Datasets:

skylenage-ai
/

MedPRMBench-Test

answer_changed bool	correct_answer string	corrupted_answer string	corrupted_steps list	dataset string	dataset_type string	error_categories list	error_codes list	error_injection_reason string	error_step_code_map list	error_steps list	id string	modified_steps list	options list	original_steps list	question string	severity_level string	severity_score float64	split string	vote_error_failed bool	vote_reasoning_adopt_count int64	vote_reasoning_reject_count int64
true	Macrophage myofasciitis	Non-radiographic axial spondyloarthritis	[ "Thyroid-related myopathy was considered — “Endocrinology assessment suggested that this patients’ weakness was less likely related to thyroiditis.”", "Hyperkalemic periodic paralysis was excluded — “Hyperkalemic paralysis was ruled out.”", "Given the normal CK and EMG, major alternative endocrine etiologies ca...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "E-5", "R-5" ]	I kept steps 1, 2, 4, 5, and 6 aligned with the original. I replaced the original endocrine-rule-out step with Variant 1’s shortcut statement to preserve the E-1 prerequisite omission at step 3. For step 7, I merged Variant 2’s premature closure on non-radiographic axial spondyloarthritis with Variant 3’s contradictory...	[ { "error_description": "", "error_step_indices": [ 3 ], "error_type": "E-1", "modified_steps": null }, { "error_description": "", "error_step_indices": [ 7 ], "error_type": "E-5", "modified_steps": null }, { "error_description": "", "error_step_ind...	[ 3, 7, 8 ]	medprmbench_00001	[ 3, 7, 8 ]	[]	[ "Thyroid-related myopathy was considered — “Endocrinology assessment suggested that this patients’ weakness was less likely related to thyroiditis.”", "Hyperkalemic periodic paralysis was excluded — “Hyperkalemic paralysis was ruled out.”", "Other endocrine causes (adrenal insufficiency, Cushing’s disease) were...	A 14-year-old girl presented with 2 months of progressive proximal muscle weakness. She initially noted difficulty combing her hair and rising from a chair; over weeks she became wheelchair-bound. She also reported morning stiffness of both small hand joints lasting about 30 minutes, dysphagia for solids and liquids, a...	Major	0.5862	test	null	null	null
true	Lymphangioleiomyomatosis	Lymphoid interstitial pneumonia (LIP)	[ "COPD/emphysema considered because of recurrent pneumothorax and cysts — “Patients with chronic obstructive pulmonary disease (COPD) or emphysema may also present with recurrent pneumothorax and multiple pulmonary cysts on imaging, but they lack the presence of LAM cells in their alveoli, which needs to be confirme...	medcasereasoning	A	[ "Sensitivity", "Simplicity", "Soundness" ]	[ "E-1", "R-4", "S-2" ]	I kept steps 1–3 from the original. I merged Variant 2’s overconfident, stem-contradicting LIP claim into Step 4, and simultaneously incorporated Variant 1’s prerequisite-skipping move (declaring LIP unlikely and proceeding to LAM without the needed autoimmune/immune-status and corroborative imaging checks) into the sa...	[ { "error_description": "Prerequisite Sensitivity: skips prerequisite evaluation for LIP (e.g., autoimmune/immune-status assessment and corroboration of interstitial infiltrates/effusions) and jumps directly to LAM-based reasoning.", "error_step_indices": [ 4 ], "error_type": "E-1", "modifi...	[ 4, 5 ]	medprmbench_00002	[ 4, 5, 6, 7 ]	[]	[ "COPD/emphysema considered because of recurrent pneumothorax and cysts — “Patients with chronic obstructive pulmonary disease (COPD) or emphysema may also present with recurrent pneumothorax and multiple pulmonary cysts on imaging, but they lack the presence of LAM cells in their alveoli, which needs to be confirme...	A 36-year-old woman presented with a 7-day history of right-sided chest pain and dyspnea without fever or cough. She reported two prior spontaneous pneumothoraces: one right-sided in 2018 managed medically, and one left-sided in 2019 treated surgically. She also noted occasional small-volume hemoptysis. On admission,...	Major	0.655	test	null	null	null
false	GiantCondylomaAcuminatum	Giant condyloma acuminatum (Buschke–Löwenstein tumor)	[ "The presence of long-standing, progressively enlarging, cauliflower-shaped perianal and scrotal lesions is most consistent with benign giant condyloma acuminatum (Buschke–Löwenstein tumor), so malignant etiologies do not need to be prioritized in the diagnosis.", "Bowenoid papulosis is definitively confirmed her...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "E-5", "R-1", "R-4", "R-5" ]	I used Variant 2's Step 1 as the composite Step 1 to simultaneously (a) skip histologic confirmation (E-1 prerequisite omission) and (b) prematurely narrow to benign giant condyloma while deprioritizing malignancy (E-5). I then inserted Variant 3's corrupted Step 2 to add the overconfident factual contradiction about H...	[ { "error_description": "", "error_step_indices": [ 1, 2 ], "error_type": "E-1", "modified_steps": null }, { "error_description": "", "error_step_indices": [ 1, 2 ], "error_type": "E-5", "modified_steps": null }, { "error_description": "", ...	[ 1, 2 ]	medprmbench_00003	[ 1, 2, 3, 4, 5, 6 ]	[]	[ "Squamous cell carcinoma was considered but ruled out on histology because “no evidence of dysplasia or malignancy.”", "Bowenoid papulosis was in the differential but excluded by the absence of dysplastic changes, as indicated by “no evidence of dysplasia or malignancy.”", "Condyloma latum from syphilis was exc...	A 44-year-old single man presented with a 10-year history of progressively enlarging perianal and lower scrotal warts. He reported pruritus and a bloody, foul-smelling discharge over the past 4 years. He had a history of smoking, alcohol use, chronic hepatitis B infection, and multiple heterosexual partners. On examin...	Critical	0.875	test	null	null	null
true	Eosinophilic granulomatosis with polyangiitis	Occult aorto‑iliac occlusive disease causing ischemic peroneal neuropathy (acute ischemic foot drop)	[ "Lumbar disc herniation was considered because of the MRI finding, but was unlikely to explain her symptoms—MRI revealed a disc herniation at L5–S1, but there was no significant nerve root compression or cord compression.", "The evolution to foot drop with a later absent peroneal evoked myogenic potential strongl...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "E-2", "E-5", "R-1", "R-4", "R-5" ]	I used Variant 1’s corrupted Step 2 (fabricated EPNS guideline/statistics) as the composite Step 2, and kept Variant 3’s inserted redundant imaging steps as composite Steps 3–4. For the vascular portion, I included Variant 2’s overconfident contradiction as composite Step 5 (root-cause R-4) while also retaining Variant...	[ { "error_description": "", "error_step_indices": [ 4 ], "error_type": "E-1", "modified_steps": null }, { "error_description": "", "error_step_indices": [ 2 ], "error_type": "E-2", "modified_steps": null }, { "error_description": "", "error_step_ind...	[ 2, 3, 4, 5, 6, 7 ]	medprmbench_00004	[ 1, 2, 3, 4, 5, 6, 7 ]	[]	[ "Lumbar disc herniation was considered because of the MRI finding, but was unlikely to explain her symptoms—“MRI revealed a disc herniation at L5–S1, but there was no significant nerve root compression or cord compression.”", "Peroneal nerve palsy was on the differential given foot drop and conduction changes—“ne...	A 48‐year‐old woman with a history of asthma presented with a 2‐day history of right lower‐extremity numbness and pain that worsened despite conservative measures. She denied any low back pain. On examination, manual muscle testing of the right tibialis anterior and extensor hallucis longus was 3/5, and gastrocnemius a...	Critical	0.91	test	null	null	null
