hllj/quesmed huggingface dataset:
A 67-year-old woman presents to A&E feeling unwell, with increased frequency of very dark urine and a burning sensation on urination for the past dayShe has a history of Stage 2 breast cancer and completed her last chemotherapy cycle 5 days ago. She has a Do Not Attempt CPR (DNACPR) form with them and an advanced directive that states she does not want intensive care intervention.


On examination, they are tender to palpate in the suprapubic region and are warm to touch. They are alert and oriented and appear to have capacity.


Their observations are as follows:


HR 97bpm.
RR 20bpm.
O2 saturations 97% on air.
BP 115/78.
Temperature 37.9C.


Which of the following is the most appropriate management option?

Options:
explanation: This is the correct answer. The patient is suffering from a urine infection which is treatable with antibiotics. They have a fever and their white blood cells are likely to be low after their chemotherapy.
name: Administer antibiotics
label: a
answer: yes
explanation: This is incorrect. The patient is suffering from a urinary tract infection and their advanced care directive permits antibiotic use; they do not want to be for intensive care interventions, which do not appear to be indicated at this stage. A DNACPR decision only applies to cardiopulmonary resuscitation during a cardiac arrest.
name: Do not treat the patient
label: c
answer: no
explanation: This is incorrect. The patient's advanced directive that states they do not want intensive care intervention. It also does not seem to be indicated in this stage. Administration of antibiotics should be the first step.
name: Refer for treatment in the intensive care unit
label: e
answer: no
explanation: This is incorrect. This would be inappropriate as the patient has the capacity to make decisions for themselves. A DNACPR decision only applies to cardiopulmonary resuscitation during a cardiac arrest.
name: Encourage cranberry juice
label: d
answer: no
explanation: This is incorrect. This would be inappropriate as the patient has the capacity to make decisions for themselves. A DNACPR decision only applies to cardiopulmonary resuscitation during a cardiac arrest.
name: Contact the patient's next of kin to discuss their treatment
label: b
answer: no

Correct answer: a

Administer antibiotics
A 37 year old male attends the GP practice due to abdominal pain that has been present for around 3 months. He describes the pain as a dull ache, 3/10 in severity. More recently he has noticed that the whites of his eyes appear more yellow when looking in the mirror. He has not lost any weight.

He is currently waiting for a respiratory clinic appointment, as he has been struggling with shortness of breath on minimal exertion for around 6 months. He does not smoke or drink alcohol, and takes no regular medications.

Blood results demonstrate deranged liver function tests. A chest x-ray shows hyperexpansion of the lungs and a flattened diaphragm.

Which of the following is the most likely diagnosis?

Options:
explanation: This is incorrect. Although sarcoidosis can affect both the liver and the lungs, their chest x-ray would likely show granulomas and they would be more likely to have other features such as erythema nodosum, a chronic dry cough and lymphadenopathy.
name: Sarcoidosis
label: e
answer: no
explanation: This is incorrect. Although the patient most likely has emphysema, the underlying cause is alpha-1 antitrypsin deficiency rather than COPD.
name: Chronic obstructive pulmonary disease (COPD)
label: b
answer: no
explanation: This is incorrect. Although the patient has deranged liver function tests, a diagnosis of chronic viral hepatitis does not explain the respiratory symptoms.
name: Chronic viral hepatitis
label: d
answer: no
explanation: This is the correct answer. Alpha-1 antitrypsin deficiency is a genetic condition. Alpha-1 antitrypsin inhibits neutrophil elastase which normally breaks down connective tissue. A deficiency therefore leaves the lungs and liver unprotected from proteolytic damage. It is associated with an increased risk of emphysema and liver damage. The typical presentation is males in their 30s and 40s.
name: Alpha-1 antitrypsin deficiency
label: a
answer: yes
explanation: This is incorrect. Alpha-1 antitrypsin deficiency carries a higher risk of developing hepatocellular carcinoma, however, this does not itself explain the respiratory symptoms. It is also less likely as the patient has not lost any weight.
name: Hepatocellular carcinoma
label: c
answer: no

Correct answer: a
A 25 year old male presents to their GP with diarrhoea and increased bowel movements up to 8 times a day. This is starting to affect their work as a secretary as they are constantly using the toilet and feel tired all the time. They are struggling with their body image as they are finding it difficult to put on weight.

