Long-standing Spiny Papules on the Lower Extremities—Quiz Case
Bibliographic record
Abstract
A 17-year-old boy with congenital absence of the intrahepatic bile ducts owing to Alagille syndrome presented with a pruritic eruption of 3 months’ duration. He also reported a new problem, seeing “dark spots” at night. His medical therapy included bile acid–binding resins and supplementation of fat-soluble vitamins. His chronic jaundice was unchanged. Physical examination revealed jaundice and numerous 2to 8-mm follicular, keratotic erythematous papules on the distal extensor surfaces of his arms and legs (Figure 1). His vitamin A level was 11 μg/dL (reference level, 26-72 μg/dL), and his carotene level was less than 2 μg/dL (reference level, 9-190 μg/dL). (To convert vitamin A and -carotene to micromoles per liter, multiply by 0.0349 and 0.01863, respectively.) Treatment resolved his lesions and vision changes. A punch biopsy specimen was obtained from the forearm for histopathologic evaluation (Figure 2 and Figure 3). What is your diagnosis?
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".