hllj/quesmed huggingface dataset:
A 35 year old woman has recently given birth to her daughter on the labour ward. She asks her midwife about how best to feed her new baby when she leaves the ward to go home. The team signpost her to the World Health Organisation (WHO) advice regarding breastfeeding.

For how long does the WHO recommend that mothers exclusively breastfeed their new-born?

Options:
explanation: The advice from the WHO is to exclusively breastfeed during the period from birth until they are 6 months old. Breastfeeding in combination with other food and drinks may be continued beyond this time. Benefits of breastfeeding include a reduced risk of neonatal infection and improved digestive function.
name: 6 months
label: a
answer: yes
explanation: The advice from the WHO is to exclusively breastfeed during the period from birth until they are 6 months old. Breastfeeding in combination with other food and drinks may be continued beyond this time. Benefits of breastfeeding include reduced risk of neonatal infection and improved digestive function.
name: 1 year
label: e
answer: no
explanation: The advice from the WHO is to exclusively breastfeed during the period from birth until they are 6 months old. Breastfeeding in combination with other food and drinks may be continued beyond this time. Benefits of breastfeeding include reduced risk of neonatal infection and improved digestive function.
name: 2 years
label: b
answer: no
explanation: The advice from the WHO is to exclusively breastfeed during the period from birth until they are 6 months old. Breastfeeding in combination with other food and drinks may be continued beyond this time. Benefits of breastfeeding include reduced risk of neonatal infection and improved digestive function.
name: 3 months
label: d
answer: no
explanation: The advice from the WHO is to exclusively breastfeed during the period from birth until they are 6 months old. Breastfeeding in combination with other food and drinks may be continued beyond this time. Benefits of breastfeeding include reduced risk of neonatal infection and improved digestive function.
name: 1 month
label: c
answer: no

Correct answer: a
A 52 year old male presents to the emergency department with his wife. He states that he does not know where he is, and is seen stumbling around the department clumsily. On examination he is found to have bilateral nystagmus. His wife reports that he has been suffering from chronic alcoholism for at least twenty years.

Which of the following vitamins is most likely to be deficient in the condition this man is exhibiting?

Options:
explanation: Thiamine (vitamin B1) deficiency is often seen in individuals with chronic alcohol exposure. It manifests itself as a triad of confusion (demonstrated by this man not knowing where he is), ataxia (seen in the man's clumsy movements) and ophthalmoplegia (seen in the man's nystagmus). This triad is known as Wernicke's encephalopathy.
name: Vitamin B1
label: a
answer: yes
explanation: Deficiency in vitamin A leads to problems with sight and visual loss. By contrast, this man demonstrates confusion (not knowing where he is), ataxia (clumsy movements) and ophthalmoplegia (nystagmus). This triad is known as Wernicke's encephalopathy and is due to B1 deficiency, secondary to chronic alcoholism.
name: Vitamin A
label: e
answer: no
explanation: Deficiency of vitamin C leads to scurvy, with symptoms of gingival hypertrophy and bleeding. By contrast, this man demonstrates confusion (not knowing where he is), ataxia (clumsy movements) and ophthalmoplegia (nystagmus). This triad is known as Wernicke's encephalopathy and is due to B1 deficiency, secondary to chronic alcoholism.
name: Vitamin C
label: b
answer: no
explanation: Deficiency of vitamin B3 leads to the condition pellagra, recognised by the triad of dermatitis, dementia and diarrhoea. By contrast, this man demonstrates confusion (not knowing where he is), ataxia (clumsy movements) and ophthalmoplegia (nystagmus). This triad is known as Wernicke's encephalopathy and is due to B1 deficiency, secondary to chronic alcoholism.
name: Vitamin B3
label: c
answer: no
explanation: Deficiency in vitamin D leads to osteomalacia or rickets, where bones are weak due to inadequate mineralisation. By contrast, this man demonstrates confusion (not knowing where he is), ataxia (clumsy movements) and ophthalmoplegia (nystagmus). This triad is known as Wernicke's encephalopathy and is due to B1 deficiency, secondary to chronic alcoholism.
name: Vitamin D
label: d
answer: no

Correct answer: a
A 62 year old male with deranged liver function tests is diagnosed with a chronic hepatitis C infection. His gastroenterologist recommends starting a new anti-viral medication, sofosbuvir.