Blood tests show a positive faecal calprotectin. The patient is referred for a colonoscopy with biopsy.

Which of the following findings on colonoscopy would support a diagnosis of Crohn's disease?

Options:
explanation: This is incorrect. Loss of haustral markings is seen in ulcerative colitis.
name: Loss of haustral markings
label: e
answer: no
explanation: This is incorrect. Continuous Inflammation is more in keeping with ulcerative colitis. By contrast, skip lesions are seen in Crohn's disease.
name: Continuous Inflammation
label: b
answer: no
explanation: This is correct. Rose-thorn ulcers are a result of transmural inflammation and may be accompanied by fistulae or abscesses. Crohn's disease is associated with intermittent inflammation, cobblestone mucosa and rose-thorn ulcers.
name: Rose-thorn ulcers
label: a
answer: yes
explanation: This is incorrect. Loss of goblet cells is seen in ulcerative colitis.
name: Loss of goblet cells
label: c
answer: no
explanation: This is incorrect. Crypt abscesses are seen in ulcerative colitis.
name: Crypt abscess
label: d
answer: no

Correct answer: a
A 29 year old female attends her GP surgery. She has been struggling with fatigue for the last 3 months, despite sleeping for at least 9 hours a day. It makes it difficult to concentrate at work. She also reports pins and needles in her lower limbs. She has a past medical history of type 1 diabetes.

Blood tests show a macrocytic anaemia and vitamin B12 deficiency.

Which of the following proteins in the gastrointestinal tract are essential for the absorption of vitamin B12?

Options:
explanation: This is incorrect. Cholecystokinin is a peptide hormone released in the duodenum that stimulates the release of digestive enzymes from the gallbladder and pancreas.
name: Cholecystokinin
label: b
answer: no
explanation: This is incorrect. Secretin is released into the intestinal lumen in response to low duodenal pH.
name: Secretin
label: c
answer: no
explanation: This is incorrect. Gastrin is a peptide hormone that stimulates the secretion of hydrochloric acid in the stomach.
name: Gastrin
label: d
answer: no
explanation: This is incorrect. This inhibits pancreatic secretion stimulated by cholecystokinin by relaxing the gallbladder. It also stimulates gastric acid secretion.
name: Pancreatic polypeptide
label: e
answer: no
explanation: This is correct. Pernicious anaemia is caused by a lack of vitamin B12. It is caused by autoimmune destruction of gastric parietal cells that are responsible for producing intrinsic factor, a protein necessary for vitamin B12 absorption. Patients may present with symptoms of anaemia such as fatigue and pallor, along with neurological deficits such as paraesthesia and loss of sensation. The patient's past medical history of type 1 diabetes is a risk factor for pernicious anaemia.
name: Intrinsic Factor
label: a
answer: yes

Correct answer: a
A 45 year old patient is recovering in the general surgical ward following a cholecystectomy. They had some complications and receive total parenteral nutrition. They have been doing some research and have questions regarding the role of hormones in their gastrointestinal tract.

Cholecystokinin (CCK) is a hormone released in the duodenum in response to a meal.

Which of the following biochemicals inhibits CCK secretion?

Options:
explanation: This is incorrect. VIP increases the secretion of bicarbonate and inhibits pepsin secretion.
name: Vasoactive intestinal peptide (VIP)
label: e
answer: no
explanation: This is incorrect. This is released by pancreatic acinar cells. It stimulates, rather than inhibits the release of CCK.
name: Monitor peptide
label: b
answer: no
explanation: This is incorrect. Motilin is a polypeptide hormone that increases gastrointestinal motility and gastric emptying.
name: Motilin
label: d
answer: no
explanation: This is correct. Somatostatin is a hormone with a range of functions. Primarily, it inhibits the release of gastrin and parietal cell acid secretion. It also suppresses pancreatic secretions by inhibiting CCK secretion.
name: Somatostatin
label: a
answer: yes
explanation: This is incorrect. Acetylcholine does not inhibit the secretion of CCK.
name: Acetylcholine
label: c
answer: no

Correct answer: a
A 50 year old male attends A&E due to a painful swollen big toe. This has been troubling him for around 24 hours. He feels systemically well, with no shivering or temperatures. He denies any trauma to the joint.

