hllj/quesmed huggingface dataset:
A 21-year-old male attends his GP with dysuria that began eight days ago. He also reports some increased urinary frequency and foul smelling urine. A urine dipstick is positive for nitrites and leucocytes. All other observations are within the normal range.

Which of the following is the most appropriate management?

Options:
explanation: For a male with a suspected urinary tract infection, the correct treatment would be treatment with nitrofurantoin for seven days. A single dose of Nitrofurantoin is not enough.
name: Single dose of nitrofurantoin
label: e
answer: no
explanation: This medication would not be an appopiate first-line choice for a urinary tract infection. Pivmecillinam may be an option there is no improvement with a first choice antimicrobial or if a first choice is not suitable.
name: Pivmecillinam for three days
label: c
answer: no
explanation: This patient is presenting with a suspected urinary tract infection. The correct treatment for a male with a suspected lower urinary tract infection is nitrofurantoin for seven days.
name: Nitrofurantoin for seven days
label: a
answer: yes
explanation: The correct treatment for a male with a suspected lower urinary tract infection is nitrofurantoin for seven days, not five days.
name: Nitrofurantoin for five days
label: b
answer: no
explanation: This patient is presenting with symptoms of a urinary tract infection. IV cephalosporin would be the appropriate management if the patient was presenting with symptoms of pyelonephritis, such as pyrexia and loin or flank tenderness.
name: IV cephalosporin for five days
label: d
answer: no

Correct answer: a
A 30-year-old female is incidentally found to have an HbA1c of 58mmol/mol. She has no previous diagnosis of Type 2 diabetes. She does not report experiencing any polyuria or polydipsia.

Which of the following is the most appropriate next step?

Options:
explanation: Gliclazide is an option in the management of diabetes. However, in order to be diagnosed with diabetes and to commence treatment, patients with no symptoms need to have to at least two separate HbA1c readings above 48mmol/mol a week apart.  This patient therefore requires a second HbA1c in one weeks time to confirm a diagnosis.
name: Commence gliclazide
label: d
answer: no
explanation: This is an asymptomatic patient with a HbA1c above diagnostic level. In order to be diagnosed with diabetes, this patient requires a second HbA1c reading above 48mmol/mol in one weeks time.
name: Commence pioglitazone
label: c
answer: no
explanation: Diabetes can be diagnosed with a HbA1c greater than or equal to 48mmol/mol as long as the patient has symptoms of diabetes alongside this. However, this patient does not have any symptoms of diabetes and this reading was found incidentally. Therefore, this patient requires a repeat HbA1c in one weeks time in order to confirm a diagnosis of diabetes.
name: Repeat HbA1c in 1 week
label: a
answer: yes
explanation: Diabetes can be diagnosed with a HbA1c greater than or equal to 48mmol/mol as long as the patient has symptoms of diabetes alongside this. However, this patient does not have any symptoms of diabetes. Therefore, this patient  cannot be diagnosed based on this HbA1c reading. The HbA1c needs to be repeated in one weeks time to confirm diagnosis.
name: Commence Insulin
label: e
answer: no
explanation: Diabetes can be diagnosed with a HbA1c greater than or equal to 48mmol/mol as long as the patient has symptoms of diabetes alongside this. However, this patient does not have any symptoms of diabetes and therefore cannot be diagnosed based on this one HbA1c reading.
name: Commence metformin
label: b
answer: no

Correct answer: a
You are called to the neurology ward to review a 60-year-old male who has had a seizure. Before his seizure began, he complained of numbness and weakness in the right side of his body.

In which of the following brain regions did his seizure most likely originate?

