hllj/quesmed huggingface dataset:
A 62-year-old man is brought to A&E after being involved in a road traffic accident. A trauma CT reveals lateral hemisection of the spine.

Which of the following symptoms are expected as a result of his injuries?

Options:
explanation: This is not seen in Brown-Sequard syndrome.
name: Cerebellar ataxia
label: e
answer: no
explanation: This symptom is often found in subacute combined degeneration of the cord, Friedrich's ataxia and anterior spinal artery occlusion. It is not a common feature of lateral hemisection of the spine.
name: Bilateral spastic paresis
label: b
answer: no
explanation: This is seen in anterior spinal artery occlusion. By contrast, lateral hemisection of the spine only affects the contralateral side.
name: Bilateral loss of pain and temperature sensation
label: c
answer: no
explanation: This is seen in syringomyelia. It is not a common feature of lateral hemisection of the spine.
name: Flaccid paresis of the hand muscles
label: d
answer: no
explanation: Lateral hemisection of the spine, or Brown-Sequard syndrome, affects the lateral corticospinal and lateral spinothalamic tracts, as well as the dorsal columns. It presents with ipsilateral spastic paresis below the lesion, ipsilateral loss of proprioception and vibration sense, and contralateral loss of pain and temperature sensation.
name: Contralateral loss of pain and temperature sensation
label: a
answer: yes

Correct answer: a
A 21-year-old woman attends her local GP practice, seeking regular contraception. She is keen to try the combined oral contraceptive.

What is the mechanism of action of this contraception?

Options:
explanation: This is the mechanism of action of the progestogen-only pill.
name: Thickening cervical mucus
label: b
answer: no
explanation: This is not a mechanism by which the combined oral contraceptive pill prevents pregnancy.
name: Reduction in patency of the fallopian tubes
label: e
answer: no
explanation: This is the mechanism of action of the intrauterine contraceptive device.
name: Decreases sperm motility and survival
label: d
answer: no
explanation: This is the mechanism of action of the intrauterine system (mirena)
name: Preventing endometrial proliferation
label: c
answer: no
explanation: The combined oral contraceptive pill contains a combination of hormones, oestrogen and progesterone. These suppress the release of the follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are needed for ovulation to occur. By preventing ovulation, the pill makes it difficult for a sperm to fertilize an egg.
name: Inhibition of ovulation
label: a
answer: yes

Correct answer: a
A mother brings her 4 month old infant to the GP for a check-up. She is concerned that he is not developing as quickly as her first two children did.

Which of the following is a red flag for developmental delay in a four-month-old infant?

Options:
explanation: No eye contact at 4 months is a red flag for developmental delay. 6 to 8 weeks is the expected time for eye contact to develop. An infant of this age would therefore be expected to make eye contact.
name: No eye contact
label: a
answer: yes
explanation: Children are expected to learn to share toys by 3 years of age. A 4 month infant would not be expected to do this.
name: Not sharing toys with friends
label: e
answer: no
explanation: A 4 month infant would be expected to sit with a rounded back. 6 months is the expected time taken for an infant to be able to sit without support.
name: Not sitting without support
label: b
answer: no
explanation: 30 months is the expected time for a baby to kick a ball. A 4 month infant would not be expected to do this.
name: Not being able to kick a ball
label: c
answer: no
explanation: Infants are expected to begin walking around the age of 12-18 months. A 4 month infant would not be expected to do this.
name: Not walking independently
label: d
answer: no

Correct answer: a
A neonate born at 32 weeks gestation is reviewed by the paediatric team for respiratory distress. On examination she has a continuous heart murmur. An echocardiogram shows a patent ductus arteriosus (PDA).

Which of the following is the most appropriate first line treatment?

