hllj/quesmed huggingface dataset:
Which of the following is the most common type of renal cancer?

Options:
explanation: Renal sarcomas are a rare type of renal cancer, accounting for only 1-2% of primary renal cancers. Fibrosarcomas are the most common type within this category.
name: Renal sarcoma
label: d
answer: no
explanation: Wilms' tumour is a rare type of kidney cancer, originating from metanephric blastema cells found in the embryo. It therefore primarily affects children. Overall, it is very rare and makes up <5% of all renal cancer cases.
name: Wilms' tumour
label: c
answer: no
explanation: Transitional cell carcinoma is the second most common type of renal cancer and makes up 10% of all cases. It is a cancer of the renal pelvis and ureter and overall is rare in occurrence.
name: Transitional cell carcinoma
label: b
answer: no
explanation: Renal adenomas are benign kidney tumours that are small and slow growing and are often <1cm in size. They do not fall into the category of metastatic renal tumours or cancers.
name: Renal adenoma
label: e
answer: no
explanation: Adenocarcinomas, or renal cell carcinomas, make up 85% of all renal cancers. It originates in the lining of the proximal convoluted tubule and generally affects individuals aged 50-70+.
name: Adenocarcinoma
label: a
answer: yes

Correct answer: a
Which of the following is a major feature of Duke's diagnostic criteria for infective endocarditis?

Options:
explanation: Janeway lesions are examples of vascular phenomena which can be seen in infective endocarditis - other examples include conjunctival haemorrhages and major arterial emboli. Vascular phenomena are minor criteria under Duke's classification, not major.
name: Appearance of Janeway lesions
label: b
answer: no
explanation: A history of IV drug use is a minor criterion under Duke's classification for the diagnosis of infective endocarditis, not major.
name: History of IV drug use
label: e
answer: no
explanation: Glomerulonephritis is an example of an immunologic phenomenon which can be seen in infective endocarditis - other examples are Osler's nodes and Roth's spots. These are minor criteria under Duke's classification, not major.
name: Diagnosis of glomerulonephritis
label: d
answer: no
explanation: An echocardiogram positive for signs of infective endocarditis, e.g. new valvular regurgitation or vegetation, is a major criterion for the diagnosis of infective endocarditis. The other major criterion is positive blood cultures.
name: Valvular vegetation seen on echocardiogram
label: a
answer: yes
explanation: Infective endocarditis can lead to fevers over 38°C in patients. This is a minor criterion under Duke's classification, not a major one.
name: Fever (>38°C)
label: c
answer: no

Correct answer: a
Which of the following sets of abnormalities are most likely to be seen on cerebrospinal fluid (CSF) analysis in bacterial meningitis?

Options:
explanation: Whilst high white blood cell levels are seen, high glucose levels and low protein levels are not indicative of bacterial meningitis. Other causes, such as a virus, should be considered.
name: High white blood cell count, high glucose level, low protein level
label: c
answer: no
explanation: Whilst this is possible in bacterial meningitis, it is more indicative of fungal meningitis. CSF findings are similar in fungal meningitis to bacterial meningitis, but protein levels are more likely to be normal than high. Fibrin webs are also seen in the CSF in fungal meningitis.
name: High white blood cell count, low glucose level, normal protein level
label: e
answer: no
explanation: Whilst high protein levels are seen, low white blood cell count and high glucose levels are not indicative of bacterial meningitis. Other causes, such as a virus, should be considered.
name: Low white blood cell count, high glucose level, high protein level
label: b
answer: no
explanation: This is most commonly seen on CSF analysis in meningitis. Due to an immune response to bacterial pathogens, white blood cells are raised. Bacteria require glucose to respire which causes a depletion in glucose levels in the CSF. High protein levels are also typically seen in bacterial meningitis.
name: High white blood cell count, low glucose level, high protein level
label: a
answer: yes
explanation: This is more indicative of viral meningitis. Indeed, glucose and protein levels are more likely to be normal in viral meningitis. Monocytes, in particular, can be high in viral meningitis.
name: High white blood cell count, normal glucose level, normal protein level
label: d
answer: no

Correct answer: a
Crohn's disease and ulcerative colitis are the two main types of inflammatory bowel disease.

Which of the following is a typical feature of ulcerative colitis?