Options:
explanation: Seizures that originate in the temporal lobe are  associated with emotional disturbances such as sudden terror or déjà vu. Temporal lobe seizures can also involve auditory or olfactory hallucinations.
name: Temporal lobe
label: e
answer: no
explanation: The seizure in this question is most likely to originate in the parietal lobe as this is most associated with sensory symptoms like numbness and weakness.
name: Cerebellum
label: d
answer: no
explanation: Seizures that affect the occipital lobe of the brain are often associated with visual symptoms. This can include seeing flashes of colour or shapes before a seizure occurs.
name: Occipital lobe
label: c
answer: no
explanation: The frontal lobe is associated with motor symptoms, including a type of seizure called a Jacksonian march. This is a seizure where shaking or tingling begins in one area of the body and gradually spreads its way to another area.
name: Frontal Lobe
label: b
answer: no
explanation: Seizures that originate in the Parietal Lobe can cause sensory symptoms such as numbness and weakness.
name: Parietal lobe
label: a
answer: yes

Correct answer: a
A 25-year-old builder presents to the GP with leg pain for the last two months. He describes a unilateral shooting pain that travels down the back of his left leg below the knee. He also has pins and needles in this area.

Which of the following is the most likely diagnosis?

Options:
explanation: Polymyalgia rheumatica would typically present with shoulder and hip girdle stiffness. It can also be associated with more systemic symptoms such as fever, anorexia, muscle pains and tiredness.
name: Polymyalgia rheumatica
label: e
answer: no
explanation: Cauda equina syndrome can cause bilateral sciatica symptoms, as well as other symptoms like perianal anaesthesia, urinary incontinence or sexual dysfunction. This would be an important differential to rule out in all patients with back pain. However, this is not the most likely diagnosis in this patient's case.
name: Cauda equina syndrome
label: b
answer: no
explanation: Myeloma can present with back pain, but the patient describes the pain going down the back of his leg. This is more typical of sciatica.
name: Multiple myeloma
label: c
answer: no
explanation: This clinical picture makes sciatica the most likely diagnosis in this patient. The unilateral shooting pain down the leg associated with tingling and weakness is typical of sciatica. Patients can often have back pain alongside this, but it is not typically as bad as the pain in their legs or feet.
name: Sciatica
label: a
answer: yes
explanation: This option would be more likely with a history of trauma, such as involvement in a road traffic collision. This patient is more likely to be experiencing symptoms of sciatica.
name: Vertebral fracture
label: d
answer: no

Correct answer: a
A 66-year-old male presents to his GP with a painful, swollen left knee. On examination, it feels hot to touch. Joint fluid analysis shows rhomboid-shaped crystals that are positively birefringent.

Which of the following is the most likely diagnosis?

Options:
explanation: Gout would also present with a single red, hot swollen joint. However, on joint fluid analysis gout would show negatively birefringent crystals that are needle-shaped, rather than rhomboid-shaped.
name: Gout
label: b
answer: no
explanation: Rheumatoid arthritis can produce an inflammatory joint effusion that gives patients warm, swollen joints. These effusions would consist of mainly neutrophils and the gram-stain would be negative.
name: Rheumatoid arthritis
label: e
answer: no
explanation: This is a typical presentation of pseudogout: a single red, hot swollen joint, most commonly affecting the wrist or the shoulder. Pseudogout causes rhomboid-shaped crystals that are positively birefringent to be seen on aspiration.
name: Pseudogout
label: a
answer: yes
explanation: Paget's disease of the bone would usually present as an isolated rise in alkaline phosphatase (ALP) levels alongside bone pain. This description of a single hot and swollen joint with rhomboid-shaped crystals on joint fluid analysis is more typical of pseudogout.
name: Paget's disease of the bone
label: d
answer: no
explanation: Septic arthritis will produce similar symptoms to the ones described: joint pain, swelling, redness and warmth. However, individuals with septic arthritis will be be systemically unwell and have a fever, tachycardic or be hypotensive. Additionally, the joint fluid analysis results are more suggestive of pseudogout.
name: Septic arthritis
label: c
answer: no

Correct answer: a
A 20-year-old male comes into the GP for a routine blood test. He is found to have low calcium, low phosphate, low viatmin D levels, and high levels of parathyroid hormone (PTH).

Which of the following is the most likely diagnosis?

