hllj/quesmed huggingface dataset:
A 20-year-old female presents to the emergency department as she has dislocated her shoulder. She has a past medical history of Ehlers-Danlos syndrome.

Ehlers-Danlos syndrome is caused by a genetic mutation of which structure?

Options:
explanation: Ehlers-Danlos syndrome occurs due to a genetic mutation in collagen, not fibrin. Different types of mutations in fibrin can cause bleeding disorders such as hypofibrinogenemia.
name: Fibrin
label: c
answer: no
explanation: Ehlers-Danlos syndrome occurs due to a genetic mutation in collagen, not elastin. Loss of function mutations in the elastin gene can cause the heart defect supravalvular aortic stenosis.
name: Elastin
label: d
answer: no
explanation: A mutation of the CFTR gene, otherwise known as the cystic fibrosis transmembrane conductance regulator gene, causes cystic fibrosis. Ehlers-Danlos syndrome is caused by a genetic mutation of collagen.
name: Cystic fibrosis transmembrane conductance regulator (CFTR)
label: b
answer: no
explanation: Keratin is the building block of hair and nails. Mutations in keratin does not cause the development of Ehlers-Danlos syndrome.
name: Keratin
label: e
answer: no
explanation: Enlers-Danlos syndrome is a group of inherited conditions that cause hypermobile joints, hyperelastic skin and fragile blood vessels. This occurs due to a genetic mutation of collagen.
name: Collagen
label: a
answer: yes

Correct answer: a
An 18-year-old university student presents to her GP with a sore throat and fatigue for the past three weeks. She was prescribed a course of amoxicillin a week ago which she stopped taking as she developed a widespread macular rash. On examination, she is noted to have cervical lymphadenopathy.

Which of the following is a possible complication of the most likely diagnosis?

Options:
explanation: Hodgkin's lymphoma is not a known complication of glandular fever. However, having glandular fever can be assoictaed with a higher risk of developing non-Hodgkin's lymphoma.
name: Hodgkin's lymphoma
label: d
answer: no
explanation: This is a typical description of glandular fever. An important complication of this condition includes splenic rupture, so individuals are advised to avoid contact sports for a month after diagnosis. Signs of splenic rupture include: abdominal pain, referred shoulder tip pain and tachycardia.
name: Splenic rupture
label: a
answer: yes
explanation: This question describes a patient with glandular fever. An important complication of glandular fever is splenic rupture. ST-elevation myocardial infarction is not a complication of this condition.
name: ST-elevation myocardial infarction (STEMI)
label: e
answer: no
explanation: Ramsey-Hunt syndrome occurs when a herpes zoster infection affects the facial nerve. It is not a complication of glandular fever.
name: Ramsey-Hunt syndrome
label: b
answer: no
explanation: Hepatitis A is not a complication of glandular fever. Glandular fever can, however, lead to development of autoimmune hepatitis which is an important complication to monitor for.
name: Hepatitis A
label: c
answer: no

Correct answer: a
A 15-year-old male attends his GP with a six-month history of weight loss and diarrhoea. On further questioning, he is found to be sweaty and restless, and has had trouble sleeping. On examination, he has diplopia and you notice the upper eyelid is slow to descend on downgaze. The GP suspects a diagnosis of Graves' disease.

Which type of hypersensitivity reaction is Graves' disease?

Options:
explanation: Graves' Disease is a type 5 hypersensitivity reaction. These reactions occur when antibodies bind to cell surface receptors. A further example of a type 5 hypersensitivity reaction is myasthenia gravis. Type 5 reactions are relatively new within the medical literature, and previously Graves' would have been considered a Type 2 reaction, which your university may still be teaching. If this is the case, we would advise clarifying with your university.
name: Type 5
label: a
answer: yes
explanation: Type 2 hypersensitivity reactions include rheumatic fever and autoimmune haemolytic anaemia. These reactions take place when either IgG or IgM bind to a cell surface antigen, so are known as cell bound reactions. The patient in this question has Graves' disease, which is a type 5 hypersensitivity reaction.
name: Type 2
label: d
answer: no
explanation: Type 1 hypersensitivity reactions occur when antigens bind and react to IgE immunoglobulins. Common examples of type 1 hypersensitivity reactions include anaphylaxis, asthma, eczema and hay fever.
name: Type 1
label: c
answer: no
explanation: Type 4 hypersensitivity reactions are known as delayed-type hypersensitivity reactions. They involve T lymphocytes and reactions often occur 24 to 72 hours after exposure to an antigen. Examples of type 4 hypersensitivity reactions include contact dermatitis and transplant rejections.
name: Type 4
label: e
answer: no
explanation: Examples of type 3 hypersensitivity reactions include systemic lupus erythematosus, and less commonly post-streptococcal glomerulonephritis. These reactions are mediated by immune complexes.
name: Type 3
label: b
answer: no

