearance — “the clinical presentation and radiological and FNA findings were suggestive of lymphoma…”",
"Large cell lymphoma was initially diagnosed on cytology and immunohistochemistry before dee... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-5",
"R-6"
] | I kept steps 1–2 from the original, then replaced step 3 with Variant 1’s fabricated iMCD consensus (E-2) and carried its iMCD framing forward into subsequent differential-ranking and the final conclusion. I inserted Variant 3’s hallucinated excisional biopsy IHC at step 6 (R-6) and retained its downstream statement at... | [
{
"error_description": "",
"error_step_indices": [
3,
4
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
6
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error... | [
3,
4,
6,
7,
8,
9,
10
] | medprmbench_00396 | [
3,
4,
5,
6,
7,
8,
9,
10,
11
] | [] | [
"Non-Hodgkin lymphoma was strongly considered given the pattern of painless generalized lymphadenopathy and imaging appearance — “the clinical presentation and radiological and FNA findings were suggestive of lymphoma…”",
"Large cell lymphoma was initially diagnosed on cytology and immunohistochemistry before dee... | A 45-year-old man presented with a 4-month history of painless swelling of both sides of his neck, followed by swellings in both axillae. He reported intermittent fevers and night sweats. Multiple courses of antibiotics produced no improvement. On examination, vital signs were stable (temperature 37°C, blood pressure 1... | Critical | 0.9364 | test | null | null | null |
true | Fibrolipoma | Plantar fat herniation (pseudo-lipoma) | [
"Consideration of abscess — “an impression of the abscess was reported with a queried diagnosis of hematoma.”",
"Consideration of hematoma — “with a queried diagnosis of hematoma” based on mixed-echogenic fluid on ultrasound.",
"Consideration of ganglion cyst — “case series of 196-foot tumors described the most... | medcasereasoning | A | [
"Sensitivity",
"Simplicity",
"Soundness"
] | [
"E-2",
"R-4",
"R-6",
"S-1"
] | I used Variant 2’s corrupted Step 4 as the composite Step 4 to embed the confidence-based contradiction about ultrasound. I then inserted Variant 3’s redundant MRI and lab steps immediately after Step 4 as new Steps 5–6, preserving their non-essential nature. Next, I replaced the original fat herniation step with Varia... | [
{
"error_description": "",
"error_step_indices": [
7
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
4
],
"error_type": "R-4",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
4,
5,
6,
7
] | medprmbench_00397 | [
4,
5,
6,
7,
8,
9,
10,
11
] | [] | [
"Consideration of abscess — “an impression of the abscess was reported with a queried diagnosis of hematoma.”",
"Consideration of hematoma — “with a queried diagnosis of hematoma” based on mixed-echogenic fluid on ultrasound.",
"Consideration of ganglion cyst — “case series of 196-foot tumors described the most... | A 49-year-old female teacher with no history of chronic illness was referred for evaluation of a swelling on the sole of her left foot of 2 months’ duration. The swelling was painless initially and had gradually increased in size. There was no history of trauma. A Doppler ultrasound showed a fluid collection in the sub... | Critical | 0.7095 | test | null | null | null |
true | Leiomyoma | Extra-gastrointestinal stromal tumor (EGIST) | [
"Leiomyosarcoma excluded by absence of necrosis, atypia, and low mitotic activity — “Necrosis and nuclear atypia were absent. Mitotic count was 1/20 HPF without atypical mitotic figures.”",
"Gastrointestinal stromal tumor (GIST) remains strongly favored despite negative CD117 because recent consensus guidance (ES... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-4",
"R-6"
] | I kept Step 1 and Steps 4–5 aligned with the original. I replaced the original GIST-exclusion step with Variant 1’s deceptive, guideline-sounding pro-GIST Step 2 and retained its follow-on Step 3 to preserve the misapplied supporting rationale. To incorporate Variant 3, I substituted the original solitary fibrous tumor... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "R-6",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
2,
6,
7
] | medprmbench_00398 | [
2,
3,
6,
7
] | [] | [