On examination, central obesity is noted. Their left big toe appears swollen and inflamed around the metatarsophalangeal joint.

An aspiration of the affected joint is performed, and the synovial fluid is analysed.

Which of the following synovial fluid analysis findings would indicate a diagnosis of gout?

Options:
explanation: This is incorrect. The presence of needle-shaped monosodium urate crystals with negative birefringence on synovial fluid analysis confirms the diagnosis of gout.
name: Positively bifringent needle shaped crystals
label: d
answer: no
explanation: This is incorrect. Positively bifringent rhomboid-shaped crystals are indicative of pseudogout.
name: Positively bifringent rhomboid-shaped crystals
label: b
answer: no
explanation: This is incorrect. The presence of needle-shaped monosodium urate crystals with negative birefringence on synovial fluid analysis confirms the diagnosis of gout.
name: Gram stain positive and neutrophils present
label: c
answer: no
explanation: This is correct. Gout is a type of arthritis caused by the accumulation of monosodium urate crystals in and around the joints. The presence of needle-shaped monosodium urate crystals with negative birefringence on synovial fluid analysis confirms the diagnosis of gout.
name: Negatively bifringent needle-shaped crystals
label: a
answer: yes
explanation: This is incorrect. The presence of needle-shaped monosodium urate crystals with negative birefringence on synovial fluid analysis confirms the diagnosis of gout.
name: Negatively bifringent rhomboid shaped crystals
label: e
answer: no

Correct answer: a
A 60 year old female attends A&E as she notices a new blistering rash across her chest, as well as multiple painful mouth ulcers. 3 days ago she started a course of amoxicillin that was prescribed by her GP for a community-acquired pneumonia. She is diagnosed with Stevens-Johnson Syndrome.

Which of the following hypersensitivity reactions is this an example of?

Options:
explanation: This is incorrect. Type 1 hypersensitivity reactions occur much more rapidly after exposure. They are IgE-mediated. Examples include atopy and anaphylaxis.
name: Type 1 Hypersensitivity
label: e
answer: no
explanation: This is incorrect. There is no such thing as a type 5 hypersensitivity reaction.
name: Type 5 Hypersensitivity
label: d
answer: no
explanation: This is incorrect. Type 2 reactions are IgG or IgM antibody-mediated and usually onset time is hours to days. Examples include haemolytic disease of the newborn and autoimmune haemolytic anaemia.
name: Type 2 Hypersensitivity
label: b
answer: no
explanation: This is incorrect. This is an antigen-antibody immune complex-mediated reaction that usually arises between hours and weeks after exposure. Examples include serum sickness and post-streptococcal glomerulonephritis.
name: Type 3 Hypersensitivity
label: c
answer: no
explanation: This is correct. Type 4 hypersensitivity is known as delayed hypersensitivity. The reaction occurs 24 to 72 hours after exposure and is T-cell mediated. Stevens-Johnson syndrome is a type IV reaction that involves the skin and mucus membranes.
name: Type 4 Hypersensitivity
label: a
answer: yes

Correct answer: a
A 27 year old male attends their GP practice due to a sore throat and feeling generally unwell. They also complain about a headache that is not relieved by paracetamol. Their symptoms began a day ago. He denies nausea, vomiting, or coughing.

On examination, he is warm to touch. The throat appears erythematous with white exudate on the tonsils. Tender lymphadenopathy is noted on palpation of the neck. He is able to speak in full sentences with no signs of airway compromise.

Which of the following is the most likely diagnosis?

