hllj/quesmed huggingface dataset:
A 27-year-old woman works part-time in a care home. She presents to her GP as she started itching her arms a lot over the last few days. Some of the care home residents are also complaining of similar symptoms.

On inspection, she has visible burrows on her arms.

What is the most appropriate medical management that the GP should prescribe?

Options:
explanation: Mebendazole is used to treat threadworm infection, not scabies mites infection.
name: Mebendazole
label: b
answer: no
explanation: Topical corticosteroids are known to exacerbate some conditions, particularly infections such as tinea and scabies.
name: Hydrocortisone 5% cream
label: e
answer: no
explanation: Malathion is also an insecticide that can kill scabies mites. However, it is not used first-line to treat scabies. Malathion 0.5% lotion is used if permethrin is ineffective.
name: Malathion
label: c
answer: no
explanation: Ivermectin is an insecticide but is not used first-line to treat scabies. It is more commonly used to treat papulopustular rosacea and in combination with topical drugs to treat Norwegian/crusted scabies that hasn't responded to topical treatment alone.
name: Ivermectin
label: d
answer: no
explanation: Permethrin 5% cream is the first-line management for the treatment of scabies. It should be applied once weekly for two doses all over the body, not including the head and face. The care home residents who have been in close contact with the worker and all members of her household should also be treated.
name: Permethrin
label: a
answer: yes

Correct answer: a
A 55-year-old female presents to ED complaining of excruciating central chest pain which radiates to the jaw. Investigations are carried out to find the underlying cause.

A 12-lead ECG is performed which shows ST elevation in leads II, III and aVF.

Which artery has been occluded in this myocardial infarction?

Options:
explanation: This patient has suffered an inferior wall STEMI. This occurs when the inferior cardiac tissue receives insufficient blood flow from the right coronary artery. This can be seen as ST-segment elevation in the inferior ECG leads (II, III, aVF)
name: Right coronary artery
label: a
answer: yes
explanation: Occlusion of the left anterior descending artery results in an anterior infarction. ECGs commonly show ST elevation in leads V1-6 and AVL. Anterior infarctions can be further classified into septal leads (V1-2), anterior leads (V3-4) and lateral leads (V5-6).
name: Left anterior descending
label: d
answer: no
explanation: The left main coronary artery arises from the left coronary cusp and bifurcates into the left anterior descending (LAD) and left circumflex arteries. This causes ST elevation in aVR which is usually greater than the ST elevation in V1. Early identification is important as acute occlusion can cause rapid haemodynamic and electrical deterioration.
name: Left main coronary artery
label: b
answer: no
explanation: The obtuse marginal artery is a branch of the lateral circumflex artery and supplies the lateral wall of the left ventricle. Occlusion of this artery usually causes a lateral MI.
name: Obtuse marginal artery
label: c
answer: no
explanation: The left circumflex artery supplies the lateral wall of the left ventricle and causes ST elevation in the lateral leads (I,aVL, V5-6).
name: Left circumflex artery
label: e
answer: no

Correct answer: a
A 71-year-old man presents to A&E following a fall. His x-rays show a fracture in the distal 1/3 of his right radius. The radiologist also comments on osteolytic lesions in his distal radius. His fracture is managed conservatively.


Blood tests are performed which show a haemoglobin of 140 g/L (normal range 130-170 g/L) and calcium of 2.7 mmol/L (2.2-2.6 mmol/L).


Which type of cell most commonly causes this patient's condition?

Options:
explanation: Neutropenia is seen in multiple myeloma, but abnormal neutrophils do not cause myeloma.
name: Neutrophils
label: d
answer: no
explanation: B cells differentiate into plasma cells.
name: B cell
label: b
answer: no
explanation: This patient has a diagnosis of multiple myeloma. There are a few clues in the history which point to multiple myeloma such as his pathological fracture (which is likely due to the lytic lesions found in his radius) and his hypercalcaemia.

