hllj/quesmed huggingface dataset:
A 34-year-old woman presents to the GP with a fever, headache and tonsillitis. Throat swabs are taken and Gram stained to reveal Gram-positive cocci in a chain-like appearance.

Which of the following is the most likely causative organism?

Options:
explanation: All fungi, such as *Candida albicans* stain Gram-positive. However, budding cells, not chains would be seen on microscopy. *Candida albicans* is a yeast that is the causative organism of thrush, not pharyngitis.
name: *Candida albicans*
label: e
answer: no
explanation: *Clostridium difficile* is a Gram-positive organism that is a major hospital concern due to its resistance and opportunism. It is most often associated with a serious bacterial infection following an antibiotic course. *Clostridium difficile* would not cause symptoms of pharyngitis and is a rod, not coccus bacteria.
name: *Clostridium difficile*
label: d
answer: no
explanation: This is a classical description of streptococcal sore throat or streptococcal pharyngitis. Gram stain will reveal Gram-positive (purple) cocci (round) bacteria in a chain-like appearance.

Tip: Remember Gram Positive as the 3 P's --  positive, peptidoglycan and purple!
name: *Group A Streptococcus*
label: a
answer: yes
explanation: *Staphylococcus aureus* is a Gram-positive bacterium that stains positively. The expected appearance is of grape-like clusters, not chains. *Staphylococcus aureus* is a commensal organism on skin and nose surfaces and does not cause pharyngitis.
name: *Staphylococcus aureus*
label: b
answer: no
explanation: *Neisseria gonorrhoeae* is the causative organism for gonorrhoea. Although it is a cocci (diplococci), it stains Gram-negative and is not associated with causing pharyngitis.
name: *Neisseria gonorrhoeae*
label: c
answer: no

Correct answer: a
A 65-year-old male presents to his GP with upper abdominal pain, indigestion and haematemesis. The GP refers him for investigations to exclude gastric malignancy.

Which of the following organisms is closely associated with gastric carcinoma?

Options:
explanation: Giardia duodenalis is an environmentally resistant gut parasite that inhibits the uptake and metabolism of bile. This leads to the accumulation of fatty acids and malabsorption. It is not associated with causing gastric cancer.
name: *Giardia duodenalis*
label: e
answer: no
explanation: Chlamydia trachomatis causes the most common bacterial sexually transmitted infection - chlamydia. It is not associated with causing gastric cancer.
name: *Chlamydia trachomatis*
label: d
answer: no
explanation: Helicobacter pylori infection is a major risk factor for developing peptic ulcer disease and gastric cancer. Often acquired in childhood, patients can have lifelong infections with mostly no symptoms. Damage to the stomach lining leads to peptic ulcers. Any form of long-term inflammation or repair leads to a cycle of damage and repair, and this increases the chance of cancer development.
name: *Helicobacter pylori*
label: a
answer: yes
explanation: Campylobacter jejuni is one of the most common causes of diarrhoea, usually acquired through contaminated food such as uncooked meat. Although associated with gastroenteritis, the bacterium is not associated with gastric cancer.
name: *Campylobacter jejuni*
label: b
answer: no
explanation: Norovirus, also known as the winter vomiting bug, is a highly infectious virus that causes viral gastroenteritis. Although it causes unpleasant symptoms such as diarrhoea and vomiting, it is not associated with causing gastric cancer.
name: *Norovirus*
label: c
answer: no

Correct answer: a
A 13-year-old girl presents to her GP with a unilateral red, painful eye with serous-like discharge. The GP suspects that this is a case of bacterial conjunctivitis and prescribes chloramphenicol.

Which of the following antibiotics is correctly matched to its mechanism of action?

Options:
explanation: Aminoglycosides, such as streptomycin and kanamycin, inhibit bacterial protein synthesis, leading to cell death.
name: Aminoglycosides -- disrupt bacterial cell wall
label: b
answer: no
explanation: Quinolones interfere with bacterial DNA replication and transcription (e.g., target DNA gyrase). An example of a quinolone is ciprofloxacin.
name: Quinolones -- inhibit cell wall synthesis
label: d
answer: no
explanation: Beta-lactam antibiotics such as penicillin act by inhibiting bacterial cell wall synthesis.
name: Beta-lactams -- inhibit bacterial RNA synthesis
label: e
answer: no
explanation: Tetracyclines such as doxycycline act by inhibiting the synthesis of bacterial proteins through ribosomal interference, preventing bacterial growth.
name: Tetracyclines -- interfere with prokaryotic ribosomes
label: a
answer: yes
explanation: Glycopeptides such as vancomycin act by inhibiting bacterial cell wall synthesis.
name: Glycopeptides -- target prokaryotic DNA gyrase
label: c
answer: no

Correct answer: a
A 22-year-old medical student presents acutely with fatigue, malaise and fever, accompanied by a sore throat after kissing a fellow student at a club five weeks ago. The symptoms have not resolved in the past three weeks.