Which of the following best describes the mechanism of action of sofosbuvir?

Options:
explanation: This describes the mechanism of action of anti-viral drugs such as oseltamivir (Tamiflu). Sofosbuvir is a nucleotide analogue that inhibits viral ribonucleic acid (RNA) polymerase and as a result, leads to defunctive RNA replication and premature death of the virus.
name: Inhibits viral release from host cell
label: d
answer: no
explanation: This describes the mechanism of drugs such as enfuvirtide, which is used to treat human immunodeficiency virus (HIV). Sofosbuvir is a nucleotide analogue that inhibits viral ribonucleic acid (RNA) polymerase and as a result, leads to defunctive RNA replication and premature death of the virus.
name: Inhibits viral to host cell fusion
label: b
answer: no
explanation: Sofosbuvir is a nucleotide analogue that inhibits viral ribonucleic acid (RNA) polymerase and as a result, leads to defunctive RNA replication and premature death of the virus.
name: Inhibits viral nucleic acid replication
label: a
answer: yes
explanation: This describes the mechanism of antiviral drugs such as amantadine, which treats certain influenza infections. It works by stopping the virus from releasing its genetic material once inside the host cell. Sofosbuvir is a nucleotide analogue that inhibits viral ribonucleic acid (RNA) polymerase and as a result, leads to defunctive RNA replication and premature death of the virus.
name: Inhibits viral uncoating
label: c
answer: no
explanation: This describes the mechanism of action of ledipasvir, which is also used in hepatitis C  treatment. It inhibits a protein that is required for viral replication. Sofosbuvir is a nucleotide analogue that inhibits viral ribose nucleic acid (RNA) polymerase and as a result, leads to defunctive RNA replication and premature death of the virus.
name: Inhibits viral protein synthesis
label: e
answer: no

Correct answer: a
A 22 year old woman presents to her GP with a change to her vaginal discharge. She says it is white and looks a little like cottage cheese. It is accompanied by some vulvar itchiness. She is 23 weeks pregnant with her first child, but the pregnancy has been uncomplicated so far. Her observations are all within the normal range, and a urine dip shows no abnormalities.

Which of the following microorganisms is most likely to account for this woman's symptoms?

Options:
explanation: Herpes infections of the genitals are associated with painful, blistering genital ulcers. By contrast white, 'cottage cheese' discharge along with itchiness is characteristic of vaginal candidiasis, or thrush. This is caused by Candida albicans.
name: Herpes-simplex virus 1
label: e
answer: no
explanation: The white, 'cottage cheese' appearance of the discharge along with itchiness is characteristic of vaginal candidiasis, or thrush. This is caused by Candida albicans. Being pregnant is an additional risk factor for developing thrush.
name: Candida albicans
label: a
answer: yes
explanation: Molluscum contagiosum infection is associated with small, pearly lesions across the genitals or all over the body. By contrast white, 'cottage cheese' discharge along with itchiness is characteristic of vaginal candidiasis, or thrush. This is caused by Candida albicans.
name: Molluscum contagiosum
label: b
answer: no
explanation: Genital discharge from Neisseria gonorrhoea is mucopurulent in nature. By contrast white, 'cottage cheese' discharge along with itchiness is characteristic of vaginal candidiasis, or thrush. This is caused by Candida albicans.
name: Neisseria gonorrhoea
label: d
answer: no
explanation: Chlamydia trachomatis is a sexually transmitted infection that can manifest in a number of ways. Although it can cause changes to vaginal discharge, this is not typically white or 'cottage cheese-like'. The white, 'cottage cheese' appearance of the discharge reported in this case is characteristic of vaginal candidiasis, or thrush. This is caused by Candida albicans.
name: Chlamydia trachomatis
label: c
answer: no

Correct answer: a
A 33 year old marathon runner is attending a specialist gynaecological clinic to discuss her secondary amenorrhoea. She is interested in learning more about her menstrual cycle.