Multiple myeloma cells are abnormal plasma cells that build up in the bone marrow and form tumours within the bones.
name: Plasma cell
label: a
answer: yes
explanation: Abnormal myeloblasts are commonly seen in acute myeloid leukaemia, not multiple myeloma.
name: Myeloblasts
label: e
answer: no
explanation: Myeloma causes the impairment of T-cell function, but abnormal T-cells do not cause myeloma.
name: T cell
label: c
answer: no

Correct answer: a
A 48-year-old woman presents to A&E with an acute history of epigastric pain, nausea and vomiting. She has a past medical history of heart failure and hyperlipidaemia. Her current medications are simvastatin, ramipril, bisoprolol, eplerenone and ivabradine. She is diagnosed with an H.pylori infection and is started on clarithromycin, amoxicillin and omeprazole.

Which of her medications are you most likely to stop during this treatment?

Options:
explanation: There are no contraindications to the use of eplerenone and statins together.
name: Eplerenone
label: d
answer: no
explanation: Although simvastatin and ivabradine together can induce bradycardia, research has shown that there is no impact on systolic, diastolic or mean blood pressure.
name: Ivabradine
label: e
answer: no
explanation: Macrolides, such as clarithromycin, should be used cautiously with statins as they can increase the risk of myopathy. Patients should be informed to look for signs of myopathy (i.e. unexplained muscle pain or tenderness, weakness or dark-coloured urine).
name: Simvastatin
label: a
answer: yes
explanation: ACE inhibitors do not interact with statins.
name: Ramipril
label: b
answer: no
explanation: There are no adverse interactions between beta-blockers and statins.
name: Bisoprolol
label: c
answer: no

Correct answer: a
A 50-year-old female is admitted to the hospital after an episode of collapse. She reveals that she's recently had several attacks of faintness, mostly on exertion. During these attacks, she feels lightheaded but does not have vertigo.

On examination, she has a pulse of 70 bpm which is slow rising, and a blood pressure of 110/80 mmHg. A systolic murmur can be heard at the left sternal edge.

What is the most likely diagnosis?

Options:
explanation: Atrial fibrillation usually presents with palpitations, dyspnoea and chest pain. Patients also have an irregularly irregular pulse. It usually doesn't cause a murmur.
name: Atrial fibrillation
label: b
answer: no
explanation: Complete heart block can present similarly with syncopal episodes, however, can also cause bradycardia (30-50 bpm) and a wide pulse pressure. A mid-late blowing diastolic murmur (Rytand murmur) is occasionally heard in these patients.
name: Complete heart block
label: c
answer: no
explanation: Vestibular neuronitis can present with recurrent attacks of vertigo. It is important to not confuse vertigo with dizziness. Vertigo is defined as feeling as though you or your surroundings are spinning, whilst dizziness can be characterised by a range of sensations such as feeling light-headed, faint, woozy, off-balance or weak.
name: Vestibular neuronitis
label: e
answer: no
explanation: This patient has not reported feeling dizzy, light-headed or nauseous when standing up suddenly. Hence, postural hypotension is an unlikely diagnosis.
name: Postural hypotension
label: d
answer: no
explanation: Aortic stenosis characteristically causes a mild ejection-systolic murmur which radiates to the carotids. The most common sign and best indicator of severity is a slow-rising pulse. Aortic stenosis typically presents with chest pain, dyspnoea and syncope/presyncope.
name: Aortic stenosis
label: a
answer: yes

Correct answer: a
A 79-year-old female visits her GP as she has been experiencing increasing breathlessness on exertion over the last 6 months.

On examination, her pulse is 72 bpm and is irregularly irregular. Her blood pressure is 117/74 mmHg. Her GP notices a diastolic murmur on auscultation.

What is the most likely cause of her murmur?

Options:
explanation: Mitral stenosis causes a mid-diastolic murmur due to the passive flow of blood from the left atrium to the left ventricle through a stenosed mitral valve during diastole.

Atrial fibrillation occurs in mitral stenosis due to increased left atrial pressure which leads to electrical remodelling and hypertrophy of the left atrium.
name: Mitral stenosis
label: a
answer: yes
explanation: Aortic stenosis typically causes an ejection-systolic crescendo-decrescendo murmur due to the narrowing of the aortic valve.
name: Aortic stenosis
label: c
answer: no
explanation: It is technically possible for symptoms of hypertrophic cardiomyopathy to present this late in life, however, HCM most commonly presents in mid-life. Symptoms of HCM include exertional dyspnoea, chest pain, fatigue and exertional syncope. It also usually causes an ejection-systolic murmur.
name: Hypertrophic cardiomyopathy (HCM)
label: d
answer: no
explanation: Mitral regurgitation causes a pan-systolic murmur due to the retrograde flow of blood from the left ventricle into the left atrium.
name: Mitral regurgitation
label: e
answer: no
explanation: Aortic regurgitation causes an early diastolic murmur due to the backflow of blood through an inadequately closed aortic valve.
name: Aortic regurgitation
label: b
answer: no