What is the likely causative organism?

Options:
explanation: Respiratory Syncytial Virus (RSV) is one of the most common causes of bronchiolitis and pneumonia in children. In tissue culture, the virus causes a characteristic syncytium. It is not associated with causing sore throats as it is a leading cause of lower respiratory tract infections.
name: *Respiratory Syncytial Virus* (RSV)
label: e
answer: no
explanation: Epstein-Barr Virus (EBV), also known as infectious mononucleosis, glandular fever or 'kissing disease' is a virus that is transmitted through saliva and causes the symptoms described in the question stem. Management is essentially conservative, and the illness is expected to resolve within 2-4 weeks.
name: *Epstein-Barr Virus* (EBV)
label: a
answer: yes
explanation: Hepatitis C is the virus that causes chronic hepatitis and is a leading cause of cirrhosis and liver cancer. Infection is acquired through blood, and the virus additionally can cross the placenta and infect the foetus.
name: Hepatitis C
label: d
answer: no
explanation: Herpes Simplex Virus-1 (HSV-1) is the causative organism of cold sores and is spread through direct contact. It is not associated with a sore throat. Complications include pneumonia in immunocompromised patients, and very rarely, herpes simplex encephalitis.
name: *Herpes Simplex Virus 1*
label: c
answer: no
explanation: Although Streptococcus pyogenes can present with a classical 'strep throat', you would expect symptoms to resolve within a week. The longevity of the infection suggests a different cause.
name: *Streptococcus pyogenes*
label: b
answer: no

Correct answer: a
A 62-year-old man presents to the emergency ward with chest pain, palpitations and dizziness. An ECG shows a characteristic saw-tooth baseline repetition at 300 bpm.

Which of the following is the most likely explanation of this patient's presentation and findings?

Options:
explanation: Hypokalaemia presents with fatigue and muscle cramps. On an ECG, you would observe ST depression and a prolonged PR interval.

Remember: Hypokalaemia causes ST depression, whereas Hyperkalaemia causes 'tall-tented' T waves! Imagine arrows going down for hypokalaemia and up for hyperkalaemia - this represents which way the T waves will effectively 'stretch'.
name: Hypokalaemia
label: c
answer: no
explanation: Mitral regurgitation is the backflow of blood across the mitral valve during systole due to the incompetence of the mitral valve. Patients would present with acute symptoms of shortness of breath, weakness and fatigue. ECG features would show right ventricular hypertrophy and right axis deviation.
name: Mitral regurgitation
label: d
answer: no
explanation: In atrial fibrillation, there are no distinct P wave patterns, and there is an irregularity in the QRS complexes. Thus, atrial fibrillation is described as being "irregularly irregular".
name: Atrial fibrillation
label: b
answer: no
explanation: Atrial flutter is a type of atrial tachycardia, localised to the right atrium. Characteristic ECG findings include a 'sawtooth' appearance. The atrial rate is often around 300 bpm.
name: Atrial Flutter
label: a
answer: yes
explanation: The stem above describes a heart rate of 300 bpm. Acute bradycardia is defined as a heart rate of less than 60 bpm and is thus excluded as a differential. Clinical features of bradycardia include dizziness, syncope and tiredness.
name: Acute bradycardia
label: e
answer: no

Correct answer: a
A 72-year-old male presents to his GP for regular blood pressure monitoring. His blood pressure reading measures 170/105 mmHg.

Which of the following options correctly describes the mean arterial pressure of this patient?

Options:
explanation: Knowing how to correctly calculate a Mean Arterial Pressure (MAP) is really important. The following equation is used.