Correct answer: a
A 30-year-old male has a new skin lesion. He has a smooth, hard growth on the left side of his nose where he has recently has his nose pierced. The lesion extends beyond the margin of the initial piercing.

What is the name given to this skin leison?

Options:
explanation: Pitted scars are often seen in individuals with acne. The description of the skin lesion in this question is more typical of a keloid scar.
name: Pitted scar
label: d
answer: no
explanation: Hypertrophic scars are usually hard and raised. They do not exceed past the borders of the original wound- which makes them different to keloid scars.
name: Hypertrophic scar
label: e
answer: no
explanation: This is a typical presentation of a keloid scar. The description of a smooth, hard growth at the site of trauma is typical of this type of scar. Keloids are most commonly found after injury to the upper chest, sternum, shoulder, face, earlobes and lower legs.
name: Keloid Scar
label: a
answer: yes
explanation: The patient in this question is most likely to have  a keloid scar. A pickaxe scar is a type of scar that is often seen if an individual has severe acne.
name: Pickaxe scar
label: c
answer: no
explanation: Actinic keratosis are premalignant lesions that often appear before the development of squamous cell carcinoma. They look like thickened papule or plaques and often have surrounding erythematous skin. They have a rough warty surface and can cause pruritis. The patient in this question is likely to have a keloid scar at the site of injury.
name: Actinic keratosis
label: b
answer: no

Correct answer: a
A 10-year-old female presents to the emergency department with shortness of breath and facial swelling after eating peanuts.

Which of the following cell types are responsible for releasing histamine in allergic reactions?

Options:
explanation: Mast cells are responsible for triggering the inflammatory response. They are present in tissues and are the cells responsible for releasing histamine during allergic reactions.
name: Mast cells
label: a
answer: yes
explanation: Neutrophils play an important role in fighting early stages of bacterial infections as they destroy rapidly dividing bacteria. They are not the cells responsible for producing histamine in allergic reactions.
name: Neutrophils
label: e
answer: no
explanation: Dendritic cells are antigen-presenting cells that help to trigger the adaptive immune response to an infectious agent. They are not responsible for releasing histamine in allergic reactions.
name: Dendritic cells
label: c
answer: no
explanation: Eosinophils defend against protozoan and parasitic infections. They would not be responsible for releasing histamine in allergic reactions.
name: Eosinophils
label: b
answer: no
explanation: Macrophages act to increase body temperature when individuals have a fever. They also act as antigen-presenting cells and are involved in phagocytosis of pathogens. Mast cells are the cells responsible for releasing histamine during allergic reactions.
name: Macrophages
label: d
answer: no

Correct answer: a
Which of the following options best describes the mechanism of action of trimethoprim?

Options:
explanation: Antibiotics like rifampicin work by inhibiting the synthesis of RNA. Trimethoprim acts by inhibiting folic acid synthesis.
name: Inhibits RNA synthesis
label: d
answer: no
explanation: Antibiotics like macrolides and aminoglycosides act by inhibiting protein synthesis. Trimethoprim instead acts by inhibiting folic acid formation.
name: Inhibits protein synthesis
label: b
answer: no
explanation: Trimethoprim acts by inhibiting folic acid formation, not by inhibiting the formation of cell walls. Cell wall inhibitors include antibiotics like penicillin, glycopeptides and cephalosporins.
name: Inhibits cell wall formation
label: c
answer: no
explanation: Trimethoprim acts by inhibiting folic acid formation. It does not damage DNA, unlike antibiotics such as metronidazole.
name: Damages DNA
label: e
answer: no
explanation: Trimethoprim is an antibiotic that acts by inhibiting folic acid formation.
name: Inhibits folic acid formation
label: a
answer: yes

Correct answer: a
A 45-year-old male found to have a QRESEARCH cardiovasclar risk algorithm (QRISK) score that is over 10%. His GP recommends he begins a medication called atorvastatin.