Options:
explanation: Ulcerative colitis is a superficial disorder, limited to the colonic mucosa. Crohn's disease, on the other hand, is transmural which means that it affects all layers of the bowel.
name: Transmural inflammation
label: c
answer: no
explanation: This is a classical feature of Crohn's disease, not ulcerative colitis. Due to its transmural nature, fistulae (communication between walls of different structures) can be seen in Crohn's disease.
name: Tendency to form a fistula
label: d
answer: no
explanation: This is a typical characteristic of Crohn's disease. Ulcerative colitis is limited to the colon, hence the name.
name: Affects any part of the gastrointestinal tract, from mouth to anus
label: b
answer: no
explanation: Ulcerative colitis is characterised by continuous inflammation of the colon, whereas Crohn's is characterised by patchy, discontinuous inflammation.
name: Continuous inflammation
label: a
answer: yes
explanation: Ulcerative colitis is not characterised by the presence of granulomas, versus Crohn's disease, where granulomatous inflammation is commonly seen.
name: Granulomatous in nature
label: e
answer: no

Correct answer: a
Which of the following is a criterion within the "Bradford Hill Criteria for Causation"?

Options:
explanation: This is not one of the 9 criteria: they are strength, consistency, specificity, temporality, dose-response, experimental evidence, biological plausibility, coherence, and analogy.
name: Chemical feasibility
label: c
answer: no
explanation: The "Bradford Hill Criteria for Causation" is a set of guidelines that helps to establish a causal relationship between a potential cause and an observed effect. The criteria include nine factors that help to determine whether a causal relationship exists. The first criterion is temporality, which means that the cause must precede the effect. This means that the cause must occur before the effect and not the other way around.
name: Temporality
label: a
answer: yes
explanation: This is not one of the 9 criteria: they are strength, consistency, specificity, temporality, dose-response, experimental evidence, biological plausibility, coherence, and analogy.
name: Accessibility
label: b
answer: no
explanation: This is not one of the 9 criteria: they are strength, consistency, specificity, temporality, dose-response, experimental evidence, biological plausibility, coherence, and analogy.
name: Accountability
label: e
answer: no
explanation: This is not one of the 9 criteria: they are strength, consistency, specificity, temporality, dose-response, experimental evidence, biological plausibility, coherence, and analogy.
name: Sensitivity
label: d
answer: no

Correct answer: a
Spirometry is required for the diagnosis of COPD.

Which of the following sets of spirometry results is most indicative of COPD?

Options:
explanation: In COPD, FEV1/FVC is reduced. The threshold for diagnosis is often an FEV1/FVC ratio below 80%. Given the low FEV1, this could be a mixed picture of both obstructive and restrictive disease.
name: FEV1: 50% of predicted, FEV1/FVC: 95% of predicted
label: e
answer: no
explanation: This could be indicative of a restrictive lung disease where FEV1/FVC ratio is >80% due to a drop in FVC with maintained FEV1. This could be better assessed if FVC was also provided.
name: FEV1: 80%, FEV1/FVC: 90% of predicted
label: d
answer: no
explanation: In COPD, FEV1 and FEV1/FVC are reduced. The threshold for diagnosis is often an FEV1/FVC ratio below 80%. FEV1 of 100% is also unlikely to be seen in COPD. If FVC and patient symptoms were also provided, we could assess if restrictive lung disease is a plausible differential here.
name: FEV1: 100% of predicted, FEV1/FVC: 80% of predicted
label: b
answer: no
explanation: In COPD, FEV1/FVC is reduced. The threshold for diagnosis is often an FEV1/FVC ratio below 80%. An FEV1 of 85%, however, is possible.
name: FEV1: 85% of predicted, FEV1/FVC: 90% of predicted
label: c
answer: no
explanation: COPD is an obstructive lung disorder characterised by reduced FEV1 and FEV1/FVC ratio due to airway obstruction. In COPD, the FEV1/FVC ratio is reduced because the airways are narrowed and there is increased resistance to airflow. This results in a decrease in the amount of air that can be exhaled in the first second (FEV1) relative to the total amount of air that can be exhaled (FVC).
name: FEV1: 74% of predicted, FEV1/FVC: 63% of predicted
label: a
answer: yes

Correct answer: a
A 'thunderclap' headache is an important red flag sign for which of the following conditions?

