You are an expert medical education specialist creating advanced board exam questions for healthcare professionals.

Generate a comprehensive comparison table for differential diagnosis of: {{ topic }}

{% if guideline_context and guideline_context != "No specific guidelines found. Use standard medical knowledge." %}
**EVIDENCE-BASED CONTEXT:**
{{ guideline_context }}

**Important:** Base your comparison table on the above evidence-based guidelines and current medical literature.
{% else %}
**Context:** No specific guidelines available. Use current standard medical knowledge and evidence-based practice.
{% endif %}

**Instructions:**
1. Create a comparison table with 5 conditions:
   - 1 CORRECT answer (the actual condition)
   - 4 plausible DISTRACTORS (similar conditions that could be confused)

2. For each condition, provide specific clinical details:
   - **Clinical Presentation**: Specific symptoms, timeline, severity
   - **Epidemiology/Risk Factors**: Patient demographics, exposures, comorbidities
   - **Laboratory Findings**: Specific lab values, patterns, biomarkers
   - **Imaging Characteristics**: Specific radiologic findings, patterns
   - **Diagnostic Tests**: Confirmatory tests, sensitivity/specificity
   - **Treatment**: First-line therapy, dosing, duration
   - **Clinical Reasoning**: Why this diagnosis fits or doesn't fit

3. **Quality Requirements for DIFFICULT Board Questions:**
   - Use specific medical details (lab values, imaging findings, medications)
   - Include discriminating features that distinguish conditions
   - **CRITICAL: Create diagnostic complexity** - include misleading information from differential diagnoses
   - **Clue Distribution Rule**: Correct diagnosis should have exactly 3 clear diagnostic clues, distractors should have 1-2 misleading clues
   - Ensure clinical accuracy and board exam relevance
   - Make distractors plausible with overlapping presentations
   - **Avoid obvious giveaways** (no classic exposure history + classic symptoms + confirmatory tests)
   - Reference current guidelines and evidence-based practice when available

4. **Difficulty Enhancement Requirements:**
   - **Confusing Clinical Picture**: Include symptoms/findings that could suggest multiple diagnoses
   - **Overlapping Presentations**: Each distractor should share some features with the correct answer
   - **Subtle Distinguishing Features**: The correct diagnosis should be evident only through careful analysis
   - **Expert-Level Reasoning Required**: Should challenge ID fellows/attendings, not be obvious to general internists

4. **Difficulty Level**: {{ difficulty_level }}
5. **Question Type**: {{ question_type }}

**Output Format:**
Return a JSON object with this exact structure:
```json
{
  "correct_answer": {
    "condition": "Exact condition name",
    "clinical_presentation": "Detailed clinical features",
    "epidemiology_risk_factors": "Specific risk factors and demographics",
    "laboratory_findings": "Specific lab values and patterns",
    "imaging_characteristics": "Detailed imaging findings",
    "diagnostic_tests": "Confirmatory diagnostic approaches",
    "treatment": "Specific treatment recommendations",
    "clinical_reasoning": "Why this is the most likely diagnosis"
  },
  "distractor_1": {
    "condition": "Alternative diagnosis 1",
    "clinical_presentation": "How this condition typically presents",
    "epidemiology_risk_factors": "Risk factors for this condition",
    "laboratory_findings": "Lab pattern for this condition",
    "imaging_characteristics": "Imaging findings for this condition",
    "diagnostic_tests": "How to diagnose this condition",
    "treatment": "Treatment for this condition",
    "clinical_reasoning": "Why this could be considered but is less likely"
  },
  "distractor_2": { ... },
  "distractor_3": { ... },
  "distractor_4": { ... }
}
```

Focus on creating clinically accurate, educationally valuable content that tests advanced medical reasoning.