true	Bardet‐Biedl syndrome	McKusick–Kaufman syndrome	[ "McKusick–Kaufman syndrome best explains this presentation because, in postpubertal/adult females, hydrometrocolpos with post-axial polydactyly most commonly reflects MKS due to distal vaginal obstruction, and this patient’s hematometrocolpos/vaginal obstruction with polydactyly fits that pattern.", "Although Bar...	medcasereasoning	A	[ "Sensitivity", "Simplicity", "Soundness" ]	[ "E-1", "R-3", "S-2" ]	To integrate all variants, Step 1 was rewritten to retain the R-3 misapplied adult/postpubertal heuristic that hydrometrocolpos + polydactyly most commonly indicates MKS, while also implementing the E-1 omission by not performing an explicit initial MKS-vs-BBS differential before committing to MKS. Step 2 was then repl...	[ { "error_description": "Prerequisite Sensitivity (E-1): the chain skips the prerequisite step of first explicitly considering and differentiating McKusick–Kaufman syndrome versus Bardet–Biedl syndrome before committing to a diagnosis; instead it moves directly into a committed choice without a proper initial di...	[ 1, 2 ]	medprmbench_00005	[ 1, 2 ]	[]	[ "McKusick–Kaufman syndrome was initially considered because of hydrometrocolpos and polydactyly — “Initial clinical findings suggested MKS.”", "MKS was excluded as the reproductive-tract anomalies were more extensive, aligning with BBS, since MKS primarily involves distal vaginal abnormalities while BBS includes ...	A 15-year-old girl with congenital intellectual disability and blindness presents with primary amenorrhea and a 2-year history of cyclical lower abdominal and pelvic pain lasting 5 days each month. The pain has worsened over the past 2 months and is partially relieved by oral analgesics. She exhibits irritability, redu...	Major	0.77	test	null	null	null
false	autoimmune myelofibrosis	Systemic lupus erythematosus–associated autoimmune myelofibrosis	[ "Given the recurrent severe anemia with mildly elevated LDH, proceed under the assumption that hemolysis is not the primary driver and focus on an autoimmune marrow process.", "Autoimmune myelofibrosis related to systemic lupus erythematosus was suspected because the overall picture is most consistent with an SLE...	medcasereasoning	A	[ "Sensitivity", "Simplicity" ]	[ "E-1", "S-2" ]	I used Variant 1’s Step 1 to preserve the prerequisite-skipping hemolysis assumption (E-1), replacing the original hemolysis-exclusion step. I then used Variant 2’s tautological Step 2 to preserve the circular justification (S-2). The steps were kept as a coherent two-step chain with both root-cause errors flagged at t...	[ { "error_description": "Skips the prerequisite hemolysis exclusion workup/interpretation (DAT/Coombs, reticulocyte response, haptoglobin) and assumes hemolysis is not the driver before pursuing a non-hemolysis pathway.", "error_step_indices": [ 1 ], "error_type": "E-1", "modified_steps": [...	[ 1, 2 ]	medprmbench_00006	[ 1, 2 ]	[]	[ "Hemolytic anemia was excluded given a negative direct Coomb’s test and normal reticulocyte count and haptoglobin levels — “direct Coomb’s test was negative, while his reticulocyte counts and haptoglobin levels were within normal limits.”", "Autoimmune myelofibrosis related to systemic lupus erythematosus was sus...	A 44-year-old African American man with a family history of systemic lupus erythematosus presented with progressive fatigue, severe anemia, and night sweats over several months. He also reported photosensitivity and nonspecific arthralgias. His vital signs were stable, and physical examination was unremarkable. Labora...	Critical	0.805	test	null	null	null
false	Mycobacterium marinum infection	Mycobacterium marinum infection	[ "Despite negative autoimmune serology and normal inflammatory markers, the chronic progressive swelling with firm extensor-surface nodules is still most consistent with seronegative rheumatoid arthritis, and escalation of immunosuppression is appropriate.", "Because the initial hand swelling followed an acute lac...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "R-5", "R-7" ]	I merged Variant 2’s safety/soundness error into Step 1 by reversing the original skepticism about RA and explicitly endorsing immunosuppression escalation despite not addressing occult infection. I then combined Variant 3’s timing/trajectory error (using chronicity and lack of response to short-course standard antibio...	[ { "error_description": "Bypasses critical safety checks for occult infection and incorrectly frames escalation of immunosuppression as appropriate without ruling out serious infectious etiologies before/while using steroids and TNF inhibitors.", "error_step_indices": [ 1 ], "error_type": "R-5"...	[ 1, 2 ]	medprmbench_00007	[ 1, 2 ]	[]	[ "The diagnosis of rheumatoid arthritis was questioned because “All autoimmune serology was negative, and inflammatory markers were normal.”", "An atypical mycobacterial infection was suspected given his aquarium exposure and the nodular lymphatic distribution, noting that “M. marinum infections commonly present a...	A 67-year-old man presented in June 2013 with a swollen left hand after a laceration to his third finger sustained while working in soil. He also maintained three large hobby aquariums. He was treated with a 10-day course of cefprozil and clindamycin, with only marginal improvement. In October 2013, he returned with wo...	Critical	1	test	null	null	null
true	Hydatid disease	Galactocele	[ "Common breast tumors (fibroadenoma or phyllodes) and malignancy were considered given the palpable mass — “it might mimic fibroadenoma, phyllodes tumor, chronic abscess, or even malignancies, and this should be included in the differential diagnoses of breast lumps, especially in endemic regions.”", "Breast absc...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "R-3", "R-5" ]	Both variants place their single root-cause error at Step 3 but with distinct angles: R-1 introduces incorrect ultrasound-pathology mapping (floating membranes/internal echoes attributed to galactocele and hydatid described as simple), while R-3 introduces context misapplication (treating a non-lactating patient as if ...	[ { "error_description": "", "error_step_indices": [ 3 ], "error_type": "E-1", "modified_steps": null }, { "error_description": "", "error_step_indices": [ 3 ], "error_type": "R-3", "modified_steps": null }, { "error_description": "", "error_step_ind...	[ 3, 5 ]	medprmbench_00008	[ 3, 4, 5 ]	[]	[ "Common breast tumors (fibroadenoma or phyllodes) and malignancy were considered given the palpable mass — “it might mimic fibroadenoma, phyllodes tumor, chronic abscess, or even malignancies, and this should be included in the differential diagnoses of breast lumps, especially in endemic regions.”", "Breast absc...	A 31-year-old woman presented with a gradually progressive, painless lump in the left axillary tail of Spence of two years’ duration. There was no history of trauma, no nipple discharge, and no family history of breast cancer. On examination, the mass was firm, non-mobile, and measured 5 cm × 5 cm; the remainder of the...	Major	0.765	test	null	null	null
false	Histoplasmosis	Disseminated histoplasmosis (Histoplasma capsulatum) causing lip ulcers and edema	[ "Herpes simplex virus infection is unlikely because HSV PCR taken from the base of the lip ulcer was negative.", "Angioedema is unlikely because the complement C1 esterase inhibitor level was within normal limits.", "Bacterial infection is less likely because Gram stain of lesion samples was negative.", "Fung...	medcasereasoning	A	[ "Sensitivity", "Simplicity", "Soundness" ]	[ "E-1", "R-3", "S-1" ]	I kept the overall structure of the original chain but overlaid the three independent corruptions: (1) replaced the fungal-assessment step with the R-3 wording that inappropriately extrapolates test performance from immunocompetent hosts, (2) replaced the Histoplasma conclusion step with the E-1 version that asserts Hi...	[ { "error_description": "Contextual applicability error: applies the near-rule-out value of negative fungal cultures/Histoplasma antigen testing as in immunocompetent hosts to an HIV patient with immune reconstitution, incorrectly deprioritizing fungal etiologies despite the clinical context.", "error_step_i...	[ 4, 6, 7, 8 ]	medprmbench_00009	[ 1, 2, 3, 4, 5, 6, 7, 8, 9 ]	[]	[ "Herpes simplex virus infection — “HSV polymerase chain reaction taken from the base of lip ulcer was negative.”", "Angioedema — “Complement C1 esterase inhibitor level was negative.”", "Bacterial infection — “Gram stain… were negative.”", "Fungal infection (broad) — “fungal blood cultures, and urine and seru...	A 34‐year‐old African American man with hemophilia A, HIV‐1 infection, and hepatitis C virus infection presented with a 3‐month history of intermittent fever, unintentional weight loss, and progressive lip swelling with painful ulcerations. Six months earlier he had resumed antiretroviral therapy, with his CD4 count ri...	Critical	0.805	test	null	null	null