Options:
explanation: Paget's disease of the bone would present as an isolated rise in ALP levels. It would not explain the low calcium or phosphate, or the rise in PTH levels. Therefore, it is not the most likely diagnosis in this case.
name: Paget's disease of the bone
label: b
answer: no
explanation: Osteoporosis would produce normal bone profile results. It would not explain the low calcium or phosphate levels or the rise in PTH.
name: Osteoporosis
label: d
answer: no
explanation: Osteomalacia is caused by low vitamin D levels and results in bone softening. Osteomalacia can cause normal or low levels of calcium or phosphate. It will cause a rise in the levels of alkaline phosphatase (ALP). It can cause normal or high levels of PTH.
name: Osteomalacia
label: a
answer: yes
explanation: If this patient was presenting with bony metastases, the bone profile would look slightly different. Bony metastases would cause high levels of calcium and ALP, and low levels of PTH. The phosphate levels would remain in range. The biochemical results in this question suggest a diagnosis of osteomalacia.
name: Bony metastases
label: c
answer: no
explanation: Primary hyperparathyroidism will cause high levels of calcium, ALP and PTH. It will cause low phosphate levels. The biochemical results in this question suggest a diagnosis of osteomalacia.
name: Primary hyperparathyroidism
label: e
answer: no

Correct answer: a
A 30-year-old female attends the GP with a 11-day history of dysphagia. On further questioning, she also describes having a burning sensation in her chest.

Which of the following medications is the most likely cause of her symptoms?

Options:
explanation: Alendronic acid is an example of a bisphosphonate. Bisphosphonates can cause oesophagitis, oesophageal ulcers, dysphagia and dyspepsia. To reduce the risk of these side effects, there are guidelines surrounding these medications, including taking the tablets on an empty stomach and sitting upright for 30 minutes after taking these medications.
name: Alendronic acid
label: a
answer: yes
explanation: Phenytoin would not cause the symptoms this patient is experiencing. The dyspepsia and dysphagia described is more likely to be a consequence of alendronic acid, a bisphosphonate.
name: Phenytoin
label: c
answer: no
explanation: Amiodarone is a medication that can be used to treat atrial fibrillation. It would not cause the symptoms this patient is experiencing. However, amiodarone can cause hypothyroidism or hyperthyroidism, as well as corneal deposits and liver failure.
name: Amiodarone
label: b
answer: no
explanation: The symptoms this patient is describing is not likely to be a result of ramipril. The dyspepsia and dysphagia described is more likely to be a consequence of alendronic acid, a bisphosphonate.
name: Ramipril
label: d
answer: no
explanation: The symptoms this patient is describing is not likely to be a result of hydroxychloroquine. The dyspepsia and dysphagia described is more likely to be down to alendronic acid. Hydroxychloroquine can cause retinopathy or rashes, but dysphagia is not a known side effect of this medication.
name: Hydroxychloroquine
label: e
answer: no

Correct answer: a
A 17-year-old university student presents to the GP as he has noticed yellowing of the skin. On further questioning, he tells you this skin yellowing comes and goes. He undergoes blood tests which show a raised bilirubin. Alkaline phosphatase (ALP), alanine transaminase (ALT) and albumin are all within the normal range. He drinks two to three units of alcohol per week and his BMI is 21.

Which of the following is the most likely diagnosis?

Options:
explanation: Wilson's disease would show a low serum ceruloplasmin and copper levels. Wilsons disease would not account for the high ALT.
name: Wilson’s disease
label: c
answer: no
explanation: Alpha-1 antitrypsin deficiency is an inherited condition that causes lung emphysema and liver cirrhosis. You would expect patients to present with shortness of breath and a raised ALP on blood results.
name: Alpha-1 antitrypsin deficiency
label: d
answer: no
explanation: This patient is presenting with intermittent jaundice and a high bilirubin which makes a diagnosis of Gilbert's syndrome the most likely diagnosis.
name: Hepatitis E
label: e
answer: no
explanation: Haemochromatosis is a disorder of iron metabolism where excessive iron builds up in the body and accumulates in the body. It is deposited in a number of sites including the liver, heart, joints, pancreas and skin. You would expect haemochromatosis to show deranged LFTs as well as a raised serum ferritin and raised transferrin saturation.
name: Haemochromatosis
label: b
answer: no
explanation: This patient is presenting with the signs and symptoms of Gilbert's syndrome. This condition causes intermitted episodes of jaundice which often occur due to stress, infection, fasting or exercise. Gilbert's syndrome will cause a raised bilirubin level in an otherwise normal set of bloods.
name: Gilbert's syndrome
label: a
answer: yes

Correct answer: a
A 65-year-old female presents to the GP with bone pain that began eight months ago. A blood test reveals no abnormalities except for a raised alkaline phosphatase (ALP) level.