Correct answer: a
A 68-year-old retired electrician is currently an inpatient on the cardiology ward. He complains of worsening breathlessness that woke him up during the night. He had a myocardial infarction 4 months ago.

His pulse is 99 bpm, blood pressure is 162/101 and respiratory rate is 20 breaths/minute.

Auscultation of his chest reveals bibasal crepitations and there is a dullness to percussion of both bases.

His chest x-ray shows small bilateral pleural effusions with upper lobe blood vessel diversion.

What is the most appropriate diagnostic investigation for this man's condition?

Options:
explanation: A CTPA scan can be used to diagnose reduced LV function but is not the first-line imaging technique recommended by NICE.
name: Computerised tomography pulmonary angiography (CTPA)
label: b
answer: no
explanation: D-dimer can be used as a prognostic factor in patients with heart failure but is not used in its diagnosis.
name: Serum D-dimer
label: e
answer: no
explanation: This man has developed heart failure. An echocardiogram will show poor left ventricular (LV) function and reduced ejection fraction. NT-pro-BNP is used to determine the urgency of the echocardiogram.
name: Echocardiography
label: a
answer: yes
explanation: Coronary angiography is considered the best method for diagnosing coronary heart disease.
name: Coronary angiography
label: c
answer: no
explanation: Heart failure can cause an abnormal ECG, but ECG changes are not enough to be able to diagnose heart failure.
name: Electrocardiogram (ECG)
label: d
answer: no

Correct answer: a
A 27-year-old female seeks advice after having a 'funny turn'. She fainted for a few minutes and then regained consciousness and has felt fine since. She mentions that two of her maternal first cousins died in their teens while swimming.

An electrocardiogram (ECG) is carried out, which shows a QTc interval of 560ms (reference <460 ms)

What is the most likely cause of her cousins' deaths?

Options:
explanation: Hypertrophic obstructive cardiomyopathy is the commonest cause of sudden cardiac death in young patients. Patients with HOCM also tend to experience exertional dyspnoea and syncope. However, prolonged QT segments are not consistent with the diagnosis of HOCM. Features of HOCM include left ventricular hypertrophy, ST changes including T wave inversion, and deep Q waves.
name: Hypertrophic obstructive cardiomyopathy (HOCM)
label: e
answer: no
explanation: There are congenital and acquired causes of long QT syndrome, and this patient's cousin likely has a congenital cause. In long QT syndrome, there is delayed repolarisation of the ventricles which can lead to ventricular tachycardia/torsade de pointes. These tachyarrhythmias can lead to collapse or even sudden death. Long QT syndrome is also associated with seizures and palpitations.
name: Ventricular tachyarrhythmia
label: a
answer: yes
explanation: Complete heart block can also present with syncopal episodes, and if untreated, can lead to sudden cardiac arrest. However, most causes of heart block are acquired, not genetic. Indeed, most cases of heart block present at older ages.
name: Complete heart block
label: b
answer: no
explanation: Strokes are uncommon in teenagers (the patient's cousins passed away in their teens). This patient is also not presenting with the typical features of a stroke.
name: Stroke
label: d
answer: no
explanation: This patient does not describe any of the typical symptoms of a pulmonary embolism, such as pleuritic chest pain, dyspnoea, tachycardia and tachypnoea. Furthermore, pulmonary embolism is rare in adolescents.
name: Pulmonary embolism
label: c
answer: no

Correct answer: a
A 25-year-old man presents to his GP complaining of shortness of breath. He is found to have a radio-femoral delay, and rib notching is noticed on a CXR. His blood pressure is raised. His pulmonary exam is normal.

His height and weight are measured and are 196cm and 92 kg respectively.

What is the most likely diagnosis in this patient?