false	Drug-induced lung injury	Sai-rei-to–induced diffuse alveolar hemorrhage (drug-induced lung injury)	[ "Drug-induced lung injury by Sai-rei-to was most likely — the tight temporal association (symptoms starting about 2 weeks after initiation) and lack of prior interstitial lung disease or collagen vascular disease history support Sai-rei-to–associated drug-induced interstitial lung disease.", "Community-acquired p...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "E-3", "R-5" ]	I kept Step 1 essentially aligned with the original/variants (drug-induced lung injury most likely). I merged Variant 1 and Variant 2 into a single composite Step 2 that simultaneously (a) excludes infection purely from negative bacteriology (E-1 prerequisite omission) and (b) asserts CAP is the only legitimate alterna...	[ { "error_description": "Excluded infection solely based on negative bacteriological tests, skipping prerequisite evaluation/clinical reassessment to rule out atypical/viral/serologic causes before attributing findings to drug-induced DAH.", "error_step_indices": [ 2 ], "error_type": "E-1", ...	[ 2, 3 ]	medprmbench_00010	[ 1, 2, 3 ]	[]	[ "Drug-induced lung injury by Sai-rei-to was most likely — “Drug-induced interstitial lung disease (ILD) caused by Sai-rei-to was the most likely diagnosis, because he had no history of interstitial pneumonia or collagen disease, and he had started taking Sai-rei-to a month earlier.”", "Community-acquired pneumoni...	An 88-year-old man with hypertension and chronic kidney disease presented with progressive dry cough, dyspnea, fever, and chills. Twenty-five days earlier, he had started a herbal medicine, Sai-rei-to, and symptoms began two weeks after initiation. He was an ex-smoker, took no other medications, and had no history of p...	Critical	1	test	null	null	null
true	GallbladderVolvulus	Acute calculous cholecystitis	[ "Ileosigmoid knot, pseudo-obstruction, severe constipation, and sigmoid diverticular disease were considered given acute abdominal pain but were excluded because the abdominal x‐ray on admission was normal.", "Because she had a similar, self-limited episode 1 month earlier, the current presentation is most consis...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "R-2", "R-7" ]	I kept Step 1 from the original. For Step 2, I merged Variant 3’s temporal misclassification and delayed-management framing with Variant 1’s prerequisite-skipping jump directly to volvulus, preserving both errors even though they create internal tension. For Step 3, I used Variant 2’s inconsistency (preserved flow/impa...	[ { "error_description": "Prerequisite Sensitivity: skips first establishing/assessing acute (acalculous) cholecystitis as the immediate working diagnosis before using ischemic/malposition imaging findings to jump directly to gallbladder volvulus.", "error_step_indices": [ 2 ], "error_type": "E-...	[ 2, 3 ]	medprmbench_00011	[ 1, 2, 3 ]	[]	[ "Ileosigmoid knot, pseudo-obstruction, severe constipation, and sigmoid diverticular disease were considered given acute abdominal pain but were excluded because “abdominal x‐ray on admission was normal.”", "Acute cholecystitis was suspected based on gallbladder enlargement, wall thickening, and pericholecystic f...	A previously healthy 5‐year‐old girl presented with 9 hours of intermittent, moderate–severity epigastric pain radiating to the right lower quadrant. The pain was unchanged by position and was associated with multiple episodes of nonbloody vomiting. She was afebrile, had normal urination and bowel movements, and report...	Critical	0.91	test	null	null	null
true	Metformin toxicity	Metformin-associated lactic acidosis	[ "Diabetic ketoacidosis is the most likely cause of the marked ketosis and severe high–anion gap metabolic acidosis, as the elevated β-hydroxybutyrate with profound acidemia is most consistent with DKA; the near-normal glucose can be attributed to poor intake or delayed presentation.", "Type A lactic acidosis due ...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "E-3", "R-5" ]	I used Variant 3’s Step 1 (DKA anchoring) to incorporate the R-5 safety error, kept its Step 2 for continuity, replaced Step 3 with Variant 2’s definitive-exclusion language to incorporate the E-3 error, and replaced Step 4 with Variant 1’s unverified MALA conclusion to incorporate the E-1 error. This preserves each va...	[ { "error_description": "Safety Awareness error: anchors on diabetic ketoacidosis despite no diabetes history and low-normal glucose, omitting the critical life-threatening consideration of metformin-associated lactic acidosis in an end-stage kidney disease patient, creating a dangerous misdiagnosis trajectory."...	[ 1, 3, 4 ]	medprmbench_00012	[ 1, 2, 3, 4 ]	[]	[ "Starvation ketoacidosis rather than diabetic ketoacidosis — “more likely secondary to starvation ketoacidosis than diabetic ketoacidosis given the patient’s low-normal glucose and no past history of diabetes.”", "Type A lactic acidosis due to sepsis or shock was considered but infection was excluded — “clinicall...	A 60-year-old man with end-stage kidney disease secondary to presumed ischemic nephropathy treated with thrice-weekly hemodialysis was brought to the hospital for confusion, altered level of consciousness, and hypothermia. He had no history of diabetes mellitus. His medications included atorvastatin, amlodipine, pantop...	Critical	1	test	null	null	null
false	cerebral venous thrombosis	Cerebral venous thrombosis (left transverse sinus thrombosis)	[ "Alzheimer’s disease was initially considered because of age and cognitive decline, but “the rapid progression, sudden‐onset symptoms, and lack of response to treatment were inconsistent with typical dementia.”", "Frontotemporal dementia was entertained, but “the sudden onset of symptoms reduced the likelihood of...	medcasereasoning	A	[ "Sensitivity", "Simplicity", "Soundness" ]	[ "E-1", "R-1", "S-1" ]	I used the S-1 variant’s inserted redundant steps as the composite chain’s steps 3–4. I kept the E-1 variant’s MRI-based wording for ruling out tumor and arterial stroke (steps 5–6). To integrate both E-1 and R-1 (which both corrupt the vascular-etiology step), I merged their competing, errorful claims into a single co...	[ { "error_description": "Prerequisite Sensitivity: The chain jumps to diagnosing cerebral venous thrombosis without first establishing the intermediate vascular dementia/vascular localization hypothesis and without the targeted imaging reevaluation needed to justify CVT as the specific cause.", "error_step_i...	[ 7 ]	medprmbench_00013	[ 3, 4, 5, 6, 7, 8 ]	[]	[ "Alzheimer’s disease was initially considered because of age and cognitive decline, but “the rapid progression, sudden‐onset symptoms, and lack of response to treatment were inconsistent with typical dementia.”", "Frontotemporal dementia was entertained, but “the sudden onset of symptoms reduced the likelihood of...	A 74-year-old right-handed woman was brought to the psychiatry clinic with a 5-month history of abrupt onset of disorganized speech, severe anxiety, and self-harm behaviors that began after a family trip. Her speech was rapid, fluent, and nonsensical—exemplified by the phrase “Our neighbor has gone to the cobbler to bu...	Critical	0.8525	test	null	null	null