Options:
explanation: This is incorrect. Also known as infectious mononucleosis, glandular fever presents similarly with sore throat, fever and headache. However glandular fever is less common, and additional symptoms including severe fatigue and splenomegaly may also be present.
name: Glandular fever
label: e
answer: no
explanation: This is incorrect. The CENTOR criteria indicate the likelihood of tonsillitis being bacterial. Patients showing tonsillar exudate, tender cervical lymphadenopathy, fever and the absence of a cough are more likely to have bacterial tonsillitis compared to viral tonsillitis.
name: Viral tonsilitis
label: c
answer: no
explanation: This is incorrect. Laryngitis is inflammation of the larynx. Symptoms usually include hoarseness, a sore throat and a cough. A sore throat, fever and a headache with tender lymphadenopathy is suggestive of bacterial tonsillitis.
name: Laryngitis
label: d
answer: no
explanation: This is incorrect. A sore throat, fever and a headache with tender lymphadenopathy is suggestive of bacterial tonsillitis.
name: Pharyngitis
label: b
answer: no
explanation: This is correct. The CENTOR criteria indicate the likelihood of tonsillitis being bacterial. Patients showing tonsillar exudate, tender cervical lymphadenopathy, fever and the absence of a cough are more likely to have bacterial tonsillitis compared to viral tonsillitis.
name: Bacterial tonsilitis
label: a
answer: yes

Correct answer: a
An 18 year old male attends his GP surgery with concerns about his body image. He has not got any pubic hair and is self-conscious because he has a large amount of breast tissue compared with his other male friends.

On examination, the patient is tall and lean with wide hips. The GP notes small testes.

Which of the following is the most likely karyotype of this patient?

Options:
explanation: This is incorrect. This is the karyotype for Jacob's Syndrome. This is also characterised by a male genotype and tall stature. However, Jacob's syndrome is also associated with aggression and a predisposition to mental illness.
name: XYY
label: b
answer: no
explanation: This is correct. Klinefelter syndrome is not an inherited condition and it occurs spontaneously. The phenotype is male with a tall stature, gynaecomastia, small testes and a feminine fat distribution. In Klinefelter syndrome, one of the X chromosomes is inactivated, becoming a 'Barr body'. These patients can also present with hypogonadotropic hypogonadism and high urinary gonadotropins.
name: 47 XXY
label: a
answer: yes
explanation: This is incorrect. Individuals with triple X syndrome are generally phenotypically female.
name: 47 XXX
label: e
answer: no
explanation: This is incorrect. This is the karyotype for Turner's syndrome, which is characterised by the loss of an X chromosome. This is also a sporadic genetic condition but presents with a female phenotype.
name: 45 XO
label: d
answer: no
explanation: This is incorrect. Fragile X syndrome is an inherited condition presenting with features such as a long face, large protruding ears, intellectual impairment and post-pubertal macroorchidism (large testes).
name: Fra (X)
label: c
answer: no

Correct answer: a
A 16 year old girl presents to the children's A&E department with her parents. She has a cough productive of green sputum and is feeling generally unwell. Her past medical history includes cystic fibrosis.

On examination of the respiratory system, crackles can be heard bilaterally.

Their blood tests reveal an elevated white blood cell count.

Which of the following is the most likely causative organism?

Options:
explanation: This is incorrect. Legionella pneumophilia infections typically present with fever, myalgia and malaise followed by a dry cough. It is usually seen in patients exposed to poor hotel air conditioning.
name: Legionella pneumophilia
label: e
answer: no
explanation: This is incorrect. This is a gram-positive cocci found in clusters and is associated with intravenous drug users, elderly patients or patients who already have an influenza infection. Although it is the most common type of pneumonia it is not the most common in those with cystic fibrosis.
name: Streptococcus pneumoniae
label: b
answer: no
explanation: This is correct. This is a gram-negative rod and is a multi-drug-resistant pathogen. *P. aerunginosa* is the most common pathogen in people with cystic above the age of 16. Management should involve blood cultures and local infectious disease guidelines. Antibiotics such as ciprofloxacin are usually given first line, at a higher dose than for those without cystic fibrosis.
name: Pseudomonas aeruginosa
label: a
answer: yes
explanation: This is incorrect. This is a gram-negative anaerobic rod that typically affects those with a weakened immune system: the elderly, alcoholics and diabetics. It usually presents with the classic 'red currant jelly' sputum. It is a less common cause of a lower respiratory tract infection in those with cystic fibrosis than Pseudomonas aeruginosa.
name: Klebsiella pneumoniae
label: d
answer: no
explanation: This is incorrect. Although a common cause of pneumonia, it is not the most common in those with cystic fibrosis.
name: Haemophilus influenzae
label: c
answer: no

Correct answer: a
A 25 year old female is brought into A&E after falling from a horse. She sustained a mid-shaft femur fracture.