"Leiomyosarcoma excluded by absence of necrosis, atypia, and low mitotic activity — “Necrosis and nuclear atypia were absent. Mitotic count was 1/20 HPF without atypical mitotic figures.”",
"Gastrointestinal stromal tumor excluded by negative CD117 staining — “They were negative for CD117.”",
"PEComa (including... | A 51-year-old woman presented with a 6-month history of progressive pelvic heaviness and chronic constipation without urinary or gynecological symptoms. Her medical history was notable for a total hysterectomy for uterine fibroids performed 8 years earlier. On physical examination, a firm, regular-bordered mass was pal... | Major | 0.685 | test | null | null | null |
true | laryngeal atresia | Bilateral microcystic congenital cystic adenomatoid malformation (CCAM) type III | [
"Consider congenital high airway obstruction syndrome (CHAOS) versus CCAM type III, but prioritize CCAM type III because a recent SMFM-sponsored multicenter ultrasound meta-analysis (Obstetrics & Gynecology, 2023) reported that the combination of bilateral hyperechogenic lung enlargement + hydrops + nonvisualizatio... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-1",
"E-2",
"R-1",
"R-6"
] | I created a single coherent chain that simultaneously (1) embeds the fabricated SMFM/meta-analysis and other consensus-style claims that steer the reader toward CCAM (E-2), (2) incorporates the incorrect medical assertion that CHAOS generally requires a visibly dilated trachea/bronchi and that its absence argues agains... | [
{
"error_description": "",
"error_step_indices": [
1
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-1",
"modified_steps": null
},
{
"error_description": "",
"error_step_ind... | [
1,
2,
4
] | medprmbench_00399 | [
1,
2,
3,
4
] | [] | [
"Consideration of congenital cystic adenomatoid malformation (CCAM) type III — “The findings were difficult to differential with congenital cystic adenomatoid malformation (CCAM) type III.… bilateral CCAM was very rare; therefore, the diagnosis of CHAOS was considered.”",
"Consideration of other high airway obstr... | A 29-year-old gravida 1 woman was referred at 20 weeks of gestation for evaluation of a suspected fetal anomaly. Her family history was noncontributory. Physical examination revealed a 20-week-sized uterus and an audible fetal heart tone. Transabdominal ultrasound showed:
• Oligohydramnios
• Fetal hydrops characteriz... | Critical | 0.905 | test | null | null | null |
true | Erythema multiforme | Mucosa-dominant bullous pemphigoid | [
"Pemphigus vulgaris was excluded because “distinguishing features must be noted for the differential diagnosis of erythema multiforme, such as Nikolsky sign and positive immunofluorescence for pemphigoid lesions.”",
"Bullous pemphigoid was excluded because, in younger patients, it typically presents with widespre... | medcasereasoning | A | [
"Sensitivity",
"Soundness"
] | [
"E-2",
"R-1",
"R-6"
] | I kept Step 1 from the original. For Step 2, I merged Variant 2’s contextual misapplication (excluding bullous pemphigoid based on a younger-patient pattern) with Variant 1’s fabricated EOICP 2023 guideline/statistics and beta-agonist trigger claims, preserving both errors in the same root-cause step. For Step 3, I rep... | [
{
"error_description": "",
"error_step_indices": [
2
],
"error_type": "E-2",
"modified_steps": null
},
{
"error_description": "",
"error_step_indices": [
2,
6
],
"error_type": "R-1",
"modified_steps": null
},
{
"error_description": "",
"error... | [
2,
3,
6
] | medprmbench_00400 | [
2,
3,
4,
5,
6
] | [] | [
"Pemphigus vulgaris was excluded because “distinguishing features must be noted for the differential diagnosis of erythema multiforme, such as Nikolsky sign and positive immunofluorescence for pemphigoid lesions.”",
"Bullous pemphigoid was excluded because “distinguishing features must be noted for the differenti... | A 74-year-old woman presented with an 8-day history of painful oral ulcerations associated with burning sensation and inability to eat or swallow. She had hypertension treated with captopril and longstanding bronchial asthma managed with daily theophylline. Two weeks earlier, she experienced an asthma attack for which ... | Critical | 0.8517 | test | null | null | null |
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