false	Urticarial vasculitis	Urticarial vasculitis	[ "Broad differential of annular urticarial lesions in childhood — importantly, recurrent annular plaques that recur in identical locations and resolve without residual injury are most characteristic of erythema multiforme (a targetoid hypersensitivity eruption that classically recurs at the same sites), making eryth...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "R-1", "R-7" ]	I used Variant 2’s Step 1–2 wording to embed the R-1 evidence-based misstatements (EM recurring at identical sites and being the leading diagnosis). I then combined Variant 3’s Step 3–4 trajectory/timing argument (vasculitis considered too early/transient; defer vasculitis-directed evaluation and treat as acute urticar...	[ { "error_description": "Incorrectly claims erythema multiforme characteristically recurs at identical sites and that the overall pattern is most characteristic of EM, inappropriately redirecting the leading diagnosis away from urticarial vasculitis.", "error_step_indices": [ 1 ], "error_type":...	[ 1, 3 ]	medprmbench_00014	[ 1, 2, 3, 4 ]	[]	[ "Broad differential of annular urticarial lesions in childhood — “Annular urticarial lesions in a child must establish a differential diagnosis with urticaria multiforme, common urticaria, acute hemorrhagic edema of infancy, erythema marginatum, erythema annulare centrifugum, annular erythema in childhood, erythema...	A 6‐year‐old girl with no relevant medical history presented with intensely pruritic skin lesions on her anterior thighs. The lesions first appeared 2 weeks earlier in recurrent 3‐day outbreaks, always at the same locations, and resolved spontaneously without residual injury. She had no systemic symptoms, preceding inf...	Critical	0.905	test	null	null	null
true	immune-related pneumonitis	Steroid-refractory immune checkpoint inhibitor–induced pneumonitis	[ "Connective tissue– or vasculitis-associated ILD was excluded based on negative autoantibodies in serological testing.", "Hypersensitivity pneumonitis was ruled out due to the absence of any identifiable history of antigen exposure.", "Bacterial pneumonia was considered and excluded when broad-spectrum antibiot...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "E-3", "R-5" ]	I kept the original step structure but replaced Step 6 with the premature 'infection sufficiently unlikely to proceed without further infectious exclusion' logic and the ensuing jump to ICI pneumonitis, which simultaneously captures the E-1 prerequisite omission and the R-5 safety bypass (both rooted at Step 6). I then...	[ { "error_description": "Skipped the prerequisite of confirming lower-respiratory infection exclusion via BAL/bronchoscopy culture results before concluding ICI-induced pneumonitis, effectively jumping ahead after biopsy/antibiotic nonresponse.", "error_step_indices": [ 6 ], "error_type": "E-1"...	[ 6, 7 ]	medprmbench_00015	[ 1, 2, 3, 4, 5, 6, 7, 8 ]	[]	[ "Connective tissue– or vasculitis‐associated ILD was excluded — “Connective tissue disease‐associated interstitial lung disease (ILD) and vasculitis‐associated ILD were deemed unlikely based on the negative autoantibodies results in serological testing…”", "Hypersensitivity pneumonitis was ruled out — “hypersensi...	An 82-year-old man with epithelioid pleural mesothelioma (cT1N0M0) was treated with ipilimumab and nivolumab. After eight courses, follow-up chest CT showed new bilateral infiltrative shadows. He reported fever and dyspnea. Laboratory tests revealed elevated C-reactive protein and surfactant protein D levels; Krebs von...	Critical	1	test	null	null	null
true	Gemcitabine‐induced skin necrosis	Culture-negative bacterial cellulitis with skin necrosis and concomitant pseudogout (CPPD) of the right knee	[ "Simple bacterial cellulitis with secondary ulceration is the most likely explanation for the painful erythematous calf lesion; despite negative cultures/biopsy, culture-negative skin infection is common in older adults and should be prioritized over chemotherapy-related mimics.", "Chemotherapy extravasation inju...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "E-5", "R-1", "R-5" ]	I used Variant 3 to replace Step 1 with the unsafe prioritization of bacterial cellulitis and retained its conclusion framework, while keeping Step 2 (extravasation) and Step 4 (DVT) consistent with all versions. I integrated Variant 2 by substituting Step 3 with the authoritative dismissal of vasculitis and the claim ...	[ { "error_description": "", "error_step_indices": [ 1 ], "error_type": "E-1", "modified_steps": null }, { "error_description": "", "error_step_indices": [ 3 ], "error_type": "R-1", "modified_steps": null }, { "error_description": "", "error_step_ind...	[ 1, 3, 5 ]	medprmbench_00016	[ 1, 2, 3, 4, 5, 6 ]	[]	[ "Pseudocellulitis from gemcitabine — “Pseudocellulitis has been reported as an adverse reaction of gemcitabine … frequently misdiagnosed as an infection and inappropriately treated with antibiotics.”", "Chemotherapy extravasation injury — “We did not find any reports of gemcitabine causing tissue necrosis due to ...	A 74‐year‐old man with a history of well-differentiated T3N1M0 pancreatic adenocarcinoma status post Whipple procedure completed six cycles of gemcitabine monotherapy (1000 mg/m2 on days 1, 8, 15 of a 28-day cycle). Two weeks after his final infusion, he noted a painful ulcer on the posterior aspect of his right calf a...	Critical	0.965	test	null	null	null
true	AdenoidCysticCarcinoma	Recurrent chondroid syringoma	[ "A Bartholin gland cyst was initially considered but excluded because of the patient’s age and absence of pain or discomfort with activity — “The cyst was excluded, because it is more common in young women, and causes symptoms of pain during walking, sitting, and intercourse, which were absent in this case.”", "B...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "E-5", "R-1", "R-4", "R-5", "R-6" ]	All three variants localized their root-cause error to Step 2, so the composite Step 2 explicitly merges: (1) anchoring on benign recurrent chondroid syringoma and dismissing malignancy (E-5), (2) the incorrect characterization of chondroid syringoma as infiltrative/hypervascular/rapidly recurrent to argue against it (...	[ { "error_description": "", "error_step_indices": [ 2 ], "error_type": "E-1", "modified_steps": null }, { "error_description": "", "error_step_indices": [ 2, 3, 4 ], "error_type": "E-5", "modified_steps": null }, { "error_description": "", ...	[ 2, 3, 4 ]	medprmbench_00017	[ 2, 3, 4 ]	[]	[ "A Bartholin gland cyst was initially considered but excluded because of the patient’s age and absence of pain or discomfort with activity — “The cyst was excluded, because it is more common in young women, and causes symptoms of pain during walking, sitting, and intercourse, which were absent in this case.”", "C...	A 64-year-old woman presented with a slowly enlarging mass in the left labia majora over 10 years. Her vital signs were normal. On examination, the mass was firm, painless, immobile, and measured approximately 7 × 4 cm, extending toward the mons pubis. Routine laboratory tests were normal. Surgical history: – In 2000...	Critical	0.7475	test	null	null	null
true	Spontaneous cerebrospinal fluid rhinorrhea	Chronic rhinosinusitis (isolated left sphenoid sinusitis)	[ "Consider spontaneous CSF rhinorrhea because of copious clear, predominantly unilateral rhinorrhea that worsens with bending/lifting/strain and is poorly responsive to rhinitis therapies; the headache/visual symptoms improving after onset of drainage suggests elevated intracranial pressure patterns with a spontaneo...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "R-1", "R-7" ]	I kept Step 1 aligned with the shared framing across variants (CSF rhinorrhea considered). For Step 2, I merged Variant 1’s prerequisite-omission language (not needing to formally rule out allergic rhinitis) with Variant 2’s incorrect evidence claims about unilateral allergic rhinitis and treatment-refractory “local al...	[ { "error_description": "Prerequisite Sensitivity: skips the prerequisite of actively excluding allergic rhinitis/benign rhinitis etiologies before committing forward in the reasoning, asserting they do not need to be formally ruled out.", "error_step_indices": [ 2 ], "error_type": "E-1", "...	[ 2, 3 ]	medprmbench_00018	[ 1, 2, 3, 4, 5 ]	[]	[ "Consideration of spontaneous CSF rhinorrhea because of the presentation of clear unilateral nasal discharge exacerbated by posture and menstrual cycle — “Copious clear unilateral rhinorrhea … poor response to antihistamines and ipratropium nasal spray; can be exacerbated by menstrual cycle.”", "Allergic rhinitis...	A 44-year-old obese woman with chronic migraines, recurrent sinusitis, and allergic rhinitis presented for evaluation of a possible sinus infection. She reported a 2-month history of copious clear rhinorrhea, purulent postnasal drainage, and cough. She also experienced self-limiting episodes of clear nasal discharge at...	Critical	0.94	test	null	null	null