Options:
explanation: Renal artery stenosis is caused by atherosclerosis. It is often seen in older people and can worsen over time, often resulting in hypertension and kidney damage. This patient is too young for renal artery stenosis to be the likely diagnosis.
name: Renal artery stenosis
label: b
answer: no
explanation: This is a typical presentation of coarctation of the aorta. It can present in adulthood as well as in infancy. The notching of the ribs is not seen in young children but is seen in adults due to the formation of collateral vessels.
name: Coarctation of the aorta
label: a
answer: yes
explanation: This is not the typical presentation of Ehlers-Danlos syndrome. Common findings in Ehlers-Danlos syndrome include hyperelasticity of the skin, and hypermobility of joints which are prone to sprains, dislocation and subluxation. Rare symptoms include easy bruising and aneurysms.
name: Ehlers-Danlos syndrome
label: d
answer: no
explanation: Asthma usually develops in childhood, but can also present for the first time in adults. However, this patient does not have any of the typical features of asthma.
name: Asthma
label: e
answer: no
explanation: This individual is very tall, as are most patients with Marfan's syndrome. But none of the other physical findings associated with Marfan syndrome are mentioned in the history, such as ectopia lentis (upward dislocated lens), arachnodactyly, loose joints, wingspan to arm ratio >1.05, pectus excavatum or aortic dissection/dilation.
name: Marfan's syndrome
label: c
answer: no

Correct answer: a
A 57-year-old woman presents to her GP with an ulcer over her left heel. She works as a construction site manager and has a past medical history of diabetes as well as a myocardial infarction 3 years ago.

On examination, the ulcer is 3.5cm in diameter and deeply penetrating. Her sensory examination is normal, and her doppler ratio on the left is 0.68 and 0.98 on the right.

What's the most likely mechanism of this ulcer?

Options:
explanation: This patient's normal sensory examination makes a neuropathic ulcer unlikely.
name: Neuropathic ulcer
label: b
answer: no
explanation: Arterial ulcers are the result of insufficient tissue perfusion secondary to atherosclerosis. This results in ischaemia and subsequent skin breakdown. This patient's ABPI of 0.68 ABPI is indicative of peripheral arterial disease which is associated with the development of arterial ulcers. Furthermore, this patient's history of myocardial infarction increases the likelihood of her having systemic atherosclerosis.
name: Arterial ulcer
label: a
answer: yes
explanation: This patient's ABPI, examination, and history of myocardial infarction point towards an arterial ulcer as opposed to a venous one.
name: Venous ulcer
label: d
answer: no
explanation: Although this patient has a history of diabetes, she has no history of diabetic neuropathy or reduced sensation.
name: Diabetic ulcer
label: e
answer: no
explanation: There is no mention of a traumatic process or injury in this patient's history.
name: Traumatic ulcer
label: c
answer: no

Correct answer: a
A 69-year-old man presents to his GP as he is unhappy with how his toenails are growing. He is a known diabetic.

On examination, his toe web spaces are macerated. His GP notices that several of his toenails have white and yellow opaque streaks and that the end of some of his toenails have lifted up. Yellow spots are also evident in the lanula.

Microscopy and culture of nail clippings show trichophyton tonsurans.

What is the most appropriate treatment for this gentleman's condition?

Options:
explanation: Itraconazole is an alternative treatment for dermatophyte infections. However, it is typically given orally, not topically.
name: Topical itraconazole
label: c
answer: no
explanation: This patient has a fungal nail infection which can be treated with antifungal medication. Oral terbinafine is first line in the treatment of confirmed dermatophyte nail infections.
name: Oral terbinafine
label: a
answer: yes
explanation: Topical nystatin can also be used to treat fungal nail infections, however, it is not used as a first-line treatment.
name: Topical nystatin
label: d
answer: no
explanation: Topical treatment with voriconazole can be considered if the infection involves just the tip of the toenail, but this patient's infection is quite widespread.
name: Topical voriconazole
label: e
answer: no
explanation: Intravenous infusions of amphotericin B are used as empirical treatment for potentially life-threatening fungal infections, such as aspergillosis or cryptococcosis.
name: Intravenous amphotericin B
label: b
answer: no

Correct answer: a
A 3-year-old girl is brought to her GP by her mother. She complains of dryness, redness and scaling on her daughter's arms. Her daughter is constantly itching her arms. She is worried about a diagnosis of atopic eczema. The GP advises using emollients after bathing and avoiding triggers.