At which of the following points of the menstrual cycle would progesterone levels be expected to peak?

Options:
explanation: During ovulation, a surge in luteinizing hormone causes the dominant follicle to release an ovum from the ovary. Progesterone levels slowly build up to a peak after this, with ongoing secretion from the corpus luteum.
name: Ovulation
label: c
answer: no
explanation: During the luteal phase, the corpus luteum releases peak levels of progesterone. This functions to thicken the uterine lining and prepare for implantation. If implantation occurs, the corpus luteum continues to secrete progesterone to maintain the embryo. If there is no implantation, the corpus luteum degenerates and the cycle is restarted.
name: Luteal phase
label: a
answer: yes
explanation: During the menstruation phase, follicle-stimulating hormone and luteinizing hormone levels are above that of progesterone and oestrogen respectively. The lining of the uterus is shed from the body due to the lack of implantation.
name: Menstruation
label: b
answer: no
explanation: The dominant hormone during the follicular phase is oestrogen. Oestrogen is secreted by the granulosa cells that surround follicles causing them to mature and be ready for ovulation.
name: Follicular phase
label: d
answer: no
explanation: This is not a recognised part of the menstrual cycle. During the luteal phase, the corpus luteum releases peak levels of progesterone to thicken the uterine lining and prepare for implantation. If implantation occurs, the corpus luteum continues to secrete progesterone to maintain the embryo. If there is no implantation then the corpus luteum degenerates and the cycle is restarted
name: The thrombocytic phase
label: e
answer: no

Correct answer: a
A 30 year old man is having a picnic with his family when he suddenly stops what he is doing, stumbles to the ground and loses consciousness. His muscles visibly stiffen and his legs and arms begin to rhythmically jerk. He has a known history of epilepsy.

Which of the following terms best describes the type of epileptic seizure demonstrated?

Options:
explanation: Myoclonic seizures involve brief, non-rhythmic jerking spasms of a muscle or group of muscles. The rhythmic jerking and muscular stiffness of this case are more indicative of a tonic-clonic seizure.
name: Myoclonic seizure
label: c
answer: no
explanation: The key to this question is the rhythmic jerking of the patient's limbs coupled with muscular stiffness. These are characteristic of a tonic-clonic seizure (also called grand mal or convulsive seizures). Additional features of this type of seizure not present in this case include urinary incontinence and tongue biting.
name: Tonic-clonic seizure
label: a
answer: yes
explanation: This type of seizure is characterised by a loss of muscle tone, with consciousness normally retained. The rhythmic jerking and muscular stiffness of this case are more indicative of a tonic-clonic seizure.
name: Atonic
label: d
answer: no
explanation: Absence seizures present with brief periods of impaired awareness or responsiveness, lasting less than 20 seconds. The rhythmic jerking and muscular stiffness of this case are more indicative of a tonic-clonic seizure.
name: Absence seizure
label: b
answer: no
explanation: This is not an epileptic-type seizure. They tend to occur in children who also have a febrile illness. The patient in this case is an adult with known epilepsy, and no febrile illness is noted. This is therefore not the most likely option.
name: Febrile seizure
label: e
answer: no

Correct answer: a
A 38 year old man is unfortunately diagnosed with colorectal cancer, following a colonoscopy and biopsy. He undergoes a CT and PET-CT scan of the chest, abdomen and pelvis for staging purposes. This indicates a colonic tumour that had extended into the bowel muscularis but not through the subserosa. Two regional lymph nodes also show evidence of disease. No distant metastasis was found.

Which of the following tumour, node, metastasis (TNM) stages best describes this man's condition?