false	Multisystem inflammatory syndrome in children	Multisystem inflammatory syndrome in children (MIS-C)	[ "Rheumatic fever was considered given cardiac dysfunction but excluded by a negative ASOT — “At this point, a diagnosis of rheumatic heart disease and rheumatic fever was entertained; an ASOT titer was obtained, being negative.”", "The very high procalcitonin and shock physiology are sufficient to confirm bacteri...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "E-3", "E-5", "R-1", "R-4", "R-5" ]	I preserved Step 1 from the original (non-error). From Variant R-5, I replaced Step 2 with the premature 'confirmed septic shock' assertion that ignores sterile cultures (safety-check bypass). For Step 3, I used Variant E-3’s vasculitis-only framing that dismisses other valid alternatives as contraindicated based on ne...	[ { "error_description": "", "error_step_indices": [ 2 ], "error_type": "E-1", "modified_steps": null }, { "error_description": "", "error_step_indices": [ 2 ], "error_type": "R-4", "modified_steps": null }, { "error_description": "", "error_step_ind...	[ 2, 3 ]	medprmbench_00019	[ 2, 3, 5 ]	[]	[ "Rheumatic fever was considered given cardiac dysfunction but excluded by a negative ASOT — “At this point, a diagnosis of rheumatic heart disease and rheumatic fever was entertained; an ASOT titer was obtained, being negative.”", "Bacterial septic shock was considered due to hemodynamic collapse and high procalc...	An 18-year-old African male with no prior medical history presented first with a 2-day history of tonsillitis and a new macular rash on his chest that extended to his arms. Three days later he developed abdominal cramping and multiple episodes of non-bloody, watery diarrhea without nausea or vomiting, along with fevers...	Major	0.86	test	null	null	null
null	Serous cystadenoma	Benign epithelial ovarian cystadenoma	[ "The markedly elevated total testosterone with normal DHEA/DHEA-S indicates an ovarian source of androgen excess, so an androgen-secreting ovarian tumor is the most likely diagnosis.", "The absence of an adrenal mass on CT further supports a non-adrenal (ovarian) etiology.", "Because the biochemical pattern is ...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "R-2", "R-5" ]	I used Variant 1’s Step 1 to preserve the prerequisite-sensitivity omission (no assay confirmation before inferring ovarian source). I kept the original/Variant 1 Step 2 unchanged. I then inserted Variant 2’s contradictory Step 3 to create the step-consistency error (adrenal-pattern claim despite prior ovarian-pattern ...	[ { "error_description": "Interprets the androgen panel as confirming an ovarian source without first confirming assay validity/true testosterone elevation with a high-specificity method (e.g., LC–MS/MS) or excluding spurious immunoassay elevation.", "error_step_indices": [ 1 ], "error_type": "E...	[ 1, 3, 4 ]	medprmbench_00020	[ 1, 2, 3, 4 ]	[]	[ "Step 1: Evidence for ovarian rather than adrenal source — “High testosterone levels but normal DHEA and DHEAS levels indicate an ovarian origin for the increased androgens.”", "Step 2: Adrenal tumor unlikely by imaging — “…no adrenal mass was noted….”", "Step 3: Sex cord–stromal tumors as a possible androgen s...	A 60-year-old postmenopausal woman with a history of total abdominal hysterectomy 20 years earlier for fibroids presented with a 1-year history of clitoral enlargement, hirsutism, deepening of voice, decreased libido, and increasing abdominal girth. Baseline renal and hepatic chemistries, TSH, and lipid panel were unch...	Critical	0.895	test	null	3	0
true	spinal epidural lipomatosis	Multiple sclerosis	[ "Steroid-induced epidural lipomatosis is unlikely because he denied steroid or other drug intake.", "Endogenous hypercortisolism (Cushing syndrome) is unlikely given no clinical evidence of Cushing’s syndrome or endocrinopathy.", "Obesity-associated epidural lipomatosis is unlikely because he is non-obese (BMI ...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "E-5", "R-2" ]	Used Variant 2’s Step 4 to embed the differential-coverage error (E-5) and Variant 1’s Step 5 to embed the prerequisite-skip error (E-1), preserving the deferral of contrast imaging and premature closure on lipomatosis. Retained Variant 2’s Step 6 to keep the continued de-emphasis of infection. Then replaced the final ...	[ { "error_description": "Prematurely narrows the differential by treating fat-signal MRI as essentially diagnostic of epidural lipomatosis and dismissing the need to pursue other important epidural mass etiologies (e.g., abscess, tumors) using a worst-first approach.", "error_step_indices": [ 4 ], ...	[ 4, 5, 7 ]	medprmbench_00021	[ 1, 2, 3, 4, 5, 6, 7 ]	[]	[ "Steroid-induced epidural lipomatosis — “denied history of ... drug intake like steroids”", "Endogenous hypercortisolism (Cushing syndrome) — “without any evidence of Cushing’s syndrome or endocrinopathies”", "Obesity-associated lipomatosis — “Non-obese patient [weight 65 kg ... BMI 23.30 kg/m2]”", "Spinal an...	An 18-year-old man presented with 6 months of fluctuating lower-limb weakness. He awoke one morning unable to move his legs but recovered movement over 30 minutes, with residual unsteadiness. He remained asymptomatic for 4 months, then developed ascending spastic weakness of the lower limbs over 3 months until he was u...	Critical	0.91	test	null	null	null
true	Bickerstaff brainstem encephalitis	Post-infectious acute disseminated encephalomyelitis (ADEM)	[ "Acute infectious herpetic encephalomyelitis is unlikely because the CSF is acellular with negative viral PCR and MRI of the brain and spinal cord is normal.", "Tacrolimus neurotoxicity is unlikely because MRI is normal and the serum tacrolimus level is low.", "Anti-GQ1b–associated Miller Fisher syndrome (MFS) ...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "E-5", "R-1" ]	I kept steps 1–2 aligned with the original/variants (ruling out herpetic encephalomyelitis and tacrolimus toxicity). To integrate E-1 and E-5 simultaneously, I used Variant 2’s Step 3 wording that asserts anti-GQ1b positivity plus ophthalmoplegia/areflexia “essentially confirms” MFS and makes other differentials unnece...	[ { "error_description": "Prerequisite Sensitivity: The chain anchors on anti-GQ1b positivity to assert an anti-GQ1b spectrum/GBS-variant diagnosis without first completing prerequisite supportive phenotype confirmation (e.g., appropriate interpretation of NCS/EMG timing or repeat studies) before using the antibo...	[ 3, 4 ]	medprmbench_00022	[ 1, 2, 3, 4 ]	[]	[ "Acute infectious herpetic encephalomyelitis — “Acellular CSF with negative viral PCR and a normal MRI of the brain and spinal cord made this unlikely.”", "Tacrolimus neurotoxicity — “its neurotoxic effects were ruled out by a normal MRI and by low serum levels.”", "Acute inflammatory demyelinating polyneuropat...	A woman in her late 70s presented with a 2-week history of progressive bilateral leg weakness, unstable gait, and fluctuating drowsiness with moments of confusion. This followed a 4-week history of progressive bilateral lumbosacral herpes zoster infection that spread to her right groin and right leg. Her medical histor...	Critical	0.835	test	null	null	null