Options:
explanation: Diuretics have no role in the treatment of PDA, unless there is associated fluid overload.
name: Furosemide
label: d
answer: no
explanation: ACE inhibitors have no role in treating PDA.
name: Ramipril
label: e
answer: no
explanation: PDA is a condition whereby there is a failure of the ductus arteriosus to close after birth, allowing oxygenated blood from the descending aorta to flow back to the pulmonary artery. This subsequently leads to inadequate oxygenation and respiratory distress. Indomethacin inhibits prostaglandin synthesis which otherwise maintains the patency of the ductus arteriosus. The indomethacin therefore supports duct closure, often preventing the need for surgical intervention.
name: Indomethacin
label: a
answer: yes
explanation: This would maintain the patency of the ductus arteriosus. Sometimes this is desirable, for example when there is a right-to-left shunt and the PDA is necessary for oxygenated blood to mix. Prostaglandins are used here to keep it open until surgery is successful. However, prostaglandins are not used in the closure of a PDA.
name: Prostaglandins
label: c
answer: no
explanation: This is only indicated if non-surgical management fails. In many cases, medical management through indomethacin is adequate to allow closure of the PDA.
name: Surgical management
label: b
answer: no

Correct answer: a
A 25-year-old primigravida at 39 weeks of gestation presents to the labour ward with regular contractions that have been present for the past 2 hours. She reports discomfort in her lower back and lower abdomen, and her cervix is found to be 4 cm dilated.

Which of the following stages of labour best describes this patient's current clinical condition?

Options:
explanation: There is no official pre-labour stage. The first stage of labour is the latent phase of stage 1. This patient's cervix has dilated by 4cm, meaning she has passed this stage.
name: Pre-labour
label: e
answer: no
explanation: Stage 3 describes the time from delivery of the foetus to when the placenta and membranes are delivered. As this woman is still dilating, this is incorrect.
name: Stage 3
label: d
answer: no
explanation: Stage 2 describes the time from full dilation of the cervix to delivery of the foetus. As this woman is not yet fully dilated, this is incorrect.
name: Stage 2
label: c
answer: no
explanation: This woman has passed the latent phase as her cervix is dilated by greater than 3cm.
name: Latent phase of stage 1
label: b
answer: no
explanation: Stage 1 of labour describes the time from the onset of labour to when the cervix is fully dilated. It lasts between 10-16 hours in a normal primigravida patient. It is split into a latent phase and active phase. The latent phase is for 0-3cm of cervical dilation, and the active is for 3-10cm of dilation.
name: Active phase of stage 1
label: a
answer: yes

Correct answer: a
A 32-year-old man presents to the GP surgery with erectile dysfunction. He is concerned about his testosterone levels.

In which of the following sites is testosterone converted to dihydrotestosterone?

Options:
explanation: The adrenal glands produce androgens such as dehydroepiandrosterone (DHEA) and androstenedione, which can be converted to testosterone and other androgens in peripheral tissues. However, DHT is not directly converted from testosterone in the adrenal glands.
name: Adrenal glands
label: c
answer: no
explanation: The liver is involved in the metabolism of androgens and other hormones, but it does not play a direct role in the conversion of testosterone to dihydrotestosterone.
name: Liver
label: d
answer: no
explanation: Although Leydig cells are involved in the production of testosterone, they do not play a direct role in the conversion of testosterone to dihydrotestosterone. Instead, dihydrotestosterone is produced from testosterone in the Sertoli cells.
name: Leydig cells in the testes
label: e
answer: no
explanation: The hypothalamus is involved in the regulation of the hypothalamic-pituitary-gonadal axis, which controls the production of testosterone in the testes. However, the hypothalamus is not directly involved in the conversion of testosterone to dihydrotestosterone.
name: Hypothalamus
label: b
answer: no
explanation: Dihydrotestosterone (DHT) is a sex hormone important for masculine characteristics and muscle growth. It is produced when testosterone, produced by Leydig cells, is converted to DHT by the enzyme 5-alpha reductase in the Sertoli cells of the testes.
name: Sertoli cells in the testes
label: a
answer: yes

Correct answer: a
A 28-year-old female presents to GP with amenorrhoea. A urine pregnancy test is positive for human chorionic gonadotropin (hCG).

Which of the following describes the primary role of hCG in early pregnancy?

