hllj/quesmed huggingface dataset:
A 21 year old female presents to A&E with a 2-day history of worsening pins and needles down her right arm and hand. She reveals she has had a  previous self-limiting episode of left eye pain with loss of vision mainly affecting her colour vision. She has a past medical history of Coeliac disease which is well-controlled with diet.

On examination there is also reduced power in her right upper limb. There are no other examination findings.

Given the most likely diagnosis, what is the best imaging investigation to confirm it?

Options:
explanation: This is not the most suitable imaging for examining soft tissue like the brain and spinal cord in MS. It can help rule out any fractures in the skull.
name: X-Ray Head
label: d
answer: no
explanation: This is not the most suitable imaging for examining soft tissue like brain and spinal cord in MS. It can help rule out more emergent conditions like intracranial haemorrhages.
name: CT Head
label: b
answer: no
explanation: This is not the most suitable imaging for examining soft tissue like the brain and spinal cord in MS. It can help rule out more emergent conditions like intracranial haemorrhages.
name: Ultrasound Head
label: c
answer: no
explanation: Given the patient's age group, presentation of sensory and motor loss, with previous episodes of unilateral painful vision loss, the most likely diagnosis is multiple sclerosis (MS). This refers to auto-inflammatory demyelination of neurones in the central nervous system. MRI is more suitable for scanning the central nervous system as it is sensitive to soft tissue changes. In an MRI, these appear as periventricular white matter lesions. With her presentation with 2 episodes, a finding of 2 or more lesions will lead to a diagnosis of MS
name: MRI of the Head and Spine
label: a
answer: yes
explanation: While this is sensitive to soft tissue and neurological problems, it is not the first line investigation used to diagnose MS. In MS, it will show increased activation of inflammatory cells in white matter and periventricular lesions.
name: PET scan Head
label: e
answer: no

Correct answer: a
A 66 year old male has recently been diagnosed with a type of motor neurone disease called primary lateral sclerosis.

Which of these are signs that will be observed on examination?

Options:
explanation: Hyporeflexia is a sign of lower motor neuron lesions. Weakness can be associated with upper or lower motor neuron lesions.
name: Hyporeflexia and weakness
label: b
answer: no
explanation: While hyperreflexia is a sign of upper motor neuron lesions, downward plantar reflexes are considered normal. Upper motor neuron disease would present with upward plantar reflexes.
name: Hyperreflexia and downward plantar reflexes
label: c
answer: no
explanation: Primary lateral sclerosis (PLS) is a type of motor neurone disease (MND) which only causes upper motor neuron features. This includes hyperreflexia and rigidity.
name: Hyperreflexia and rigidity
label: a
answer: yes
explanation: Hyporeflexia is a sign of lower motor neuron lesions, while spasticity is a sign of upper motor neuron lesions.
name: Hyporeflexia and spasticity
label: d
answer: no
explanation: While hyperreflexia is a sign of upper motor neuron lesions, fasciculations are observed in lower motor neuron disease.
name: Hyperreflexia and fasciculations
label: e
answer: no

Correct answer: a
A 70-year-old male is brought into A&E by his wife due to behavioural changes observed for the last 1 month. This was preceded by a fall down the stairs. The patient appears to have slurred speech and also complains of dull headache and appears confused.

He has a past medical history of hypertension and atrial fibrillation, for which he takes ramipril and warfarin.

A CT scan of his head shows a left-sided crescent-shaped hypodense lesion crossing the sutures of the skull. What is the most likely type of pathology?

Options:
explanation: This would present with the sudden onset thunderclap headache. On CT scan, this would appear as hyperdensity in the subarachnoid space including the ventricles and cerebral cortical lining.
name: Subarachnoid haemorrhage
label: d
answer: no
explanation: The presentation of the patient is suggestive of a chronic subdural haemorrhage. On a CT scan, this appears as a hypodense crescent-shaped lesion which extends across the sutures of the skull. Sometimes, there may be mass effect causing midline shift or sulcal effacement.
name: Subdural haemorrhage
label: a
answer: yes
explanation: This would present more acutely, especially after trauma. On a CT scan, this would appear as a hyperdense lentiform or lemon-shaped hyperdense lesion, not crossing the skull sutures.
name: Extradural haemorrhage
label: b
answer: no
explanation: Ischaemic stroke can be a differential diagnosis, given the patient's presentation. On CT scan, a chronic ischaemic stroke would appear as a hypodense lesion in the cerebral cortex, with associated mass effect.
name: Ischaemic stroke
label: c
answer: no
explanation: This refers to an intracerebral haemorrhage and would present more acutely with stroke-like symptoms. On a CT scan, this would appear as a hyperdense collection in the cerebral cortex with surrounding hypodense oedema.
name: Intraparenchymal haemorrhage
label: e
answer: no

Correct answer: a
A man is being tested for visual field loss with an MRI. This reveals a lesion on the left parietal optic radiation.

