## Augmented Question Generation
You are an expert in crafting complex, **USMLE‑style (NBME‑format) multiple‑choice medical & clinical questions**.

**Inputs**
- **Clinical Building Blocks**  
  """
  {clinical_building_blocks}
  """
- **Existing MedQA‑style clinical question** (structure reference only)  
  """
  {existing_medqa_question}
  """

---

### Reference & Diversify Existing Question Structure
- Use the existing question solely for **format, difficulty, and diagnostic flow**—do **not** copy its storyline.  
- **Recreate and diversify** the clinical context, symptom progression, and differential diagnoses.  
- Enrich the vignette with **clinically relevant events** (injury mechanisms, toxic exposures, detailed history) drawn from the Clinical Building Blocks.

### Projection & MCQ Creation (USMLE Blueprint)
1. **Develop a Complex Clinical Scenario** (align with USMLE Step 2 CK style)  
   - Start with a concise patient vignette (age, sex ➔ CC ➔ HPI ➔ pertinent PE or test results).  
   - Integrate at least one USMLE‑relevant **clue** (key lab, imaging sign, pathophysiologic mechanism) that enables logical deduction.  
   - Add dynamic elements such as **disease progression, comorbidities, medication side‑effects, or diagnostic errors**.

2. **Create a New Multiple‑Choice Question** (NBME single‑best‑answer format)  
   - Stem must require **medical reasoning** (diagnosis, best next step, mechanism, complication, prognosis, pharmacology, etc.).  
   - Provide **exactly four answer options (A–D)**: **one correct answer** and **three clinically plausible distractors** (common diagnostic mistakes, related differentials, incorrect treatments).  
   - Ensure **every option is a bona‑fide medical concept or action** consistent with current USMLE testing standards.

### Final Output & Hard Restrictions
- Verify **clinical accuracy, originality, and internal consistency**.  
- **Output Restriction:**  
  - **ONLY** output the **New Clinical Question** and the **4 answer options** in the format below.  
  - **NO** explanations, rationales, answer keys, or extra text.

### Output Format

**New Clinical Question:**

Question: <clinical question text>  
Choose one of the following:  
A. <Option 1>  
B. <Option 2>  
C. <Option 3>  
D. <Option 4>

---

### Key Considerations (USMLE Focus—do not output)
- Strictly follow USMLE/NBME blueprint domains: diagnosis, management, pathology, physiology, pharmacology, epidemiology.  
- Leverage the **Clinical Building Blocks** to ensure all details are medically sound.  
- Use the existing MedQA question solely for stylistic guidance; craft an **entirely new scenario**.  
- Distractors must be realistic, challenging, and clinically relevant—never arbitrary terms.  