MAP = DP + 1/3 (SP - DP)

MAP is Mean Arterial Pressure
DP is Diastolic Pressure
SP is Systolic Pressure

MAP = 105 + 1/3 (170-105) = 127 mmHg
name: 127 mmHg
label: a
answer: yes
explanation: Refer to the Mean Arterial Pressure equation above. Remember, Diastolic Pressure must be subtracted from Systolic Pressure!
name: 162 mmHg
label: b
answer: no
explanation: Refer to the Mean Arterial Pressure equation above. Remember to divide the Pulse Pressure (Systolic - Diastolic Pressure) by 3, not 2!
name: 137.5 mmHg
label: e
answer: no
explanation: Refer to the Mean Arterial Pressure equation above. Remember, it is Diastolic Pressure that is added to the 1/3 (SP - DP), not Systolic Pressure!
name: 192 mmHg
label: c
answer: no
explanation: Refer to the Mean Arterial Pressure equation above. Remember, Diastolic Pressure must be subtracted from Systolic Pressure!
name: 140 mmHg
label: d
answer: no

Correct answer: a
Which of the following options accurately describes findings on an ECG?

Options:
explanation: The QRS complex on an ECG represents ventricular depolarization. Broad QRS complexes are usually caused by bundle branch blocks or a complication at the atrioventricular (AV) node.
name: QRS complex indicates ventricular depolarization
label: a
answer: yes
explanation: A saw-tooth baseline on an ECG with a repetition at 300bpm indicates Atrial Flutter. This is a type of atrial tachycardia, localised to the right atrium.
name: A saw-tooth baseline on an ECG is indicative of Atrial fibrillation
label: d
answer: no
explanation: P-waves indicate atrial depolarisation after the action potential generated by the sinoatrial node. If the Bundle of His fibres are blocked, you can observe a heart block.
name: The P wave indicates the depolarisation of the Bundle of His
label: b
answer: no
explanation: Vagal nerve stimulation is responsible for the parasympathetic system and thus would decrease heart rate. This results in an increase in PR intervals.
name: PR interval duration is decreased on vagal stimulation
label: e
answer: no
explanation: Tall 'tented' T waves occur in hyperkalaemia and may be an early sign of ST elevation in myocardial infarction.

Remember: Hypokalaemia causes ST depression, whereas Hyperkalaemia causes 'tall-tented' T waves! Imagine arrows going down for hypokalaemia and up for hyperkalaemia - this represents which way the T waves will effectively 'stretch'.
name: Tall T waves on an ECG occur in hypokalaemia
label: c
answer: no

Correct answer: a
A 73-year-old woman presents to the emergency department with sudden onset, severe, crushing, left-sided chest pain. An ECG is ordered and shows persistent ST-elevation with a new left bundle branch block. Blood tests have been ordered, but have yet to be completed.

Which of the following is the most likely cause of this patient's presentation?

Options:
explanation: A Non-ST-elevation MI (NSTEMI) is caused by a severe, but incomplete occlusion of a coronary artery. Blood tests would show raised troponin. The ECG can be normal or abnormal, but no ST-elevation would be seen.
name: Non-ST-elevation Myocardial Infarction (NSTEMI)
label: b
answer: no
explanation: Cardiac tamponade occurs when there is an accumulation of a substance in the pericardial space, raising the intra-pericardial pressure and pressing on the heart. Cardiac output is reduced as a consequence. An ECG would show low-voltage QRS complexes or electrical alternans.
name: Cardiac Tamponade
label: d
answer: no
explanation: Myocarditis is a disease where the myocardium becomes inflamed. Although patients present with similar symptoms of heart failure described above, ECG would demonstrate non-specific ST segment changes. Troponin enzymes would be elevated.
name: Myocarditis
label: c
answer: no
explanation: An ST-elevation MI (STEMI) is caused by a complete occlusion of a coronary artery. It is characterised by diagnostic features of cardiac chest pain, persistent ST-elevation and/or new left bundle branch block on an ECG.
name: ST-elevation Myocardial Infarction (STEMI)
label: a
answer: yes
explanation: Heart blocks are caused by altered conduction through the AV node. A first-degree heart block can be identified on an ECG by finding a PR interval over 200 ms.
name: First Degree Heart Block
label: e
answer: no

Correct answer: a
A patient with septic shock is given a 500 ml fluid challenge bolus. After 10 minutes, his blood pressure increases.

Which of the following options best describes by which mechanism his blood pressure increases?

Options:
explanation: A decrease in venous return would lead to a decrease in stroke volume. This would drive the cardiac output down, and thus would lower blood pressure.
name: A fluid bolus would lead to a decrease in venous return, increasing blood pressure
label: e
answer: no
explanation: Vascular tone is set by the innervation of the sympathetic nervous system. A decrease in sympathetic tone allows vasodilation. Administering a fluid challenge will not immediately affect vascular tone.