true	Cerebral salt wasting syndrome	Syndrome of inappropriate antidiuretic hormone secretion (SIADH)	[ "SIADH is definitively favored because the patient is clearly euvolemic—there are no signs of dehydration or hypovolemic shock on presentation—and the combination of hypotonic hyponatremia with inappropriately high urine sodium after a recent intracerebral hemorrhage without diuretic use is classic for SIADH.", "...	medcasereasoning	A	[ "Sensitivity", "Simplicity", "Soundness" ]	[ "E-1", "R-4", "S-1" ]	I used the R-4 variant’s first two steps to set the composite chain’s main diagnostic direction and its overconfident contradiction about euvolemia, and I preserved E-1 by keeping the reasoning anchored on urine sodium/osmolality-based differentiation without any explicit prerequisite step confirming true extracellular...	[ { "error_description": "", "error_step_indices": [ 1 ], "error_type": "E-1", "modified_steps": null }, { "error_description": "", "error_step_indices": [ 1 ], "error_type": "R-4", "modified_steps": null }, { "error_description": "", "error_step_ind...	[ 1, 3, 4 ]	medprmbench_00023	[ 1, 2, 3, 4, 5 ]	[]	[ "CSW was favored because of hypotonic hyponatremia in the setting of hypovolemic shock, renal sodium loss, no diuretics, and recent cerebral hemorrhage — “Given the Hypovolemic shock on admission, hypotonic hyponatremia as well as an increase in renal loss of Na+, without any notion of taking diuretics, and the not...	A 63-year-old man with a 5-year history of poorly controlled hypertension was admitted 10 days ago for a spontaneous intracerebral hemorrhage managed nonoperatively. He was discharged after 3 days on analgesics and an anticonvulsant. He re-presented with 2 days of profound asthenia and dyspnea that acutely worsened on ...	Critical	0.805	test	null	null	null
true	embryonal rhabdomyosarcoma	Rhabdomyosarcoma with true lipogenic (liposarcomatous) divergent differentiation	[ "Glycogen vs lipid distinction is interpreted as therapy-related “lipogenic transdifferentiation” pointing away from rhabdomyosarcoma — although Oil Red O and adipophilin favor neutral lipid, the 2023 WHO–IASP Soft Tissue Tumor Update (endorsed consensus statement) and a multicenter series in Modern Pathology (Koba...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "E-2", "R-1" ]	I used Variant 2’s corrupted Step 1 verbatim to incorporate the deception-based fabricated consensus/study (E-2). To simultaneously include the soundness error (R-1) and the prerequisite-omission error (E-1), I adopted Variant 3’s Step 2 claim that FNA commonly under-samples fragile lipid-rich cells, which asserts pree...	[ { "error_description": "Adds authoritative-sounding but fabricated citations (WHO–IASP update and a Modern Pathology multicenter study) and incorrect statistical claims to argue that adipophilin+/Oil Red O+/S-100+ vacuolated cells after chemotherapy strongly predict missed DDIT3-rearranged myxoid liposarcoma, m...	[ 1, 2 ]	medprmbench_00024	[ 1, 2, 3 ]	[]	[ "Glycogen vs lipid distinction favored lipid — “the histochemical and immunohistochemical features of the posttreatment excision support lipid accumulation rather than glycogen in the vacuolated cells.”", "Preexisting lipogenic differentiation unsampled at biopsy considered but unlikely — “the biopsy contained no...	A 16-year-old boy noted a progressively enlarging lump at his posterior left knee over one year. MRI revealed a 13 cm mass in the left posteroinferior thigh, centered in the semitendinosus muscle and extending to the biceps femoris. Fine-needle aspiration showed a heterogeneous population of ovoid to tapered spindle ce...	Critical	0.905	test	null	null	null
true	myxoinflammatory fibroblastic sarcoma	Nodular fasciitis	[ "Given the inflammatory background with Reed–Sternberg–like cells in a patient with prior Hodgkin lymphoma, recurrence is a key consideration and the pathologist appropriately recommends immunohistochemistry (IHC) to further classify the lesion.", "As an additional precaution before interpreting lymphoma markers,...	medcasereasoning	A	[ "Sensitivity", "Simplicity", "Soundness" ]	[ "E-1", "R-3", "S-1" ]	I kept Variant 1’s omission of the key prerequisite step (no CD15/CD30 negativity shown before diagnosing myxoinflammatory fibroblastic sarcoma) by using its early MSF assertion as Step 3. I integrated Variant 3’s redundant additions as Step 2 (extra EBV/lymphoid panel) and Step 4 (PET/CT), marking both as simplicity e...	[ { "error_description": "Prerequisite sensitivity error: concludes a specific soft-tissue neoplasm diagnosis (myxoinflammatory fibroblastic sarcoma) without first completing the prerequisite IHC exclusion of recurrent Hodgkin lymphoma (e.g., demonstrating CD15/CD30 negativity).", "error_step_indices": [ ...	[ 2, 3, 4, 5 ]	medprmbench_00025	[ 1, 2, 3, 4, 5 ]	[]	[ "Consideration of recurrent Hodgkin lymphoma — “the pathologist recommended immunohistochemistry (IHC) staining to rule out recurrence of Hodgkin lymphoma due to the presence of inflammatory background and Reed–Sternberg–like cells.”", "Exclusion of Hodgkin lymphoma by negative classical markers — “CD15 and CD30 ...	A 25-year-old man with a history of Hodgkin lymphoma presented with a 2-month history of a gradually enlarging mass over the dorsum of his left hand. Six years earlier, he had been diagnosed with Hodgkin lymphoma on the basis of mediastinal lymphadenopathy and systemic symptoms, and he received 13 courses of chemothera...	Critical	0.875	test	null	null	null
true	neuroendocrine carcinoma	Neuroendocrine carcinoma of the pineal region	[ "Consider pineal region tumors in the differential, including pineal parenchymal tumors such as pineoblastoma given the location, hydrocephalus, and aggressive primitive round-cell histology with rosette-like features.", "Prioritize pineoblastoma over metastatic neuroendocrine carcinoma because cytokeratin (AE1/A...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "R-1", "R-2" ]	I kept Step 1 close to the original. I merged Variant 2 (R-1) and Variant 3 (R-2) into a single Step 2 by preserving both the incorrect cytokeratin interpretation and the contradictory statement that the renal lesion was FDG-avid, even though these tensions make the step internally inconsistent. I then used Variant 1’s...	[ { "error_description": "Introduces the incorrect medical claim that cytokeratin positivity is characteristic of pineoblastoma and generally not expected in metastatic neuroendocrine carcinoma, thereby mis-weighting the immunophenotype to favor pineoblastoma over neuroendocrine carcinoma.", "error_step_indic...	[ 2, 3 ]	medprmbench_00026	[ 1, 2, 3, 4 ]	[]	[ "Consideration of pineal parenchymal tumors — “The initial differential diagnosis included pineal parenchymal tumors, such as a pineoblastoma…”", "Consideration of metastatic neuroendocrine carcinoma — “…as well as metastatic neuroendocrine carcinoma.”", "Favoring neuroendocrine carcinoma based on dual marker e...	A 53-year-old man with hypertension presented with five days of intractable vomiting, generalized weakness, ataxia, and severe headaches. On examination, he was lethargic, retching frequently, and had bilateral papilledema with impaired upward and downward gaze; gait could not be assessed safely. CT and MRI of the brai...	Critical	0.905	test	null	null	null
true	anisakiasis	Anisakiasis with spontaneous splenic rupture	[ "Hemorrhage from a perforated viscus was considered — “The differential diagnosis of shock in this patient with abdominal pain included hemorrhage, which can result from a perforated viscus…”", "Ruptured abdominal aortic aneurysm was deprioritized because a rupture would be expected to cause a slower, more chroni...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "E-4", "R-7" ]	I combined the distinct corrupted components from each single-error variant into one coherent chain. From R-7, I used the temporally incorrect deprioritization of ruptured AAA and carried its subacute framing forward by interpreting the CT-confirmed splenic rupture as evolving over 48 hours (reflected in steps 2, 7, an...	[ { "error_description": "Trajectory (time-course) error: mischaracterizes ruptured AAA as typically slow/subacute and therefore less urgent in abrupt shock, then propagates this temporal framing by reinterpreting CT-proven splenic rupture as a subacute process developing over ~48 hours rather than an acute hemor...	[ 2, 3, 8 ]	medprmbench_00027	[ 2, 3, 4, 5, 6, 7, 8, 9 ]	[]	[ "Hemorrhage from a perforated viscus was considered — “The differential diagnosis of shock in this patient with abdominal pain included hemorrhage, which can result from a perforated viscus…”", "Ruptured abdominal aortic aneurysm was considered — “…hemorrhage … can result from a ruptured abdominal aortic aneurysm...	A 53-year-old woman presented to the emergency department with sudden, severe abdominal pain 60 minutes earlier, preceded by anchovy ingestion 48 hours before. She also reported weakness, diaphoresis, and hypotension. Her pain was rated 8/10 and was diffuse, with maximal tenderness in the periumbilical and epigastric a...	Critical	0.8711	test	null	null	null