What type of visual field defect is he experiencing?

Options:
explanation: This would be due to a lesion in the right occipital cortex
name: Left homonymous hemianopia with macular sparing
label: d
answer: no
explanation: This would be due to a lesion in the right optic tract
name: Left homonymous hemianopia
label: e
answer: no
explanation: This would be due to a lesion in the right temporal homonymous quadrantanopia
name: Left inferior homonymous quadrantonopia
label: b
answer: no
explanation: The left-sided parietal optic radiation carries information from the right lower visual field. Hence, a lesion in this would lead to right inferior homonymous quadrantanopia
name: Right inferior homonymous quadrantanopia
label: a
answer: yes
explanation: This would be due to a lesion in the left optic nerve
name: Left monocular blindness
label: c
answer: no

Correct answer: a
A 55-year-old male presents in A&E with his family due to altered speech for the last 3 hours. He is noted to have non-sensical speech that sounds like fluent jargon. He has a past medical history of atrial fibrillation.

On examination, he is not able to follow instructions well. There are no other neurological signs. What artery is most likely to have been affected?

Options:
explanation: Stroke in the posterior inferior cerebellar artery causes cerebellar dysfunction, bilateral motor and sensory deficits, or visual movement or field defects. It rarely affects speech
name: Posterior inferior cerebellar artery
label: e
answer: no
explanation: This artery supplies the temporal cortex which contains the Wernicke's area. The type of aphasia this man is presenting with is receptive or Wernicke's aphasia, typically presenting with the inability to understand information and production of fluent jargon.
name: Middle cerebral artery
label: a
answer: yes
explanation: Stroke in the lenticulostriate arteries leads to pure sensory or motor symptoms, and rarely affects the speech. Typically, it would present with dysarthria or difficulty articulating words.
name: Lenticulostriate arteries
label: d
answer: no
explanation: Stroke in ACA leads to mixed contralateral motor and sensory symptoms, and expressive or Broca's aphasia, typically presenting with difficulty forming and completing sentences.
name: Anterior cerebral artery
label: b
answer: no
explanation: Stroke in the basilar artery leads to locked-in syndrome with motor and sensory symptoms, and dysarthria, typically presenting with difficulty articulating words.
name: Basilar artery
label: c
answer: no

Correct answer: a
A 20year old male presents to A&E after falling down 2 flights of stairs. He has no significant past medical history.

On assessment, his eyes remain closed on painful stimuli. He also moans to the painful stimulus and his arms are in a flexed position away from body.

What is his Glasgow Coma Scale?

Options:
explanation: E3: eyes open to painful stimulus
V2: only moans and groans
M4: normal flexion to painful stimulus
name: E2 V2 M4
label: b
answer: no
explanation: E2: eyes opening to painful stimulus
V3: intelligible single words
M4: normal flexion to painful stimulus
name: E2 V3 M4
label: e
answer: no
explanation: E1: no eye opening at any time
V2: only moans and groans
M3: abnormal flexion to painful stimulus
name: E1 V2 M3
label: c
answer: no
explanation: E1: no eye opening at any time
V2: only moans and groans
M4: normal flexion to painful stimulus
name: E1 V2 M4
label: a
answer: yes
explanation: E1: no eye opening at any time
V3: intelligible single words
M4: normal flexion to painful stimulus
name: E1 V3 M4
label: d
answer: no

Correct answer: a
An 8-year-old boy is brought into GP with 2 day history of ear pain in his right ear and reduced hearing. On examination, he has a red swollen tympanic membrane in the right ear, normal examination of left ear.

The GP diagnoses him with otitis media. What will be the observations on doing Weber’s and Rinne’s tests on him?