Options:
explanation: Whilst SDH can cause a severe headache, a 'thunderclap' headache is well-known as a classic red flag for a subarachnoid haemorrhage.
name: Subdural haemorrhage (SDH)
label: b
answer: no
explanation: Whilst EDH can cause a severe headache, a 'thunderclap' headache is well-known as a classic red flag for a subarachnoid haemorrhage.
name: Extradural haemorrhage (EDH)
label: c
answer: no
explanation: A 'thunderclap' headache is a key red flag sign for a subarachnoid haemorrhage. It is severe, with sudden onset and takes seconds to minutes to reach maximum severity.
name: Subarachnoid haemorrhage (SAH)
label: a
answer: yes
explanation: Whilst cluster headaches can be very severe, a 'thunderclap' headache is well known as a classic red flag for a subarachnoid haemorrhage. Cluster headaches are often described as unilateral pain that lasts 15-180 minutes (if untreated).
name: Cluster headache
label: e
answer: no
explanation: Migraines can cause severe headaches, but 'thunderclap' suggests a very sudden onset, which is less likely to be seen in migraines.
name: Migraine
label: d
answer: no

Correct answer: a
Which of the following is the most common electrolyte imbalance seen in hospitalised patients?

Options:
explanation: Hyponatraemia is the most common electrolyte imbalance seen in hospitalised patients. Its symptoms are unspecific and include dizziness, nausea and often falls.
name: Hyponatraemia
label: a
answer: yes
explanation: Hypomagnesaemia is not the most common electrolyte imbalance seen in hospitalised patients. It is frequently seen alongside other electrolyte disorders and is associated with prolonged length of stay in hospital.
name: Hypomagnesaemia
label: e
answer: no
explanation: Hypocalcaemia is not the most common electrolyte imbalance seen in hospitalised patients. It is more common in the intensive care unit. Depending on population demographics, a common cause can be vitamin D deficiency.
name: Hypocalcaemia
label: c
answer: no
explanation: Hypercalcaemia, whilst common, is not the most common electrolyte imbalance seen in hospitalised patients. Malignancy is the most common aetiology.
name: Hypercalcaemia
label: d
answer: no
explanation: Hypernatraemia in hospitalised patients is not the most common electrolyte imbalance seen. It is often iatrogenic and caused by increased water loss, restricted water intake, or excessive IV fluid replacement.
name: Hypernatraemia
label: b
answer: no

Correct answer: a
Which of the following is a core criterion within the DSM-5 criteria for major depressive disorder?

Options:
explanation: These are indeed symptoms of depression but are not a core criterion in the DSM-5 criteria for major depressive disorder. The incidence of psychomotor retardation/activation can be used to aid diagnosis alongside the core symptoms.
name: Psychomotor retardation or activation
label: b
answer: no
explanation: These are indeed symptoms, but not a core criterion in the DSM-5 criteria for major depressive disorder. The incidence of hypersomnia/insomnia can be used to aid diagnosis alongside the core symptoms
name: Hypersomnia or insomnia
label: e
answer: no
explanation: This is indeed a symptom of depression, but not a core criterion in the DSM-5 criteria for major depressive disorder. The incidence of suicidality can be used to aid diagnosis alongside the core symptoms.
name: Suicidality
label: c
answer: no
explanation: Anhedonia, or decreased interest or pleasure, is one of the core symptoms of major depressive disorder. Either anhedonia or a diminished/irritable mood for over 2 weeks is required for diagnosis, making them the 2 core symptoms.
name: Anhedonia
label: a
answer: yes
explanation: This is indeed a symptom of depression, but not a core criterion in the DSM-5 criteria for major depressive disorder. Feelings of guilt or worthlessness can be used to aid diagnosis alongside the core symptoms.
name: Feelings of guilt or worthlessness
label: d
answer: no

Correct answer: a
A patient with suspected acid-base imbalance has an arterial blood gas performed. The results are as follows:

pH: 7.31
PaCO2: 6.8kPa
Base excess(BE): 3

Normal ranges:
pH: 7.35-7.45
PaCO2: 4.7-6.4kPa
Base excess: -2 to 2

What acid-base imbalance is this?