Which of the following options is most associated with atopic eczema?

Options:
explanation: Mutations in the CARD14 gene have been shown to be associated with psoriasis.
name: CARD14
label: b
answer: no
explanation: Anti-synthetase antibodies, particularly anti-Jo-1, are associated with a type of polymyositis that includes respiratory involvement, Raynaud's syndrome and fever. It is also associated with the cutaneous variant of polymyositis, called dermatomyositis.
name: Anti-synthetase antibodies (Anti Jo-1)
label: e
answer: no
explanation: HLA antigens are encoded by genes on chromosome 6. HLA-DR4 is associated with type 1 diabetes mellitus and rheumatoid arthritis.
name: HLA-DR4
label: d
answer: no
explanation: HLA-DQ2 and HLA-DQ8 are important HLA antigens to remember as they are associated with coeliac disease. They are encoded by genes on chromosome 6.
name: HLA-DQ2 and HLA-DQ8
label: c
answer: no
explanation: A mutation in the filaggrin gene has been implicated in up to 50% of eczema cases. FLG encodes filaggrin, a protein required for the skin to perform its role as an effective barrier. A deficiency in FLG is thought to allow antigens access through the skin where they can initiate an immune and inflammatory response.
name: Filaggrin gene
label: a
answer: yes

Correct answer: a
A 4-month-old girl was diagnosed with eczema two months ago.

She is currently having a non-infective flare-up on her face, despite the frequent use of aqueous cream.

What is the most appropriate treatment?

Options:
explanation: The management of facial eczema requires the use of a low-strength steroid cream, such as hydrocortisone.
name: Topical hydrocortisone
label: a
answer: yes
explanation: Tacrolimus ointment is used to treat symptoms of eczema in patients who either can't use other steroids or haven't responded to them.
name: Topical tacrolimus
label: e
answer: no
explanation: Betamethasone is a moderate-potency steroid and is too strong for this mild case of eczema. It may be used in short bursts in cases of severe eczema.
name: Betamethasone (Betnovate®)
label: b
answer: no
explanation: The patient is already using an emollient (aqueous cream).
name: Emollient ointment
label: d
answer: no
explanation: Dithranol is used to treat chronic plaque psoriasis, not eczema.
name: Dithranol
label: c
answer: no

Correct answer: a
A 79-year-old female has a chest infection that is slow to clear despite several courses of broad-spectrum oral antibiotics.


Her bloods are taken which show the following results:


||||
|--------------|:-------:|---------------|
|Haemoglobin|126 g/L|(M) 130 - 170, (F) 115 - 155|
|White Cell Count|38x10<sup>9</sup>/L|3.0 - 10.0|
|Lymphocytes|32x10<sup>9</sup>/L|1.5 - 4.0|
|Platelets|124x10<sup>9</sup>/L|150 - 400|


A large cervical node is biopsied which under microscopy shows a sheet of mainly small lymphoid cells.


What is the most likely diagnosis?

Options:
explanation: You would not expect to see a raised WCC and lymphocytosis in multiple myeloma
name: Multiple myeloma
label: b
answer: no
explanation: You would also expect to see Reed-Sternberg cells on lymph node biopsy in HL. A normocytic anaemia may also be seen.
name: Hodgkin's lymphoma (HL)
label: c
answer: no
explanation: There are no risk factors for TB in this case such as HIV, immunosuppression or IV drug use. Symptoms of TB include weight loss, night sweats, cough +/- haemoptysis and shortness of breath.
name: Tuberculosis (TB)
label: e
answer: no
explanation: Chronic lymphocytic leukaemia occurs due to the proliferation of well-differentiated lymphocytes which are mostly non-functional. This leads to immunosuppression and increased infections. Lymphocytosis is commonly seen in CLL.
name: Chronic lymphocytic leukaemia (CLL)
label: a
answer: yes
explanation: Recurrent pneumonia is commonly seen in small-cell lung cancer. You may also see other features such as shortness of breath, cough and haemoptysis. There are no signs of small cell lung cancer cells in this patient's lymph node biopsy.
name: Small cell lung cancer
label: d
answer: no

Correct answer: a