Remember, most blood vessels lack parasympathetic input!
name: A fluid bolus will decrease systemic vascular resistance, increasing blood pressure
label: b
answer: no
explanation: A fluid bolus would not have any immediate effect on heart rate. A decreased heart rate would lead to decreased cardiac output and decreased blood pressure.
name: A fluid bolus would decrease heart rate, increasing blood pressure
label: c
answer: no
explanation: Administering a fluid bolus will effectively increase the stroke volume and drive cardiac output to increase. This in turn will lead to increased mean arterial pressure.

Remember these two equations for Cardiology:

Cardiac Output (CO) = Stroke Volume (SV) x Heart Rate (HR)
Mean Arterial Pressure (MAP) = Cardiac Output (CO) x Systemic Vascular Resistance (SVR)
name: A fluid bolus will increase stroke volume and drive cardiac output, increasing blood pressure
label: a
answer: yes
explanation: A fluid bolus increases the effective circulating blood volume by effectively increasing stroke volume. Adding 500mls of any solution to blood will increase the circulating blood volume!
name: A fluid bolus would decrease the effective circulating blood volume, increasing blood pressure
label: d
answer: no

Correct answer: a
A 6-year-old girl presents to her GP with chest tightness, laboured breathing and a wheeze. Spirometry shows an obstructive picture. The GP rightly suspects this is asthma.

Which of the following options correctly describes the mechanism of action of pharmacological agents used in this condition?

Options:
explanation: B1 adrenergic receptors are responsible for heart rate and myocardial contraction. Stimulating B1 receptors would not lead to bronchodilation, and as such are not used for the management of asthma.
name: B1 agonists
label: c
answer: no
explanation: B2 adrenergic receptor stimulation leads to vasodilation and bronchodilation. B2 antagonists lead to adverse effects if used in asthmatics.
name: B2 antagonists
label: b
answer: no
explanation: B1 adrenergic receptors are responsible for heart rate and myocardial contraction. Stimulating or blocking B1 receptors would not lead to bronchodilation, and as such are not used for the management of asthma.
name: B1 antagonists
label: e
answer: no
explanation: Asthma is a type of obstructive lung disease characterised by airway bronchoconstriction as a result of inflammation of the airways. First-line treatment is a short-acting inhaled B2 agonist such as salbutamol. B2 adrenergic receptor stimulation leads to vasodilation and bronchodilation.
name: B2 agonists
label: a
answer: yes
explanation: A1 adrenergic receptors are responsible for systemic vascular tone and vasoconstriction. Stimulating these receptors leads to an increase in cardiac output. A1 adrenergic receptors are not involved in bronchodilation, and as such, are not used for asthma management.
name: A1 agonists
label: d
answer: no

Correct answer: a
A 24-year-old man presents to the emergency department following an anxiety attack during which he hyperventilated.


If an ABG were to be performed, the following values would be obtained.



||||
|--------------|:-------:|------------------|
|pH|7.49|7.35 - 7.45|
|PaO₂|15 kPa|11 - 15|
|PaCO₂|3.5 kPa|4.6 - 6.4|
|Bicarbonate|23 mmol/L|22 - 30|


Which of the following options is the most likely explanation for this patient's ABG results?

Options:
explanation: Although there is respiratory involvement, the patient's pH is above the normal range, and thus he is alkalotic, not acidotic.
name: Respiratory acidosis
label: b
answer: no
explanation: Although the patient is alkalotic, signified by his pH which is above the normal range. Metabolic involvement is unlikely as his HCO3 levels are within normal range. His CO2 levels are below the normal range, making this a respiratory alkalosis.
name: Metabolic alkalosis
label: d
answer: no
explanation: In mixed respiratory and metabolic acidosis, you would see the involvement of both respiratory and metabolic systems. As his pH is above the normal range, acidosis can be ruled out immediately as he is alkalotic.
name: Mixed respiratory and metabolic acidosis
label: e
answer: no
explanation: The patient is alkalotic, not acidotic as his pH is above the normal range. Additionally, metabolic involvement is unlikely as his HCO3 levels are within normal range.
name: Metabolic acidosis
label: c
answer: no
explanation: The patient's pH is above the normal range and therefore he is alkalotic. Upon establishing this, the following step in ABG interpretation is to establish if this alkalosis is due to a respiratory or metabolic involvement. As PaCO2 levels are below the normal range, this is consistent with respiratory involvement. As HCO3 levels are within normal range we can rule out a mixed metabolic and respiratory alkalosis. Therefore this patient has respiratory alkalosis.
name: Respiratory Alkalosis
label: a
answer: yes

Correct answer: a
A 62-year-old man presents to his GP with chronic progressive laboured breathing and a productive cough which he has had for four months. The patient has a family history of lung disease and smokes regularly.