Which of the following is the most likely diagnosis?

Options:
explanation: A presentation of ankylosing spondylitis would normally describe back pain that gets better with exercise. It would not account for the rise in ALP levels, and therefore Paget's disease is a more likely diagnosis in this case.
name: Ankylosing spondylitis
label: d
answer: no
explanation: This patient is presenting with bone pain and an isolated rise in their ALP levels which is typical of a diagnosis of Paget's disease. Paget’s disease may also be diagnosed on X-ray where you may find osteolysis or an increase in bone size.
name: Paget’s disease of the bone
label: a
answer: yes
explanation: If the patient had osteoporosis, this would produce a normal bone profile and would not account for the raised ALP. Paget's disease is more likely to account for the biochemical findings in this patient.
name: Osteoporosis
label: e
answer: no
explanation: Gout would normally present with a single red, hot and swollen joint. Gout would not account for a raise in ALP, so is not the most likely diagnosis in this case.
name: Gout
label: c
answer: no
explanation: Pseudogout would present as a single inflamed joint, and it usually affects the wrist or shoulder joints. It would not account for this patient’s high ALP, so is not the most likely diagnosis in this case.
name: Pseudogout
label: b
answer: no

Correct answer: a
A 20-year-old male presents to the GP with worsening back pain for the past ten months. He tells you the pain is worse in the morning, but gets better on exercise. You note he had an episode of anterior uveitis a month ago.

Which of the following is the most likely diagnosis?

Options:
explanation: This patient is presenting with the typical symptoms of ankylosing spondylitis: back pain and stiffness worse in the morning that gets better with movement. This condition is also associated with anterior uveitis, which this patient experienced one month ago.
name: Ankylosing Spondylitis
label: a
answer: yes
explanation: Cauda equina syndrome would present with symptoms such as saddle anaesthesia, serve sudden onset back pain and urinary incontinence. This patient is more likely to have ankylosing spondylitis.
name: Cauda equina syndrome
label: b
answer: no
explanation: Polymyalgia rheumatica would typically cause shoulder and hip girdle stiffness alongside some systemic symptoms such as fever, anorexia, weight loss and malaise. Normally, there would be raised inflammatory markers.
name: Polymyalgia Rheumatica
label: c
answer: no
explanation: This patient's presentation is more typical of ankylosing spondylitis. The age and gender of this patient (a young man) also points towards this diagnosis.
name: Mechanical back pain
label: e
answer: no
explanation: Paget's disease would present with bone pain and an isolated rise in alkaline phosphatase (ALP). It could also be picked up on X-ray where you may find osteolysis, increased bone size and sclerosis or pathological fractures.
name: Paget’s disease of the bone
label: d
answer: no

Correct answer: a
A 37-year-old female attends the GP practice complaining of episodes of throbbing pain on the left side of her head. Before these episodes, her vision can go funny. The episodes can last from 10- 24 hours at a time.  She has a past medical history of osteoarthritis and is currently taking naproxen.

Which of the following is the most likely diagnosis?

Options:
explanation: You would expect a tension headache to present as a bilateral, non-pulsatile headache. They can feel tight, like around the head. They are not associated with aura’s or photophobia, and therefore do not fit this woman’s symptoms.
name: Tension headache
label: b
answer: no
explanation: Cluster headaches present as unilateral headaches that are worse around the eye. They occur in attacks, or clusters over time. Patients would typically describe associated symptoms such as a bloodshot eye, rhinorrhea, lid swelling and facial flushing. The length of attacks is a lot shorter than migraines, typically lasting between 15 minutes and three hours.
name: Cluster headache
label: c
answer: no
explanation: This classically presents as a temporal headache alongside  jaw claudication (pain on chewing food) and scalp tenderness. It can also lead to blindness if not treated promptly. The patient may also describe a thickened tender temporal artery on examination. You should also look out for a patient with symmetrical proximal muscle weakness and oligoarthritis as giant cell arteritis is often associated with polymyalgia rheumatica.
name: Giant cell arteritis
label: e
answer: no
explanation: This is a typical presentation of a migraine. The question describes a unilateral headache associated with photophobia and phonophobia. Migraines can last anything from four to 72 hours at a time. Episodes of migraine can be preceded by an aura, such as a visual aura, like in this patient, or can present with sensory symptoms like paraesthesia. Migraines can have various triggers, which include medications such as aspirin and naproxen and certain foods like cheese or chocolate.
name: Migraine
label: a
answer: yes
explanation: This presents as short episodes of stabbing pain, affecting one side of the face, in the trigeminal nerve distribution. They are triggered by talking, eating or touching the face. The headache in this patient is not described as following the trigeminal nerve distribution, and no triggers are given that would indicate trigeminal neuralgia being the most likely diagnosis.
name: Trigeminal Neuralgia
label: d
answer: no