Which of the following correctly descibes the mechanism of action of statins?

Options:
explanation: This is the mechanism of action of sulphonamides and trimethoprim. Statins do not work in this way, but instead by inhibiting HMG-CoA reductase.
name: Inhibit folic acid formation
label: c
answer: no
explanation: This is the mechanism of action of warfarin, not statins. Statins inhibit HMG-CoA reductase, which reduces the amount of cholesterol in the blood.
name: Inhibit vitamin K epoxide reductase complex 1
label: b
answer: no
explanation: Antibiotics like macrolides and tetracycline work to inhibit protein synthesis. Statins instead work by inhibiting HMG-CoA reductase.
name: Inhibit protein synthesis
label: d
answer: no
explanation: Antibiotics like metronidazole work by damaging DNA. Statins do not work in this way, but instead by inhibiting HMG-CoA reductase.
name: Damage DNA
label: e
answer: no
explanation: This is the correct answer. Statins inhibit HMG-CoA reductase which, in turn, reduces the amount of cholesterol made by the liver (and also helps the liver remove cholesterol that has already been formed and deposited in the blood).
name: Inhibit HMG-CoA reductase
label: a
answer: yes

Correct answer: a
Which is the first immunoglobulin to be secreted in repsonse to infection?

Options:
explanation: IgE is associated with Type 1 Hypersensitivity reactions. It is synthesized by plasma cells and provides immunity to parasites such as helminths. It is not the first immunoglobulin to be secreted in infection, this is IgM.
name: IgE
label: d
answer: no
explanation: The role of IgD is less clear than that of the other antibodies. It is possible that it enhances the response of the other classes of antibodies, or helps to block viral replication. It is not the first immunoglobulin to be secreted in infection, this is IgM.
name: IgD
label: e
answer: no
explanation: IgA is the most predominant immunoglobulin found in breast milk. It can also be found in secretions of the digestive, respiratory and urogenital systems. The other main role of IgA is to provided protection on cell mucus membranes. It is not the first immunoglobulin to be secreted in infection, this is IgM.
name: IgA
label: c
answer: no
explanation: This immunoglobin is the only type that is able to pass into the foetal circulation. IgG is also involved in phagocytosis of bacteria and viruses, and is the most abundant type of immunoglobulin found in the blood serum. However, the first immunoglobulin to be secreted in infection is IgM.
name: IgG
label: b
answer: no
explanation: The defining feature of IgM is that it is the first immunoglobulin to be secreted in response to infection. It is secreted as a pentamer.
name: IgM
label: a
answer: yes

Correct answer: a
A 71-year-old male attends his GP to receive the results for his routine blood test. His medications include furosemide, metformin, propranolol, ramipril and nicorandil. His potassium levels are found to be 6.0mmol/L (normal range 3.5-5.3 mmol/L).

Which of the following medications is likely to be the biggest contributor to his hyperkalaemia?

Options:
explanation: Ramipril can cause high potassium levels as it blocks the aldosterone pathway, and therefore leads to more potassium being retained in the body. Hyperkalaemia is defined as a serum potassium of higher than 5.5mmol/L.
name: Ramipril
label: a
answer: yes
explanation: Furosemide is a loop diuretic that works by inhibiting the Na-K-Cl co-transporter in the loop of Henle- in the kidney. This means that furosemide causes hypokalaemia, rather than hyperkalaemia.
name: Furosemide
label: b
answer: no
explanation: Beta blockers can cause a number of side effects including bronchospasm, insomnia and erectile dysfunction. They do not, however, cause hyperkalemia.
name: Propranolol
label: e
answer: no
explanation: Nicorandil is a vasodilatory drug used used in the treatment of angina. It does not cause hyperkalemia but can, however, have a range of other side effects including headaches, flushing and skin ulceration.
name: Nicorandil
label: d
answer: no
explanation: Metformin is not a direct cause of hyperkalaemia.  Instead, this high potassium level is more likely to be caused by use of an angiotensin-converting enzyme (ACE) inhibitor.
name: Metformin
label: c
answer: no

Correct answer: a
A nine-year-old male attends his GP with recurrent haemarthroses. He undergoes multiple blood tests, which reveal low levels of factor VIII.