On examination, there is a wheeze on auscultation and peripheral cyanosis in the fingers. The patient has a 'barrel' chest.

Which of the following is the most likely diagnosis?

Options:
explanation: Congestive heart failure can present with chronic shortness of breath. Other features in the presentation such as shortness of breath while lying flat and a history of cardiovascular disease would be indicative.
name: Congestive heart failure
label: e
answer: no
explanation: Although tuberculosis would present with a chronic picture, you would expect other accompanying features such as weight loss and drenching night sweats.
name: Tuberculosis
label: d
answer: no
explanation: Asthma does not usually present as a constant, chronic problem, and there would be some variation in the four months that he would have had this problem. Additionally, you would expect an allergy-associated history with asthma, including triggers which would exacerbate the condition.
name: Asthma
label: b
answer: no
explanation: Although smoking is a major risk factor for lung cancer development, you would expect other features such as weight loss and coughing up blood to suspect lung cancer.
name: Lung cancer
label: c
answer: no
explanation: Chronic obstructive pulmonary disease (COPD) is a respiratory disease characterised by irreversible obstruction of the airways. Family history and smoking are risk factors.

Remember: a barrel chest presentation is a buzzword for COPD in exams!
name: Chronic obstructive pulmonary disease (COPD)
label: a
answer: yes

Correct answer: a
A 67-year-old man presents to the emergency department with a newly-acquired drooping eyelid, constricted pupil and decreased sweating on the right side of his face. He is sent for a chest X-ray, and a mass is found in the apical zone of his right lung.

Which of the following is the most likely mechanism of this patient's presentation?

Options:
explanation: The patient is presenting with Horner's syndrome, the three characteristics of which are ptosis, miosis and anhydrosis. In carotid artery dissection, there would be an additional red flag feature of neck pain.
name: Horner's syndrome as a result of carotid artery dissection
label: c
answer: no
explanation: The patient is presenting with Horner's syndrome, the three characteristics of which are ptosis, miosis and anhydrosis. The mass described in the question stem is a Pancoast tumour which is a tumour originating in the apical zone of the lung. As it grows, it leads to impingement of the sympathetic chain resulting in Horner's syndrome.
name: Horner's syndrome as a result of a Pancoast tumour
label: a
answer: yes
explanation: Cervical ribs are osseous anomalies which would cause Horner's syndrome through the compression of the sympathetic chain. Additional symptoms which include the compression of the subclavian vein or artery would result in Thoracic outlet syndrome.
name: Horner's syndrome caused by a cervical rib
label: e
answer: no
explanation: Congenital Horner's syndrome would be present with the patient from birth, and thus would not explain a newly-acquired presentation.
name: Congenital Horner's syndrome
label: d
answer: no
explanation: The patient is presenting with Horner's syndrome, the three characteristics of which are ptosis, miosis and anhydrosis. Features indicative of strokes such as sudden onset and involvement of other body features such as arms and legs would be seen.
name: Horner's syndrome as a result of a stroke
label: b
answer: no

Correct answer: a
A critically ill 23-year-old male is brought via ambulance to the emergency department. He is taking quick, shallow breaths and is clearly in respiratory distress. An A to E assessment is performed; it is found that he has a deviated trachea. He is normally fit and healthy, and this has not happened previously.

Which of the following is the most likely cause of this patient's acute presentation?

Options:
explanation: Although asthma attacks could present with shortness of breath and respiratory distress, tracheal deviation would not be seen and is a characteristic of a pneumothorax.
name: Asthma attack
label: b
answer: no
explanation: Lung cancer is usually seen in smokers and is accompanied by gradual, progressive systemic symptoms of weight loss and night sweats. Tracheal deviation is indicative of pneumothorax.
name: Lung cancer
label: e
answer: no
explanation: A pneumothorax is defined as air within the pleural space. The question stem describes a classic presentation of a spontaneous pneumothorax, which is an emergency presentation.

Remember: tracheal deviation is a buzzword for pneumothorax!
name: Pneumothorax
label: a
answer: yes
explanation: Although a severe chest infection can present with respiratory distress and shortness of breath, tracheal deviation is indicative of pneumothorax.
name: Chest infection
label: d
answer: no
explanation: Heart failure can present with shortness of breath. However, it is very unlikely to have a heart failure presentation in an otherwise fit and healthy 23-year-old. Tracheal deviation would not be seen in acute heart failure but would be seen in a pneumothorax.
name: Heart failure
label: c
answer: no

Correct answer: a