Options:
explanation: This would indicate bone conduction is better than air conduction in the unaffected ear.
name: Weber's lateralises to left ear
label: d
answer: no
explanation: Otitis media is a form of conductive hearing loss, that affects air conduction. In this type of hearing loss, Weber's lateralises to the affected ear as bone conduction is better than air conduction.
name: Weber's lateralises to right ear
label: a
answer: yes
explanation: This would indicate air conduction is better than bone conduction in the affected ear.
name: Rinne's positive in right ear
label: c
answer: no
explanation: This would indicate there is no conductive hearing loss in the affected ear, which is unlikely.
name: No lateralisation with Weber's test
label: e
answer: no
explanation: This would indicate air conduction is better than bone conduction in the affected ear.
name: Rinne's positive in the right ear
label: b
answer: no

Correct answer: a
A 27 year old male presents to his GP with a 1 month history of sharp right-sided headaches. On taking a history, he reports the pain to be a 10/10, coming on suddenly at night and lasting about 30 minutes. He also mentions that his right eye waters when he has the headache.

He is known to smoke 10 cigarettes a day. Given the most likely type of headache, what is a definitive treatment when he has an acute attack?

Options:
explanation: This is used as a prophylaxis for cluster headaches.
name: Verapamil
label: c
answer: no
explanation: This is not shown to be effective in cluster headaches.
name: Paracetamol
label: b
answer: no
explanation: Given the most likely diagnosis of cluster headaches, 100% oxygen and sumatriptan are used to acutely treat them.
name: 100% Oxygen
label: a
answer: yes
explanation: This is used as a prophylaxis for cluster headaches.
name: Prednisolone
label: e
answer: no
explanation: This is not shown to be effective in cluster headaches.
name: Ibuprofen
label: d
answer: no

Correct answer: a
A 78 year old male is seen in the ENT clinic for bilateral hearing loss. The man complains it is worse in the left ear and does not report any ear pain, fullness, tinnitus, discharge, nausea and vomiting, or loss of balance.
There are no findings on examining the ears.

On performing audiometry, the audiogram shows two overall downward sloping lines indicating loss of hearing at high frequencies.

What is the most likely cause of hearing loss?

Options:
explanation: This is unlikely as the patient would present with symptoms of loss of balance, vertigo, nausea and vomiting, along with hearing loss.
name: Labyrinthitis
label: e
answer: no
explanation: This would present with symptoms of ear fullness and tinnitus, in younger patients. The audiogram would also have shown loss of hearing at low frequency.
name: Meniere's disease
label: c
answer: no
explanation: This is unlikely as an ear examination would have shown fluid behind the tympanic membrane. The audiogram would also have indicated conductive hearing loss.
name: Otitis media with effusion
label: b
answer: no
explanation: The audiogram is indicative of bilateral sensorineural hearing loss. Given the age and presentation of the patient, it is most likely to be age-related hearing loss due to degeneration of cochlea or auditory nerves, known as presbyacusis.
name: Presbycusis
label: a
answer: yes
explanation: This would present with symptoms of ear pain and discomfort, rather than hearing loss. An ear examination would show inflammation of the ear canal.
name: Otitis externa
label: d
answer: no

Correct answer: a
Children with Down's syndrome are at risk of Eustachian tube dysfunction, which can cause conductive hearing loss.

What is the function of the Eustachian tube?

Options:
explanation: This is the function of the bony ossicles, malleus, incus and stapes in the middle ear.
name: Transmit sound waves from the tympanic membrane to the inner ear
label: b
answer: no
explanation: This is the function of the cochlea.
name: Converts sound waves into electrical signals for auditory transduction
label: e
answer: no
explanation: This is the function of the auricle or pinna.
name: Collect sound waves from outside and channel them into the external auditory meatus for amplification
label: c
answer: no
explanation: The Eustachian tube is a space connecting the middle ear cavity of both ears to the nasopharynx. It is involved in equalising the air pressure on the inner and outer sides of both the tympanic membranes. It also helps drain fluids and secretions from the middle ear and prevents middle ear infections.
name: Normalise the air pressure on both sides of each tympanic membrane
label: a
answer: yes
explanation: This is the function of the vestibule.
name: Provide a sense of balance and spatial awareness for coordination
label: d
answer: no

Correct answer: a
Stapedius muscle acts on the stapedius to stabilise it and prevent oscillation. Damage to the muscle or innervation can lead to hyperacusis or hypersensitivity to loud noises.