Correct answer: a
A 25-year-old female presents to the GP with palpations and shortness of breath for the last two weeks. She describes several episodes of feeling hot and breathless before seeing vivid images. She says these episodes began after she was involved in a car crash two weeks ago.

Which of the following is the most likely diagnosis?

Options:
explanation: Schizotypal personality disorder is a personality disorder is characterized by bizarre or magical thinking. It causes individuals to have difficulty with social interactions.
name: Schizotypal personality disorder
label: e
answer: no
explanation: This patient is experiencing symptoms of acute stress reaction, which is a mental health condition that can occur up to a month after someone goes through a traumatic event.
name: Acute stress reaction
label: a
answer: yes
explanation: EUPD is characterized by individuals having sudden mood swings, unstable relationships, and an unstable sense of self and self-image. The patient in this question is experiencing symptoms of acute stress reaction after experiencing a traumatic event.
name: Emotionally unstable personality disorder (EUPD)
label: d
answer: no
explanation: Post traumatic stress disorder can only be diagnosed when a person has symptoms for more than one month. Therefore, the correct answer to this question is acute stress reaction.
name: Post-traumatic stress disorder
label: b
answer: no
explanation: Bipolar disorder is diagnosed when someone has both a major depressive episode and an episode of mania or hypomania. Manic episodes involve elated mood or irritability, often involving people making dangerous decisions with little thought for consequences. The patient in this question is experiencing symptoms of acute stress reaction after experiencing a traumatic event.
name: Bipolar Disorder
label: c
answer: no

Correct answer: a
A 50-year-old female is found collapsed in her home. She is found to have thin hair, and is hot and clammy to touch. Her wife tells you that she has lost some weight in the last month. On examination, you notice brisk reflexes and a heartrate of 144. A thyroid function test shows a low thyroid-stimulating hormone (TSH) and high T4.

Which of the following is the most likely diagnosis?

Options:
explanation: Hyperosmolar hyperglycaemic state is a complication of untreated type 2 diabetes. Like DKA, it often presents with polyuria and polydipsia. It does not produce ketones, making it different to diabetic ketoacidosis.
name: Hyperosmolar hyperglycaemic state (HHS)
label: e
answer: no
explanation: Thyrotoxicosis occurs when there is excess thyroid hormone action at the level of the tissues. The most common cause of this is Grave's disease. This patient is presenting with lots of the typical symptoms of thyrotoxicosis: weight loss, heat intolerance, tremor, palpitations, irritability and muscle weakness.
name: Thyrotoxicosis
label: a
answer: yes
explanation: An Addisonian crisis is a severe presentation of Addison's disease when it is left untreated. It can present with symptoms such as dizziness, fainting, abdominal pain, depression and muscle weakness. Patients will often describe a bronze hyperpigmentation to the skin. The key biochemical finding of hyponatremia.
name: Addisonian crisis
label: c
answer: no
explanation: Hypothyroidism would present with weight gain, rather than weight loss. It would also cause symptoms like lethargy, anhydrosis, constipation and in some patients menorrhagia.
name: Hypothyroidism
label: b
answer: no
explanation: Diabetic ketoacidosis will often present with polyuria and polydipsia preceding unconsciousness. This patient is presenting with lots of the typical symptoms of thyrotoxicosis.
name: Diabetic ketoacidosis (DKA)
label: d
answer: no

Correct answer: a