Which of the following describes the order of fracture healing?

Options:
explanation: This is incorrect. The order of fracture healing is: inflammation, soft callus, hard callus, bone remodelling.
name: Bone remodelling, soft callus, hard callus, inflammation
label: b
answer: no
explanation: This is incorrect. The order of fracture healing is: inflammation, soft callus, hard callus, bone remodelling.
name: Inflammation, hard callus, soft callus, bone remodelling
label: c
answer: no
explanation: This is incorrect. The order of fracture healing is: inflammation, soft callus, hard callus, bone remodelling.
name: Bone remodelling, restructuring, ossification, repair
label: e
answer: no
explanation: This is incorrect. The order of fracture healing is: inflammation, soft callus, hard callus, bone remodelling. Ossification relates to soft and hard callus formation.
name: Bone remodelling, ossification, restructuring, repair
label: d
answer: no
explanation: This is the correct answer. A fibrin clot is formed at the site of the fracture, followed by soft callus formation whereby cartilage and collagen unite. After this, a hard callus forms as the cartilage becomes woven bone through ossification. Finally, woven bone is converted into lamellar bone during the bone remodelling stage.
name: Inflammation, soft callus, hard callus, bone remodelling
label: a
answer: yes

Correct answer: a
A 5 year old female presents to a paediatric orthopaedic clinic. Her parents are very worried because she has sustained multiple low-trauma fractures. She is also known to have hearing loss, scoliosis, easy bruising and a blue tinge to her sclera.

After ruling out non-accidental injury, she is diagnosed with osteogenesis imperfecta.

Which of the following describes the pathophysiology of osteogenesis imperfecta?

Options:
explanation: This is incorrect. This is associated with rickets which also carries an increased fracture risk. However, osteogenesis imperfecta is a genetic disorder of type 1 collagen.
name: Vitamin D deficiency
label: b
answer: no
explanation: This is incorrect. Paget's disease is associated with excessive bone turnover due to the increase in osteoclast and osteoblast activity. However, osteogenesis imperfecta is a genetic disorder of type 1 collagen.
name: Increased osteoclast and osteoblast activity
label: d
answer: no
explanation: This is correct. Osteogenesis imperfecta is a genetic disorder of type 1 collagen. It causes fragile bones and low trauma fractures. Education about the condition and its treatment is essential.
name: Type 1 collagen synthesis defect
label: a
answer: yes
explanation: This is incorrect. This is associated with achondroplasia. However, osteogenesis imperfecta is a genetic disorder of type 1 collagen.
name: Mutated fibroblast growth factor receptor (FGFR)
label: e
answer: no
explanation: This is incorrect. This would explain Marfan syndrome - a connective tissue disorder. However, osteogenesis imperfecta is a genetic disorder of type 1 collagen.
name: Genetic defect in fibrillin synthesis
label: c
answer: no

Correct answer: a
A 58 year old male is being treated in the intensive care unit following a myocardial infarction, after which he suffered a cardiac tamponade as a complication. He is found to have reduced urine output and an acute kidney injury (AKI) on their latest set of blood tests.

Which of the following best categorises this patient's AKI?

Options:
explanation: This is incorrect. Although the patient has had a myocardial infarction likely from a thrombus, the patient will have suffered cardiogenic shock from the tamponade, thus causing reduced perfusion to the kidneys.
name: Renal - renal vein thrombosis
label: b
answer: no
explanation: This is correct. The cardiogenic shock from the cardiac tamponade caused reduced perfusion to the kidneys, resulting in a pre-renal AKI.
name: Pre-renal - cardiogenic shock
label: a
answer: yes
explanation: This is incorrect. There is nothing in the patient's history to suggest they suffer from benign prostatic hypertrophy.
name: Post-renal - benign prostatic hypertrophy
label: c
answer: no
explanation: This is incorrect. There is nothing in the stem to suggest the patient is suffering from a kidney stone.
name: Post-renal - kidney stone
label: e
answer: no
explanation: This is incorrect. The patient is most likely suffering from cardiogenic shock which would cause a pre-renal AKI.
name: Renal - acute glomerulonephritis
label: d
answer: no

Correct answer: a