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原文摘要

Large language models (LLMs) are increasingly studied for clinical decision support, and medical question answering provides a testbed for evaluating this capability. In particular, medical multiple-choice questions (MCQs) reflect a core challenge in clinical decision-making: plausible options often share overlapping evidence, while only a few decisive factors distinguish the correct option from incorrect ones. However, existing retrieval-based and reasoning-oriented methods mainly focus on supplying broadly relevant knowledge or eliciting reasoning paths, rather than identifying the compact differential evidence that separates confusing alternatives. In this work, we present a retrieval-grounded differential evidence framework for medical MCQs. Our method extracts option-specific pieces of differential evidence and organizes them into concise evidence prompts for answer selection. This design better aligns external knowledge with differential reasoning while reducing irrelevant context. Experiments show consistent accuracy gains across multiple datasets and target LLMs. Ablation studies further show that our framework outperforms both directly using retrieved evidence chunks and closed-source LLM-generated general hints, and that its improvements are not solely explained by answer-proximal guidance, but are consistent with differential evidence serving as a compact aid for reasoning over competing alternatives. Our findings also offer insights for medical reasoning and other decision-making settings with multiple possible choices.