Which of the following is the most likely diagnosis?

Options:
explanation: This is a typical description of a patient with haemophilia A. Haemophilia A can vary in severity, but typically presents with bleeding into soft tissues, muscles and joints. It is diagnosed with a factor VIII assay and genetic testing. It is caused by deficiency of clotting factor VIII, an important part of the intrinsic component of the coagulation cascade.
name: Haemophilia A
label: a
answer: yes
explanation: Alexander's disease is a rare genetic bleeding disorder, which would show a deficiency in factor VII, not factor VIII. Alexander's disease presents with easy bruising, frequent nosebleeds and prolonged bleeding after physical injury. It does not commonly present with haemarthroses.
name: Alexander's disease
label: c
answer: no
explanation: Acute myeloid leukaemia would present with symptoms such as weight loss, frequent infections, tiredness and shortness of breath. This question is more typical of a presentation of haemophilia.
name: Acute myeloid leukaemia
label: e
answer: no
explanation: Acute lymphoid leukaemia does occur in children, and can present with increased bleeding. It is an important diagnosis to rule out. However, it would not explain the low levels of Factor VIII. It would also be likely to present with other symptoms such as pallor, frequent infections, weight loss and fatigue.
name: Acute lymphoid leukaemia
label: d
answer: no
explanation: Haemophilia B would show a deficiency in clotting factor IX, not clotting factor VIII.
name: Haemophilia B
label: b
answer: no

Correct answer: a
A 58-year-old man is started on a new medication for hypertension by his GP. Eight days later, he returns to his GP complaining of a dry cough.

Which of the following medications is the patient most likely to have been started on?

Options:
explanation: This patient's dry cough is most likely to have been caused by starting an angiotensin-converting enzyme (ACE) inhibitor such as Ramipril. When an ACE inhibitor is not tolerated in the treatment of hypertension, patients are offers an angiotensin II receptor blocker (ARB) instead.
name: Ramipril
label: a
answer: yes
explanation: This patient's dry cough is most likely to be caused by starting an ACE inhibitor, not a calcium channel blocker like amlodipine. Calcium channel blockers can have a range of side effects, including abdominal pain, peripheral oedema or gingival hyperplasia.
name: Amlodipine
label: d
answer: no
explanation: This patient's dry cough is most likely to be caused by starting an ACE inhibitor such as ramipril, rather than spironolactone.
name: Spironolactone
label: b
answer: no
explanation: This patient's dry cough is most likely to be caused by starting an ACE inhibitor, rather than beginning Indapamide. Indapamide can cause patients to become constipated, cause hyperuricaemia or, in rare cases, agranulocytosis.
name: Indapamide
label: c
answer: no
explanation: This patient's dry cough is most likely to be caused by starting an ACE inhibitor, rather than an angiotensin II receptor antagonist (ARB) such as losartan.
name: Losartan
label: e
answer: no

Correct answer: a
A 33-year-old female presents to A+E with shortness of breath that began four hours ago. She also reports having chest pain that is worse breathing in and has brought up some small flecks of bright red blood when coughing. She has recently returned from a two-week holiday in Australia. On examination, she has a heart rate of 120 and respiratory rate of 18. Her oxygen saturations are 90%. She has a temperature of 38.0.

Which of the following is the most appropriate initial investigation?