Options:
explanation: This patient demonstrates a tumour that extends through the submucosa and into the muscularis (T2), involvement of two lymph nodes (N1) and no distant metastases (M0).
name: T4 N1 M0
label: c
answer: no
explanation: This patient demonstrates a tumour that extends through the submucosa and into the muscularis (T2), involvement of two lymph nodes (N1) and no distant metastases (M0).
name: T3 N1 M0
label: d
answer: no
explanation: This patient demonstrates a tumour that extends through the submucosa and into the muscularis (T2), involvement of two lymph nodes (N1) and no distant metastases (M0).
name: T4 N2 M0
label: b
answer: no
explanation: The following explains the TNM system with regard to colorectal cancer:

Tumour size:

* Tis - in situ
* T1 - Extends through mucosa into submucosa
* T2 - Extends through submucosa into muscularis
* T3 - Extends through muscularis into subserosa
* T4 - Extends into neighbouring organs

Regional lymph Node involvement:

* N0
* N1 - 1-3 nodes
* N2 - 4+ regional nodes

Distant metastasis present :

* M0 - No metastasis
* M1 - metastasis present

This patient demonstrates a tumour that extends through the submucosa and into the muscularis (T2), involvement of two lymph nodes (N1) and no distant metastases (M0).
name: T2 N1 M0
label: a
answer: yes
explanation: This patient demonstrates a tumour that extends through the submucosa and into the muscularis (T2), involvement of two lymph nodes (N1) and no distant metastases (M0).
name: T3 N1 M1
label: e
answer: no

Correct answer: a
A 20 year old male presents to his GP complaining of recurrent frank haematuria when passing urine for the past 24 hours. He had a sore throat around three days earlier but denies any other past medical history or relevant family history. Observations are within normal limits, aside from a raised blood pressure of 150/95.

Which of the following is the most likely underlying diagnosis?

Options:
explanation: Any patient presenting with haematuria and hypertension should raise suspicion of nephritic syndrome. Patients suffering from Anti-GBM are more likely to present with features of lung disease (e.g., haemoptysis and shortness of breath) in addition to signs of nephritic syndrome. In this case, the fact the patient was suffering from a potential upper respiratory tract infection (URTI) only a few days prior makes this more likely to be IgA nephropathy.
name: Anti-Glomerular Basement Membrane disease (Anti-GBM)
label: c
answer: no
explanation: Any patient presenting with haematuria and hypertension should raise suspicion of nephritic syndrome. In this case, the fact the patient was suffering from a potential upper respiratory tract infection (URTI) only a few days prior makes this more likely to be IgA nephropathy. Post-infectious glomerulonephritis tends to manifest 1 - 3 weeks after a streptococcal URTI.
name: Post-infectious Glomerulonephritis
label: b
answer: no
explanation: Any patient presenting with haematuria and hypertension should raise suspicion of nephritic syndrome. In this case, the fact the patient was suffering from a potential upper respiratory tract infection only a few days prior makes this more likely to be IgA nephropathy.  The gold-standard method for diagnosis is renal biopsy, although urinalysis and urine cultures are also necessary.
name: IgA nephropathy
label: a
answer: yes
explanation: Any patient presenting with haematuria and hypertension should raise suspicion of nephritic syndrome. Alport syndrome is a genetic condition, typically presenting with nephritic features alongside hearing loss and eye abnormalities. In this case, there is no evidence of hearing or eye abnormalities. IgA nephropathy is therefore the most likely diagnosis.
name: Alport syndrome
label: d
answer: no
explanation: Patients with membranoproliferative glomerulonephritis can present with a mixture of nephritic and nephrotic features, although nephritis features are most common. They typically also suffer from autoimmune conditions or hepatitis C. The patient in this case is otherwise fit and well, making IgA nephropathy the most likely diagnosis.
name: Membranoproliferative glomerulonephritis
label: e
answer: no

Correct answer: a
A 38 year old male presents to the emergency department with sudden onset epigastric pain that radiates to his back. The pain is eased somewhat by leaning forward. On examination, he is extremely tender in the epigastric region and has extensive bruising alongside his right flank.

He has a past medical history of gallstone disease, but is otherwise well with no regular medications. He drinks moderate amounts of alcohol, around 10 units a week.

Which of the following biochemical markers are specifically elevated in the most likely underlying diagnosis?