Options:
explanation: While hCG plays a role in promoting the growth and development of the foetus by promoting the development of the placenta, this is not the primary purpose of hCG in early pregnancy.
name: Promote development of the foetus
label: b
answer: no
explanation: While hCG may play a role in suppressing the maternal immune response against the foetus, the primary purpose of hCG in early pregnancy is to maintain the production of oestrogen and progesterone by stimulating the corpus luteum.
name: Suppress the maternal immune response against the foetus
label: d
answer: no
explanation: hCG is a hormone that is produced by the developing placenta after implantation of the embryo. In early pregnancy, hCG acts on the corpus luteum in the ovary to maintain the production of oestrogen and progesterone. The corpus luteum is a temporary structure that forms from the follicle after ovulation and produces oestrogen and progesterone to support the early stages of pregnancy.
name: Maintain the corpus luteum
label: a
answer: yes
explanation: While hCG indirectly stimulates the production of oestrogen and progesterone by maintaining the function of the corpus luteum, it does not directly stimulate oestrogen production.
name: Stimulate oestrogen production
label: e
answer: no
explanation: Oxytocin is a hormone that is produced by the hypothalamus and released by the pituitary gland in response to stimulation of the nipples or cervix during labor. While hCG plays a role in promoting labor by stimulating the production of estrogen and progesterone, it does not directly stimulate the production of oxytocin.
name: Stimulate the production of oxytocin
label: c
answer: no

Correct answer: a
A 29-year-old woman presents to the GP with her partner, 3 weeks after delivering their first baby. The partner is concerned that she has been behaving strangely in recent days, and last night found her wandering the streets at night 'looking for bears'.

The patient reports hearing a voice that she believes belongs to the devil. More recently, she has also expressed the belief that the baby is not her own, but has been implanted by the neighbour as part of a plot to harm her.

She was previously fit and well, with no past medical or psychiatric history.

Which of the following is the most appropriate management?

Options:
explanation: Whilst cognitive behavioural therapy can be beneficial in post-partum psychosis, there is an urgent threat to the mother and baby and as such, they must be admitted.
name: Schedule an appointment for the patient to see a psychiatrist for intense cognitive behavioural therapy
label: c
answer: no
explanation: This is postpartum psychosis, a rare but serious psychiatric disorder that can occur in the first few weeks after delivery. Women with postpartum psychosis may experience hallucinations, delusions, disorientation, and rapid mood swings. They may be at risk for self-harm, harm to others, or suicide. Given the severity of the patient's symptoms and the potential risks to herself and others, the best course of action is to admit the patient to a mother and baby unit for close observation and treatment.
name: Organise admission to mother and baby unit
label: a
answer: yes
explanation: Separating the mother and baby is associated with adverse outcomes for postpartum psychosis. They should remain together in a mother and baby unit.
name: Admit the mother to the local psychiatric unit
label: b
answer: no
explanation: This is not an appropriate referral to the district nurse. An in-patient setting is necessary to mitigate the risks to the mother and baby. Antipsychotic treatment may be given under close supervision at the mother and baby unit.
name: Refer to the district nurse to deliver IM olanzapine
label: d
answer: no
explanation: This does not mitigate the risks both to the patient and to the baby. Admission to the mother and baby unit is more suitable.
name: Organise a social worker visit 4 times a day for 1 month
label: e
answer: no

Correct answer: a
A 62-year-old man presents to the Emergency Department with a 1-hour history of central crushing chest pain which radiates down his left arm. His past medical history includes angina, hypercholesterolaemia, and Type 2 Diabetes Mellitus.

On examination, he is pale, diaphoretic, and tachypnoeic. An ECG is performed which shows ST elevation in leads V1, V2, V3, and V4.

He is diagnosed with an ST elevation myocardial infarction (STEMI).

Which of the following arteries is most likely to be occluded and which area of the myocardium is affected?

Options:
explanation: This answer is incorrect. Whilst the LAD is the most likely artery occluded in the scenario, it supplies the anterior heart. The lateral heart is supplied by the left circumflex artery which causes changes in leads I and aVL.
name: Left anterior descending (LAD) - lateral heart
label: b
answer: no
explanation: This answer is incorrect. Whilst the left circumflex artery supplies the lateral heart, an occlusion would result in changes in leads I, aVL, V5, and V6.
name: Left circumflex artery - lateral heart
label: e
answer: no
explanation: This answer is incorrect. The RCA supplies the inferior and posterior aspects of the heart which would result in changes to leads II, III and aVF on the ECG. The anterior heart is supplied by the LAD.
name: Right coronary artery - anterior heart
label: d
answer: no
explanation: This answer is incorrect. Whilst the RCA supplies the inferior and posterior aspects of the heart, an occlusion would result in changes to leads II, III and aVF.
name: Right coronary artery (RCA) - inferior heart
label: c
answer: no
explanation: This is the correct answer. The LAD supplies the anterior heart. An occlusion in the LAD results in changes to leads V1-V4.
name: Left anterior descending (LAD) - anterior heart
label: a
answer: yes