Palsy of which cranial nerve will lead to this hyperacusis?

Options:
explanation: This is incorrect as a branch of the facial nerve supplies the stapedius.
name: Hypoglossal nerve
label: d
answer: no
explanation: Facial nerve branches into the chorda tympani and nerve to stapedius after the internal auditory meatus. This supplies the stapedius muscle in the middle ear.
name: Facial nerve
label: a
answer: yes
explanation: This is incorrect as a branch of the facial nerve supplies the stapedius.
name: Vagal nerve
label: b
answer: no
explanation: This is incorrect as a branch of the facial nerve supplies the stapedius.
name: Vestibulocochlear nerve
label: c
answer: no
explanation: This is incorrect as branch of the facial nerve supplies the stapedius.
name: Trigeminal nerve
label: e
answer: no

Correct answer: a
A 76-year-old female comes into GP with a 6 month history of visual hallucinations and fluctuating cognition. She also mentions she has noticed a tremor in her right hand for the last year.

On examination, she has a resting tremor and cog wheeling rigidity in her right hand. Her gait is slow with a stooped posture and she is slow to turn.

What is the most likely diagnosis?

Options:
explanation: This would present with a step-wise decline in cognitive function, with minimal effect on motor function.
name: Vascular dementia
label: d
answer: no
explanation: There is no drug history mentioned that may indicate drug-induced dementia. It would also lead to bilateral symptoms.
name: Drug-induced Parkinsonism
label: c
answer: no
explanation: This would present with cognitive decline >1 year after the onset of Parkinsonism.
name: Parkinson's disease
label: e
answer: no
explanation: The woman has presented with features of Parkinsonism with the onset of fluctuating cognition and visual hallucinations in <1 year. This is characteristic of Parkinson's disease dementia
name: Parkinson's disease dementia
label: a
answer: yes
explanation: In this, the woman would have presented with the Parkinsonism >1 year after onset of cognitive decline.
name: Dementia with Lewy body
label: b
answer: no

Correct answer: a
A 82 year is on levodopa and carbidopa for Parkinson's disease.

What is the mechanism of action of carbidopa?

Options:
explanation: Carbidopa is given along with levodopa for symptomatic relief in Parkinson's disease. It reduces the conversion of L-dopa to dopamine in the periphery and prevent side effects. This increases the central effect of dopamine and reduces symptoms.
name: Peripheral dopamine decarboxylase inhibitor
label: a
answer: yes
explanation: These are drugs like rasagiline and selegiline. These reduce breakdown of dopamine in the CNS and reduce symptoms of Parkinson's.
name: Monoamine oxidase inhibitor
label: d
answer: no
explanation: These are drugs like tolcapone, entacapone. These reduce breakdown of dopamine in the CNS and reduce symptoms of Parkinson's.
name: COMT inhibitors
label: e
answer: no
explanation: This is levodopa. This is converted to dopamine in the CNS and reduces symptoms of Parkinson's.
name: Dopamine precursor
label: c
answer: no
explanation: These are drugs like retigabine and pramipexole. These stimulate the central nervous syndrome and reduce symptoms in Parkinson's.
name: Dopamine agonist
label: b
answer: no

Correct answer: a
A 23-year-old woman is in labour and is getting a spinal block for pain relief.

Which layer of the meninges is the spinal block administered during childbirth?

Options:
explanation: This is incorrect, spinal blocks are injected in the epidural space.
name: Subdural space
label: e
answer: no
explanation: This is incorrect, spinal blocks are injected in the epidural space.
name: Dura mater
label: d
answer: no
explanation: This is incorrect, spinal blocks are injected in the epidural space.
name: Pia mater
label: c
answer: no
explanation: This is the space between the dura mater and arachnoid mater. Local anaesthetic is injected into the epidural space at the L2-3 or L3-4 vertebral level.
name: Epidural space
label: a
answer: yes
explanation: This is incorrect, spinal blocks are injected in the epidural space.
name: Subarachnoid space
label: b
answer: no

Correct answer: a
A man is on an anticoagulant, warfarin, for Atrial Fibrillation.

Which clotting factors does warfarin act upon?