Options:
explanation: An echocardiogram can be a useful investigation if you want to check for signs of right heart strain or hypotension in patients with high-risk pulmonary embolisms. However, the best initial investigation in this woman’s case would be to conduct a CT pulmonary angiogram.
name: Echocardiogram
label: d
answer: no
explanation: This would be the best initial investigation for a pulmonary embolism if the patient had renal impairment, a contrast allergy or was pregnant. The question mentions none of these criteria, so the best initial investigation for this woman would be a CT pulmonary angiogram.
name: V/Q scan
label: c
answer: no
explanation: The most likely diagnosis in this woman in pulmonary embolism. The best initial investigation for this woman would be a CT pulmonary angiogram.
name: Doppler ultrasound
label: b
answer: no
explanation: This patient is presenting with a pulmonary embolism after a long flight (one of the risk factors for a pulmonary embolism). The best initial investigation for this woman would be a CT pulmonary angiogram.
name: Blood pressure
label: e
answer: no
explanation: The most likely diagnosis in this woman is pulmonary embolism. This is due to the classic triad of symptoms: sudden onset shortness of breath, pleuritic chest pain and haemoptysis. Her observations of tachycardia and tachypnoea further confirm this diagnosis. The best initial investigation for this woman would be a CT pulmonary angiogram, which would likely show a filling defect in the pulmonary vasculature.
name: CT pulmonary angiogram
label: a
answer: yes

Correct answer: a
A 23-year-old female presents to A&E with a non-productive cough and fever for five days. She is diagnosed with a lower respiratory tract infection. Blood results show low sodium levels and deranged liver function tests (LFTs).

Given the likely diagnosis, which of the following is the most likely causative organism?

Options:
explanation: *Mycoplasma pneumoniae* would typically appear present with flu-like symptoms and a possible rash. It also has the potential to cause autoimmune haemolytic anaemia. This patient is most likely to have an infection caused by *legionella pneumoniae* given their blood results.
name: *Mycoplasma pneumoniae*
label: b
answer: no
explanation: *Streptococcus pneumoniae* is one of the most common causes of community-acquired pneumonia so is a good differential. However, the low sodium and deranged LFTs here are indicative of a legionella pneumonia.
name: *Streptococcus pneumoniae*
label: e
answer: no
explanation: *Klebsiella pneumoniae* usually affects patients with weakened immune systems, which includes elderly patients and those with diabetes. It is also a common cause of aspiration pneumonia so may be seen in patients with risk factors for aspiration, such as alcoholics. The patient would usually describe having  ‘’red currant’’ sputum.
name: *Klebsiella pneumoniae*
label: c
answer: no
explanation: *Pneumocystis jirovecii* usually presents as a lower respiratory tract infection in patients who are immunosuppressed e.g. those who are HIV-positive and have a CD4 count is under 200 cells/uL. This patient is most likely to have an infection caused by *legionella pneumoniae* given their blood results.
name: *Pneumocystis jirovecii*
label: d
answer: no
explanation: *Legionella pneumoniae* presents with fevers, muscle pain, shortness of breath, and a dry cough. It causes low sodium levels and deranged LFTs on blood results.
name: *Legionella pneumoniae*
label: a
answer: yes

Correct answer: a
A 23-year-old female attends the emergency department complaining of palpations for the last 15 minutes. She describes feeling dizzy and lightheaded. An ECG is conducted which shows a narrow complex tachycardia with a rate of 150bpm.

Which of the following is the most appropriate initial management for this patient?

Options:
explanation: This patient is currently experiencing an epiosde of supraventricular tachycardia (SVT). The first-line treatment for SVT is to conduct vagal manoeuvres, such as the valsalva manoeuvre where a patient can close their mouth, clamp their nose shut and exhale. Another example of a vagal manoeuvre in this stage would be carotid artery massage.
name: Valsalva manoeuvre
label: a
answer: yes
explanation: Adenosine is a treatment option used to terminate episodes of SVT. However, vagal manoeuvres such as the valsalva manoeuvre should be attempted before adenosine is given.
name: Adenosine
label: b
answer: no
explanation: Verapamil is a treatment option used to terminate episodes of SVT. However, vagal manoeuvres such as the valsalva manoeuvre should be attempted before adenosine is given.
name: Verapamil
label: c
answer: no
explanation: Catheter ablation of an accessory pathway is a treatment option to terminate episodes of SVT. However, vagal manoeuvres such as the valsalva manoeuvre should be attempted before adenosine is given.
name: Catheter ablation of an accessory pathway
label: d
answer: no
explanation: In rare cases, a pacemaker can be inserted to prevent recurrent episodes of SVT. However, in this case it would first be appropriate to attempt vagal manoeuvres to try to terminate this patients SVT.
name: Pacemaker
label: e
answer: no

Correct answer: a