Correct answer: a
A 21-year-old man is brought into A&E by ambulance after being stabbed in the abdomen. He is conscious but mildly confused, scoring 14/15 on the Glasgow Coma Scale.

Observations:

* HR - 135 bpm

* RR - 38/min

* BP - 75/40 mmHg

* Oxygen saturations - 97% on room air

His estimated blood loss (EBL) is 1600ml.

What class of hypovolaemic shock does this patient have?

Options:
explanation: This answer is incorrect. In stage 1 shock, the patient presents with anxiety, but observations are within normal limits and blood pressure is maintained.
name: 1
label: b
answer: no
explanation: This answer is incorrect. In stage 4 shock, patients have a heart rate over 140 bpm and are unconscious.
name: 4
label: d
answer: no
explanation: This answer is correct. It is important to identify the stage of shock to assess the severity of the patient's condition. The patient's observations and EBL of 1600ml fall into stage 3 of shock. By stage 3, patients demonstrate hypotension and tachycardia >120 beats per minute.
name: 3
label: a
answer: yes
explanation: This answer is incorrect. Stage 5 is not a recognised category of shock.
name: 5
label: e
answer: no
explanation: This answer is incorrect. In stage 2 shock, patients are tachycardic (>100 beats per minute) and tachypnoeic, but blood pressure is maintained.
name: 2
label: c
answer: no

Correct answer: a
A 78-year-old woman presents to the GP with a 6-month history of worsening breathlessness on exertion and swollen ankles.


On examination, the jugular venous pressure is raised 3cm above normal and there is bilateral pitting oedema to mid-calf.


N-terminal pro B-Type Naturietic Peptide (NT-proBNP) level: 860pg/L (normal: <450 pg/ml in over-75s).


She is referred for an echocardiogram for investigation of heart failure.


Which of the following is true regarding the actions of BNP?

Options:
explanation: This answer is correct. The main actions of BNP are to increase sodium and water excretion and dilate blood vessels. This vasodilation results in a decrease in systemic vascular resistance.
name: Reduces systemic vascular resistance
label: a
answer: yes
explanation: This answer is incorrect. BNP increases sodium excretion (natriuresis) in order to reduce intravascular blood volume.
name: Reduces natriuresis
label: d
answer: no
explanation: This answer is incorrect. BNP inhibits ADH release, which in turn reduces intravascular volume.
name: Stimulates release of anti-diuretic hormone (ADH)
label: c
answer: no
explanation: This answer is incorrect. BNP reduces blood pressure by reducing both systemic vascular resistance and intravascular blood volume.
name: Increases blood pressure
label: b
answer: no
explanation: This answer is incorrect. BNP inhibits the release of aldosterone from the adrenal glands to promote sodium and water excretion and reduce intravascular volume.
name: Stimulates release of aldosterone
label: e
answer: no

Correct answer: a
An 82-year-old woman with heart failure attends the GP surgery for her annual heart failure review. Her regular medications include ramipril, bisoprolol, spironolactone, and furosemide.

Her most recent echocardiogram showed both left and right sided cardiac failure.

Which of the following findings is a sign of right-sided heart failure?