Options:
explanation: Whilst pH would be low in a partially compensated metabolic acidosis, BE would also be low due to a metabolic cause. The partial compensation here would come from hyperventilation, leading to a reduced PaCO2.
name: Partially compensated metabolic acidosis
label: c
answer: no
explanation: Whilst a low pH would be seen, BE would be low in metabolic acidosis. As there is no respiratory compensation in an uncompensated metabolic acidosis, PaCO2 would be normal.
name: Uncompensated metabolic acidosis
label: e
answer: no
explanation: The low pH here accompanied by high PaCO2 suggests that the high PaCO2 is causing the increased acidity. Therefore this is a respiratory acidosis. Base excess is higher than normal, suggesting that the body is trying to counteract the acidity, making this a partially compensated respiratory acidosis.
name: Partially compensated respiratory acidosis
label: a
answer: yes
explanation: Here, pH would be normal and BE would be low due to a metabolic cause. This would be fully compensated by a low PaCO2.
name: Fully compensated metabolic acidosis
label: d
answer: no
explanation: Although this is a respiratory acidosis (given the high PaCO2 and high BE), it is not fully compensated. In a fully compensated respiratory acidosis pH would be normal.
name: Fully compensated respiratory acidosis
label: b
answer: no

Correct answer: a
Inotropes can be used in the treatment of cardiogenic shock in an intensive care setting.

Which of the following best describes the mechanism of action of positive inotropes?

Options:
explanation: Positive inotropes do not increase the secretion of atrial natriuretic peptide, leading to diuresis and natriuresis. Instead, they directly increase the contractility of the heart, leading to an increase in cardiac output. This is achieved through increasing intracellular calcium concentrations.
name: Positive inotropes increase the secretion of atrial natriuretic peptide, leading to diuresis and natriuresis
label: d
answer: no
explanation: Positive inotropes are drugs that increase the contractility (or force of contraction) of the heart. In cardiogenic shock, the heart is unable to pump blood effectively, leading to reduced cardiac output. By increasing the contractility of the heart, positive inotropes can help to increase cardiac output and improve perfusion to vital organs. Some examples of positive inotropes include dopamine, dobutamine and milrinone.
name: Positive inotropes increase the contractility of the heart by increasing intracellular calcium levels, leading to an increase in cardiac output
label: a
answer: yes
explanation: Positive inotropes do not increase sympathetic tone. Instead, they increase the contractility of the heart, leading to an increase in cardiac output.
name: Positive inotropes increase sympathetic tone, leading to an increase in heart rate and contractility
label: c
answer: no
explanation: Positive inotropes do not decrease the secretion of renin, leading to decreased activation of the renin-angiotensin-aldosterone system. Instead, they directly increase the contractility of the heart, leading to an increase in cardiac output. This is achieved through increasing intracellular calcium concentrations.
name: Positive inotropes decrease the secretion of renin, leading to decreased activation of the renin-angiotensin-aldosterone system
label: e
answer: no
explanation: Positive inotropes do not increase the tone of the systemic vasculature. Instead, they increase the contractility of the heart, leading to an increase in cardiac output.
name: Positive inotropes increase the tone of the systemic arterioles, leading to an increase in systemic vascular resistance
label: b
answer: no

Correct answer: a
Alcohol abuse can lead to Wernicke's encephalopathy.

What is the first-line treatment for Wernicke's encephalopathy?

Options:
explanation: Riboflavin (Vitamin B2) is important for overall health and helps to maintain healthy skin, eyes and nervous system. It is not the first-line treatment here.
name: Riboflavin (Vitamin B2) supplementation
label: e
answer: no
explanation: Ascorbic acid (Vitamin C) is important for overall health and immune function. It is not the first-line treatment here.
name: Ascorbic acid (Vitamin C) supplementation
label: c
answer: no
explanation: Niacin (Vitamin B3) is important for overall health and helps to maintain healthy skin and nerves. It is not the first-line treatment here.
name: Niacin (Vitamin B3) supplementation
label: d
answer: no
explanation: Insulin therapy is used to manage high blood sugar levels in diabetes. It is not the first-line treatment here.
name: Insulin therapy
label: b
answer: no
explanation: Thiamine (Vitamin B1) is the first-line treatment for Wernicke's encephalopathy, a neuropsychiatric disorder caused by thiamine deficiency. Thiamine supplementation is given intravenously or intramuscularly to reverse the neurological symptoms of the disease.
name: Thiamine (Vitamin B1) supplementation
label: a
answer: yes