true	Massive ovarian edema	Krukenberg tumor (ovarian metastasis from signet-ring cell gastric adenocarcinoma)	[ "Treat the adnexal mass as a chronic, indolent process given the 1-month insidious pain and lifelong lymphedema; therefore, immediate operative staging is not time-sensitive, and the appropriate trajectory is short-term outpatient surveillance with repeat imaging in 6–8 weeks before committing to laparotomy for sus...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "E-5", "R-1", "R-4", "R-5", "R-6", "R-7" ]	I used Variant 3’s Step 1 to embed the time/trajectory error (surveillance-first, delayed staging) and propagated its delayed-evaluation framing through later steps for coherence. I then replaced Step 2 with Variant 1’s safety-violating claim that normal markers rule out aggressive malignancy, while adding a brief link...	[ { "error_description": "", "error_step_indices": [ 1, 2, 3, 4 ], "error_type": "E-1", "modified_steps": null }, { "error_description": "", "error_step_indices": [ 4, 5 ], "error_type": "E-5", "modified_steps": null }, { "error_d...	[ 1, 2, 3, 4, 5 ]	medprmbench_00028	[ 1, 2, 3, 4, 5 ]	[]	[ "Consideration of a malignant ovarian tumor — “radiological findings were suggestive of an ovarian tumor; a staging laparotomy and surgical excision of the tumor and fibroid was planned with a provisional diagnosis of a malignant ovarian tumor with multiple fibroid and unilateral lymphedema.”", "Exclusion of dysg...	A 25-year-old nulliparous woman presented with a 1-month history of insidious-onset right lower abdominal pain. She also had lifelong non-pitting edema of the left leg extending to the labia majora. She was otherwise healthy, with regular menses and no tobacco or alcohol use. On examination, she was afebrile, blood pre...	Critical	0.895	test	null	null	null
true	Oculomotor mononeuropathy	Radiographically occult posterior communicating artery aneurysm causing compressive oculomotor nerve palsy	[ "Although noncontrast CT, brain MRI, and standard MR angiography were unremarkable, recent neuroradiology guidance (European Neurovascular Imaging Consensus Statement, Neuroradiology 2023) emphasizes that time-of-flight MRA can miss small posterior communicating artery (PCoA) aneurysms <3 mm, with reported sensitiv...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "E-2", "R-1" ]	To integrate all single-error variants, I built a single composite chain that retains: (1) the fabricated consensus/guideline-style aneurysm argument from Variant 2 (E-2) and (2) the incorrect claim that pupil sparing plus normal MRI/MRA essentially rules out aneurysmal compression from Variant 3 (R-1). Because both er...	[ { "error_description": "Skips the prerequisite step of first excluding compressive/structural etiologies (especially PCoA aneurysm) before concluding a post-vaccination immune-mediated oculomotor neuropathy.", "error_step_indices": [ 2 ], "error_type": "E-1", "modified_steps": [ 2 ...	[ 1, 2 ]	medprmbench_00029	[ 1, 2, 3, 4, 5, 6, 7 ]	[]	[ "1. Compressive causes such as posterior communicating artery aneurysm were excluded by normal imaging — “Since all possible underlying structural causes of oculomotor nerve injury were ruled out by clinical, laboratorial, and imaging workup.”" ]	A 79-year-old white man presented with sudden onset of right-sided ophthalmoplegia, diplopia, and ptosis accompanied by nausea, vomiting, and headache. The symptoms began two days after receiving an inactivated seasonal influenza vaccine containing A/New Caledonia/20/99 (H1N1)-like, A/Wisconsin/67/2005 (H3N2)-like, and...	Critical	0.94	test	null	null	null
false	DensInvaginatus	Dens invaginatus	[ "With no obvious restorations or cavitated lesions on clinical examination, caries can be set aside as the cause of the apical pathology.", "Periodontal origin was considered but excluded — “Periodontally there were no pathological pockets, and oral hygiene was good.”", "This presentation is without question ex...	medcasereasoning	A	[ "Sensitivity", "Soundness" ]	[ "E-1", "R-4", "R-5" ]	I kept the overall four-step structure from the original/variants and integrated the corrupted steps from each single-error chain at their respective positions. Step 1 uses Variant 1’s premature exclusion of caries (omitting occult-caries workup) to preserve E-1. Step 3 replaces the original trauma-exclusion step with ...	[ { "error_description": "Prerequisite Sensitivity: prematurely ruled out a carious etiology based only on absence of obvious restorations/cavitated lesions, skipping prerequisite checks for occult/non-cavitated caries (e.g., hidden proximal/fissure caries, cracks) before excluding caries.", "error_step_indic...	[ 1, 3, 4 ]	medprmbench_00030	[ 1, 3, 4 ]	[]	[ "Carious infection was considered but excluded — “Dentally the patient had an unrestored adult dentition with absent third molars and no detectable caries.”", "Periodontal origin was considered but excluded — “Periodontally there were no pathological pockets, and oral hygiene was good.”", "Traumatic injury was ...	A 25-year-old medically fit man presented to a dental emergency clinic with a 7-day history of constant aching pain localized to the left mandible. Extraoral and intraoral soft-tissue examinations were unremarkable. Periodontally, there were no pathological pockets, and oral hygiene was good. Dentally, he had an unrest...	Critical	0.8075	test	null	null	null
false	mucous extravasation phenomenon	Submandibular mucous extravasation pseudocyst (ranula)	[ "Infection was unlikely because there were no inflammatory signs and intraoral findings were normal.", "Tumor of salivary origin was less likely because in pediatric patients, salivary neoplasms are uncommon and most recurrent facial swellings are developmental or inflammatory rather than neoplastic; therefore, a...	medcasereasoning	A	[ "Sensitivity", "Simplicity", "Soundness" ]	[ "E-1", "R-3", "S-2" ]	Kept Step 1 from the original. Replaced Step 2 with Variant 2’s contextually inapplicable pediatric-epidemiology rationale to embed R-3. Used Variant 1’s Step 3 phrasing to preserve the combined aspirate-based exclusion of vascular malformation while maintaining coherence with the shortened chain. Collapsed the downstr...	[ { "error_description": "Applies pediatric epidemiology (salivary tumors are rarer in children) to an adult patient to deprioritize salivary neoplasm, despite the patient being 25 years old.", "error_step_indices": [ 2 ], "error_type": "R-3", "modified_steps": [ 2 ] }, { "...	[ 2, 4 ]	medprmbench_00031	[ 1, 2, 3, 4 ]	[]	[ "Infection was unlikely — “Absence of inflammatory signs and normal intraoral findings excluded chances of infection.”", "Tumor of salivary origin was less likely — “The recurrent nature of the swelling … nullified the tumerous etiology.”", "Vascular malformation was excluded by aspirate — “The clinical picture...	A 25-year-old man presented with an asymptomatic, diffuse swelling on the right side of his face and neck. He reported similar, smaller swellings over the past 3–4 years that would spontaneously regress. He could not relate episodes to trauma, meals, dental pain, or systemic symptoms. On examination, a 7 × 3 cm firm, ...	Critical	0.805	test	null	null	null