Options:
explanation: This answer is incorrect. Shortness of breath on exertion is a key feature in left-sided heart failure. It is caused by both pulmonary congestion and an inability of the left ventricle to pump enough blood to meet the increased metabolic demands of the body.
name: Shortness of breath on exertion
label: b
answer: no
explanation: This answer is correct. When the right ventricle cannot pump blood effectively into the pulmonary circulation, blood backs up in the venous system. This leads to congestion within the liver and portal venous system, which can result in ascites.
name: Ascites
label: a
answer: yes
explanation: This answer is incorrect. Bibasal fine crackles on auscultation of the lungs are a sign of left-sided heart failure. The build-up of blood prior to the left ventricle causes congestion in the pulmonary system. This leads to pulmonary oedema which can be heard as bibasal fine crackles on auscultation.
name: Bibasal fine crackles
label: d
answer: no
explanation: This answer is incorrect. Orthopnoea is a symptom of left-sided heart failure due to congestion in the pulmonary system.
name: Orthopnoea
label: c
answer: no
explanation: This answer is incorrect. Hypertension is not a sign of left or right-sided heart failure. However, chronic hypertension is a risk factor for the development of heart failure.
name: Hypertension
label: e
answer: no

Correct answer: a
A 64-year-old man presents to A&E after collapsing while walking to the shop, reporting breathlessness before the fall and sudden fainting.  


He did not injure himself and currently has no symptoms. This is the first time this has happened.






The patient's observations are as follows: HR 68 bpm, RR 14/min, BP 125/75 mmHg, temperature 36.7°C, and oxygen saturations 98% on room air.



Physical examination is unremarkable except for an ejection systolic murmur at the right sternal edge, radiating to the carotids.



His blood tests, including full blood count, urea and electrolytes, CRP, and troponin, are normal. His capillary blood glucose is 5.6 mmol/L, and ECG shows no abnormalities.  


Which of the following is the most likely cause of his collapse?

Options:
explanation: This answer is incorrect. With an absence of cardiac risk factors and normal observations, ECG and troponin, a diagnosis of NSTEMI is unlikely.
name: Non-ST elevation myocardial infarction (STEMI)
label: b
answer: no
explanation: This answer is incorrect. Aortic sclerosis is an asymptomatic condition. It causes an ejection systolic murmur which does not radiate to the carotids. It does not typically present with loss of consciousness.
name: Aortic sclerosis
label: c
answer: no
explanation: This answer is correct. The ejection systolic murmur radiating to the carotids points towards a diagnosis of aortic stenosis. Patients often remain asymptomatic for a long period before decompensating and presenting acutely with a loss of consciousness or collapse, as in this scenario.
name: Aortic stenosis
label: a
answer: yes
explanation: This answer is incorrect. With an absence of cardiac risk factors and normal observations, ECG and troponin, a diagnosis of NSTEMI is unlikely.
name: Vasovagal syncope
label: d
answer: no
explanation: This answer is incorrect. The patient's capillary blood glucose is within normal limits which rules out hypoglycaemia as a cause of his syncope.
name: Hypoglycaemia
label: e
answer: no

Correct answer: a

Aortic stenosis
A newborn baby undergoes blood spot (heel prick) testing as part of their routine newborn investigations to screen for inherited conditions including sickle cell disease. The results are normal.

Which of the following globin chains make up the most prevalent form of haemoglobin in a neonate?

Options:
explanation: This answer is incorrect. Alpha-2 delta-2 is the structure of haemoglobin A2 (HbA2) which constitutes around 2.5% of haemoglobin in an adult.
name: Alpha-2 delta-2
label: d
answer: no
explanation: This answer is incorrect. This is not a recognised structure of haemoglobin.
name: Alpha-1 beta-3
label: e
answer: no
explanation: This answer is incorrect. Alpha-2 beta-2 is the structure of adult haemoglobin. The most prevalent form of haemoglobin in a neonate is foetal haemoglobin (alpha-2 gamma-2). From 3-6 months after birth, foetal haemoglobin is gradually replaced by adult haemoglobin.
name: Alpha-2 beta-2
label: b
answer: no
explanation: This answer is incorrect. Zeta-2 epsilon-2 is the structure of Gower-1 haemoglobin, which is the first type of haemoglobin produced during development in the embryonic yolk sac. After 6 weeks, foetal haemoglobin (alpha-2 gamma-2) replaces Gower-1 haemoglobin.
name: Zeta-2 epsilon-2
label: c
answer: no
explanation: This answer is correct. Alpha-2 gamma-2 is the structure of foetal haemoglobin which is the most prevalent form of haemoglobin in a neonate. The production of foetal haemoglobin begins in the sixth week of pregnancy and stops two to four months after birth.
name: Alpha-2 gamma-2
label: a
answer: yes

Correct answer: a