Options:
explanation: This presentation is characteristic of acute pancreatitis. It is characterised by severe epigastric pain that may radiate to the back, as well as nausea and vomiting in some cases. Anti-CCP is a serum biomarker usually indicative of a patient suffering from rheumatoid arthritis. It is not typically raised in acute pancreatitis.
name: Anti-Cyclic Citrullinated Peptide (Anti-CCP)
label: b
answer: no
explanation: This presentation is characteristic of acute pancreatitis. It is characterised by severe epigastric pain that may radiate to the back, as well as nausea and vomiting in some cases. Although hypocalcaemia is often seen in acute pancreatitis, it is not a specific marker for diagnostic purposes.
name: Hypocalcaemia
label: c
answer: no
explanation: This presentation is characteristic of acute pancreatitis. ESR is a generic serum biomarker used to indicate inflammation. Whilst it may also be raised in acute pancreatitis, ESR is a less specific indicator of pancreatitis in comparison to serum amylase or lipase.
name: Erythrocyte sedimentation rate (ESR)
label: d
answer: no
explanation: This presentation is characteristic of acute pancreatitis. ANA is a marker of a wide range of autoimmune diseases. It is not specifically associated with pancreatitis, particularly as the most likely underlying cause in this case is gallstones.
name: Antinuclear antibody (ANA)
label: e
answer: no
explanation: This presentation is characteristic of acute pancreatitis. It is characterised by severe epigastric pain that may radiate to the back, as well as nausea and vomiting in some cases. This patient also demonstrates Grey-Turner's sign: bruising to the flank indicating retroperitoneal bleeding associated with acute pancreatitis. Gallstones are a known cause of acute pancreatitis, as is alcohol excess. An amylase three times the upper limit of normal is indicative of acute pancreatitis, making this the correct answer. Similarly, lipase is another sensitive and specific marker or acute pancreatitis.
name: Amylase
label: a
answer: yes

Correct answer: a
A 32 year old primiparous woman enters labour on the maternity ward. Her cervix has dilated to 5cm, and is progressing by roughly a centimetre every 2 hours.

Which of the following stages of labour is the patient in?

Options:
explanation: The 1st stage of labour involves the initiation of contractions and dilation of the cervix to 10 cm. The latent stage covers cervical dilation from 0 to 3 cm and is characterised by irregular contractions. Dilation is expected to occur at a rate of 1cm every 2 hours for a woman who has not given birth before and at 1 cm every 1 hour if they have.
name: Latent 1st stage
label: b
answer: no
explanation: The 2nd stage of labour involves the descent of the baby into the pelvis through to its delivery. By contrast, the 1st stage of labour involves the initiation of contractions and dilation of the cervix to 10 cm. The active phase specifically is from 4cm to 10 cm dilation and involves more powerful regular contractions, preparing for birth. This period is also referred to as established labour. This case therefore describes the 1st stage active phase of labour.
name: 2nd stage
label: c
answer: no
explanation: The 3rd stage of labour covers the time from when the baby has been delivered through to delivery of the placenta. It typically lasts from 30 minutes to 1 hour but can be sped up by exogenous oxytocin administration. The 1st stage of labour involves the initiation of contractions and dilation of the cervix to 10 cm. The active phase specifically is from 4cm to 10 cm and involves more powerful regular contractions, preparing for birth. This period is also referred to as established labour.  This case therefore describes the 1st stage active phase of labour.
name: 3rd stage
label: d
answer: no
explanation: The 1st stage of labour involves the initiation of contractions and dilation of the cervix up to 10 cm. It can be further subdivided into the active 1st stage and the latent 1st stage. The active 1st stage is defined as cervical dilation from 4 to 10 cm and involves more powerful regular contractions, preparing for birth. This period is also referred to as established labour.
name: Active 1st stage
label: a
answer: yes
explanation: This is not a recognised stage of labour. The first stage of labour consists of the latent phase (0-3 cm of cervical dilation) and the active/established phase (4 - 10 cm dilation). This case describes the 1st stage active phase of labour.
name: Engaged 1st stage
label: e
answer: no

Correct answer: a