Options:
explanation: This is incorrect, warfarin inhibits factors II, VII, IX, and X.
name: Factor II only
label: b
answer: no
explanation: Warfarin inhibits vitamin K reductase which prevents the activation of factors II, VII, IX, X in the clotting cascade.
name: Factors II, VII, IX and X
label: a
answer: yes
explanation: This is incorrect, warfarin inhibits factors II, VII, IX, X.
name: Factors IX and X only
label: c
answer: no
explanation: This is incorrect, warfarin inhibits factors II, VII, IX, X
name: Factors II, IX, XI and XII
label: e
answer: no
explanation: This is incorrect, warfarin inhibits factors II, VII, IX, X
name: Factors IX, XI and XII
label: d
answer: no

Correct answer: a
A 78-year-old male has come to his GP for a review after having a myocardial infarction 3 weeks ago. He has newly been started on aspirin, ticagrelor, ramipril, atorvastatin and bisoprolol.

He complains of pain in his thighs. On examination, there is bilateral weakness in the thighs.

What is the most likely cause of this weakness and pain in his thighs?

Options:
explanation: Muscle weakness is not a side effect of aspirin.
name: Aspirin
label: b
answer: no
explanation: One of the most common side effects of statin use is muscle pain. Rarely, it may lead to myopathy or myositis, especially in larger muscles like the quadriceps in the thighs. The patient's presentation with bilateral thigh weakness and pain is more suggestive of statin-induced myositis. This requires urgent blood and cessation of statins.
name: Simvastatin
label: a
answer: yes
explanation: Muscle weakness is not a side effect of ticagrelor.
name: Ticagrelor
label: c
answer: no
explanation: Muscle weakness is not a common side effect of ramipril.
name: Ramipril
label: e
answer: no
explanation: Muscle weakness is not a side effect of bisoprolol.
name: Bisoprolol
label: d
answer: no

Correct answer: a
A 2-year-old is diagnosed with a primary immunodeficiency.

Which vaccine can he not take?

Options:
explanation: This is a conjugate vaccine, not a live vaccine. Hence, it is not contraindicated in this immunosuppressed patient.
name: Pneumococcal vaccine
label: b
answer: no
explanation: This is a conjugate vaccine, not a live vaccine. Hence, it is not contraindicated in this immunosuppressed patient.
name: Haemophilus influenza B
label: c
answer: no
explanation: The child has a primary immunodeficiency, which means he is immunosuppressed. MMR is a live vaccine which is contraindicated in this group of patients.
name: Measles, Mumps and Rubella (MMR)
label: a
answer: yes
explanation: This is an inactivated toxin vaccine, not a live vaccine. Hence, it is not contraindicated in this immunosuppressed patient.
name: Tetanus
label: e
answer: no
explanation: This is a conjugate vaccine, not a live vaccine. Hence, it is not contraindicated in this immunosuppressed patient.
name: Meningitis
label: d
answer: no

Correct answer: a
A 43-year-old female comes into A&E with pain in her hip following a fall from standing height. On conducting an X-Ray of her hip, there is found to be a fractured neck of the femur.

She has recently moved from Iceland, and has a past medical history of poorly controlled Coeliac disease. She complains that she has recently been experiencing pain and weakness in her lower back and legs.

What condition is she highly likely to have?

Options:
explanation: Osteopenia refers to weakening of bone without risk of fragility fractures. She may have osteopenia, however, her symptoms of bone pain and muscle weakness are characteristic of osteomalacia.
name: Osteopaenia
label: e
answer: no
explanation: Osteomalacia refers to inadequate levels of vitamin D and calcium in the body that result in softening of bones in adults. It increases the likelihood of fractures. Given this woman's history of Coeliac disease and stay in Iceland, it is likely that she has a vitamin D and calcium deficiency. Her symptoms of  bone pain and muscle weakness are also characteristic of it.
name: Osteomalacia
label: a
answer: yes
explanation: This refers to weaker bones resulting in fragility fractures and increased likelihood of fractures. She may have osteoporosis, however, her symptoms of bone pain and muscle weakness are characteristic of osteomalacia.
name: Osteoporosis
label: b
answer: no
explanation: Osteopetrosis refers to abnormal bone growth causing overly dense bones and increased likelihood of fractures. This is more common in childhood and does not present with symptoms of bone pain and muscle weakness.
name: Osteopetrosis
label: c
answer: no
explanation: This is osteomalacia in children, characterised by bow legs, poor growth and bone pain.
name: Rickets
label: d
answer: no

Correct answer: a