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MedPRMBench test set

MedPRMBench is a step-level benchmark for checking clinical reasoning chains. This repository contains the test split only: 6,500 questions, each with one original reasoning chain and one corrupted chain. Labels identify error steps and clinical error types. The data comes from the ICLR 2027 submission archive retained on 2026-09-26 and assembled on 2026-10-09.

The source archive marks this split RELEASE_CANDIDATE_NOT_YET_AUTHORITATIVE. Its status and source checksum are recorded in manifest.json. No blanket license for the seven upstream question sources is asserted here; maintainers should confirm their redistribution terms before a public release.

Load

from datasets import load_dataset

test = load_dataset("YOUR_ORG/MedPRMBench-Test", split="test")
print(len(test))  # 6500

Replace YOUR_ORG with the Hugging Face account used for upload. The dataset viewer reads data/test.parquet. The untouched archived JSONL is available at raw/test_benchmark.jsonl; its SHA-256 is in manifest.json.

Record structure

Field	Meaning
`id`, `dataset`, `dataset_type`, `split`	Record ID, source dataset, Class A (expert-authored) or B (generated), and test split.
`question`, `options`, `correct_answer`	Question, answer options, and reference answer.
`original_steps`, `corrupted_steps`, `corrupted_answer`	Paired reasoning chains and the corrupted-chain answer.
`error_steps`, `error_step_code_map`	Gold error-step indices and their type mapping; indices are 1-based.
`error_codes`, `error_categories`	Error types and their broad categories.
`modified_steps`, `error_injection_reason`	Construction metadata.
`severity_level`, `severity_score`	Rule-defined construction severity; not a physician-rated patient-harm estimate.
`answer_changed`	Whether the answer changed. In Parquet, 37 source values of `"unknown"` are null.
`vote_error_failed`, `vote_reasoning_adopt_count`, `vote_reasoning_reject_count`	Optional review metadata.

The original JSONL has 47 dictionary-form original_steps elements across six records. In Parquet, their text is extracted so every reasoning step is a string. The original values remain in the raw JSONL. Parquet represents absent optional fields as null; other field content is unchanged. There are 3,711 Class A and 2,789 Class B records.

Error codes

Code	Type	Code	Type
S-1	Non-Redundancy	S-2	Non-Circular Logic
R-1	Evidence-Based Soundness	R-2	Step Consistency
R-3	Contextual Applicability	R-4	Confidence Invariance
R-5	Safety Awareness	R-6	Information Grounding Compliance
R-7	Trajectory Reasoning	E-1	Prerequisite Sensitivity
E-2	Deception Resistance	E-3	Multi-Solution Consistency
E-4	Quantitative Correctness	E-5	Differential Diagnosis Coverage

Use the held-out split for evaluation. Selecting prompts, thresholds, or checkpoints on this split would compromise that evaluation.

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