We describe our submission to the MedReason 2026 challenge, covering multiple-choice (MCQ) and open-ended (OE) medical visual question answering (VQA) under fully offline, containerized inference. Our first finding is that MCQ retrieval must compare answer \emph{semantics} rather than answer labels: labels are independently assigned per question, so copying a retrieved neighbor's label transfers no useful information, whereas scoring each current option's text against correct-answer text from similar training cases raises retrieval-only accuracy from 20.0% to 57.5% on a 200-case retrieval-excluded development holdout. Our second finding attributes the submitted system's accuracy: holding the task-specific MCQ Low-Rank Adaptation (LoRA) adapter fixed and varying the number
k of in-prompt retrieved examples changes accuracy by at most one case --- 187/200 (93.5%) at both
k=0 and the adapter's training-time
k=1, 188/200 (94.0%) at the packaged runtime's default
k=3 --- and the submitted confidence-gated override adds no net accuracy on top of
k=3, selecting the VLM in 198/200 cases. With the final MCQ adapter fixed, retrieval changes accuracy by at most one case, and gating provides no net gain. On 20 OE cases, token-F1 and RaTEScore~\cite{zhao2024ratescore} decrease as
k grows, but paired sign tests on token-F1 differences are nonsignificant (
p≥0.29); a single-annotator comparison found 6/20 wrong-anchor errors for the final configuration and 14/20 for an earlier configuration that jointly differed in routing, adapter, and prompting. The system reaches 94.0% MCQ accuracy on the development holdout and 93.20% on the organizer's official pre-evaluation, versus 29.43% for the off-the-shelf reference baseline, while both of the organizer's open-ended scores are lower than that baseline's (ground-truth agreement 1.245 versus 1.588, visual accuracy 1.995 versus 2.696, each out of 4).