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

Options:
explanation: This best describes the mechanism of action of SGLT2 inhibitors such as dapagliflozin. SGLT2 inhibitors reversibly inhibit sodium-glucose co-transporter 2 in the renal proximal convoluted tubule. This reduces glucose reabsorption and increases urinary glucose excretion.
name: Reduction of glucose reabsorption by the kidneys and increased urinary glucose excretion
label: e
answer: no
explanation: This best describes the mechanism of action of alpha-glucosidase inhibitors such as acarbose.
name: Slowing of gastric emptying and decreasing carbohydrate absorption
label: c
answer: no
explanation: This best describes the mechanism of action of DPP4-inhibitors such as sitagliptin. Inhibition of the DPP4 enzyme reduces incretin metabolism. Incretins can help stimulate insulin production and reduce glucagon production by the liver, therefore increasing incretin levels by blocking their breakdown is an effective type 2 diabetes treatment.
name: Inhibition of DPP4, leading to stimulation of insulin production and improved satiety
label: d
answer: no
explanation: This best describes the mechanism of action of metformin, which is a biguanide used commonly in the treatment of type 2 diabetes.
name: Activation of AMPK in hepatocyte mitochondria which inhibits ATP production and leads to reduced gluconeogenesis
label: b
answer: no
explanation: Gliclazide is a sulphonylurea which can be used in the treatment of type 2 diabetes. Sulphonylureas work by binding to SUR1 receptors on ATP-sensitive potassium channels (on beta cells in the pancreas) and stimulating insulin vesicle exocytosis.
name: Inhibition of the ATP-sensitive potassium channel on pancreatic beta cells, leading to increased insulin secretion
label: a
answer: yes

Correct answer: a
Which of the following neurons primarily undergo degeneration in Parkinson's disease?

Options:
explanation: GABAergic neurons in the globus pallidus play a role in regulating movement and are not primarily affected in Parkinson's disease.
name: GABAergic neurons in the globus pallidus
label: c
answer: no
explanation: Cholinergic neurons in the basal forebrain play a role in regulating attention and arousal and are not typically affected in Parkinson's disease
name: Cholinergic neurons in the basal forebrain
label: e
answer: no
explanation: Dopaminergic neurons in the substantia nigra play a key role in regulating movement and are the primary type of neurons affected in Parkinson's disease. This leads to a reduction in dopamine levels in the brain.
name: Dopaminergic neurons in the substantia nigra
label: a
answer: yes
explanation: Cholinergic neurons in the nucleus accumbens play a role in regulating pleasure and reward. They are not typically affected by Parkinson's disease.
name: Cholinergic neurons in the nucleus accumbens
label: d
answer: no
explanation: Pyramidal neurons are involved in the regulation of voluntary muscle movement and are found in the cerebral cortex. They do not typically undergo degeneration in Parkinson's disease.
name: Pyramidal neurons
label: b
answer: no

Correct answer: a
Which of the following best describes a subdural haemorrhage?

Options:
explanation: This best describes a transient ischaemic attack or TIA. This involves a temporary reduction in blood flow to the brain, usually as a result of atherosclerosis.
name: Rapidly developing focal disturbance of brain function which can resolve within 24 hours
label: e
answer: no
explanation: This best describes an intercerebral haemorrhage which occurs due to a bleed within the brain parenchyma. It can occur spontaneously in poorly controlled hypertension and can have fatal effects.
name: Can occur spontaneously in cases of uncontrolled hypertension. It is a subtype of stroke and can have sudden clinical effects
label: d
answer: no
explanation: This best describes an extradural haemorrhage which is an acute bleed which accumulates between the dura mater and the inner surface of the skull. It is typically a high-pressure arterial bleed and hence leads to immediate clinical effects.
name: Typically caused by traumatic incidents with immediate clinical effects. Damage usually occurs to arteries
label: b
answer: no
explanation: A subdural haemorrhage is a brain bleed that accumulates within the space between the dura mater and arachnoid mater. It is typically a venous bleed that is low pressure and therefore can lead to delayed clinical effects. For example, a patient may appear well after a head injury but may become unconscious after several hours have passed.
name: Typically caused by traumatic incidents with delayed clinical effects. Damage usually occurs to veins
label: a
answer: yes
explanation: This best describes a subarachnoid haemorrhage which occurs in the subarachnoid space. It is often caused by burst aneurysms and presents clinically as a 'thunderclap headache' which is sudden and severe.
name: Typically occurs due to ruptured aneurysms and can be seen often at the Circle of Willis
label: c
answer: no

Correct answer: a