hllj/quesmed huggingface dataset:
A 22-year-old patient with a background of asthma is admitted with a four-hour history of palpitations.

His heart rate is 180bpm, blood pressure 110/68mmHg, respiratory rate 18, SpO2 98% on air

His ECG shows a heart rate of 183 bpm and a regular narrow complex tachycardia. The admission chest x-ray is clear, and troponin levels are normal.

Which of the following is the next best step in management?

Options:
explanation: Synchronised DC cardioversion is used in cases of SVT where there are adverse features (myocardial ischaemic, heart failure, syncope or shock) present.

In synchronised cardioversion, the electrical shock is delivered during ventricular depolarisation in the cardiac cycle. This is important to reduce the risk of the rhythm changing into a life-threatening cardiac arrest rhythm (e.g. VF)
name: Synchronised DC cardioversion
label: b
answer: no
explanation: Adenosine is contraindicated in poorly controlled asthmatics as it can cause bronchospasm. Therefore verapamil is often preferred in this cohort of patients who present with SVT if vagal manoeuvres fail
name: Verapamil
label: e
answer: no
explanation: Adenosine is a medication that induces a transient block at the AV node. It is used if vagal manoeuvres are unsuccessful, initially at a dose of 6mg
name: Adenosine
label: d
answer: no
explanation: Unsynchronised DC cardioversion (defibrillation) is used in cases of cardiac arrest in the presence of a shockable rhythm. The shock is delivered at any point in the cardiac cycle
name: Unsynchronised DC cardioversion
label: c
answer: no
explanation: The history and ECG findings are suggestive of a supraventricular tachycardia (SVT). In the absence of adverse features (myocardial ischaemia, heart failure, syncope or shock), the first-line management of an SVT is vagal manoeuvres. These aim to stimulate the vagus nerve to slow down the heart rate
name: Valsalva manoeuvre
label: a
answer: yes

Correct answer: a


Learning point: The Valsalva manoeuvre is the first-line treatment for stable supraventricular tachycardia, promoting vagal stimulation to restore normal heart rhythm.
A 25-year-old woman presents to her GP with an 8 hour history of a red and swollen left breast. She is ten weeks post-partum and has been regularly breastfeeding with no complications.

On examination, she has a temperature of 37.6°C and an erythematous and tender left breast. The erythema is noted to extend in a wedge-shaped distribution.

Which of the following is the next best step in management?

Options:
explanation: Antibiotics should be prescribed in cases that are likely to be due to infectious mastitis. These include the presence of a nipple fissure, symptoms not improving with continuous milk removal for 12-24 hours and a positive breast milk culture
name: Prescribe oral flucloxacillin
label: b
answer: no
explanation: This woman has signs and symptoms consistent with mastitis. First-line management is with reassurance, simple analgesia and encouragement of breastfeeding
name: Encourage breastfeeding and provide simple analgesia
label: a
answer: yes
explanation: It is essential that breastfeeding continues to help prevent stasis of breast milk which can predispose to infection and worsening of symptoms
name: Advise against breastfeeding until symptoms resolve
label: d
answer: no
explanation: Urgent breast clinic referral would be warranted if there are signs of a breast abscess. A breast abscess would present with a painful swollen lump in the breast, often with a history of recent mastitis
name: Urgent referral to the breast surgery clinic
label: c
answer: no
explanation: There are no signs that this patient is systemically unwell and in need of hospital admission. Oral antibiotics would be the next step if her symptoms do not respond to conservative management
name: Admit to hospital for IV antibiotics
label: e
answer: no

Correct answer: a


Learning point: Mastitis in breastfeeding women is typically managed with reassurance, analgesia, and continued breastfeeding to promote drainage and healing.
A 35-year-old man with presents to the Emergency Department with persistent dizziness since waking up four hours ago. He reports the room spinning around him and associated nausea but no vomiting.

Full systems review is otherwise unremarkable; however, the patient does reveal having some mild coryzal symptoms a few days ago. On examination, there is a positive head impulse test, unidirectional nystagmus and no abnormal test of skew.

Given the likely diagnosis, which of the following is the most appropriate management?

Options:
explanation: A CT head would be indicated if a central cause of vertigo (e.g. stroke) was suspected. Signs of central vertigo on a HINTS exam are a negative head impulse test, bidirectional nystagmus and an abnormal test of skew. The fact he is young and has no cardiac risk factors makes the diagnosis of stroke less likely
name: Urgent CT head
label: b
answer: no
explanation: There is no indication for treatment with antibiotics. Vestibular neuronitis is often a sequelae of a viral upper respiratory tract infection
name: Start amoxicillin
label: e
answer: no
explanation: The likely diagnosis is vestibular neuronitis. This is a peripheral cause of vertigo, and the findings described on the HINTS (head impulse, nystagmus and test of skew) examination are suggestive of this. Vestibular neuronitis is characterised by inflammation of the vestibular nerve, often after a viral infection. Common symptoms include acute, spontaneous vertigo, nausea, vomiting and unsteadiness. Prochlorperazine is often used for symptomatic treatment
name: Oral prochlorperazine
label: a
answer: yes
explanation: Aspirin would be indicated if an ischaemic stroke was suspected as the cause of vertigo following exclusion of haemorrhage on a CT head
name: Start aspirin 300mg
label: c
answer: no
explanation: Vestibular neuronitis usually self-resolves spontaneously; however, the symptoms can be debilitating. Treatment is therefore recommended if symptoms are troublesome
name: Reassure with safety-net advice
label: d
answer: no

Correct answer: a


Learning point: Oral prochlorperazine is used to manage the vertigo and nausea in vestibular neuronitis by blocking dopamine receptors, typically for short-term symptom relief.
A 24-year-old woman presents to her GP with abnormal, fishy-smelling vaginal discharge for the last three days. She denies any other genitourinary symptoms.

On examination, there is a white homogenous discharge visible on the walls of the vagina.

Which of the following is the next best step in management?

Options:
explanation: This patient's symptoms and examination findings are suggestive of bacterial vaginosis (BV). It is the most common cause of abnormal vaginal discharge in women of child-bearing age and is characterised by an overgrowth of anaerobic organisms in the vagina. In addition, there is an associated increase in vaginal pH to above 4.5. In most women with characteristic signs and symptoms, empirical treatment should be started without further investigations
name: Oral metronidazole
label: a
answer: yes
explanation: Doxycycline is the first-line treatment for Chlamydia. The white discharge and absence of any other genito-urinary symptoms make BV the most likely diagnosis
name: Oral doxycycline
label: e
answer: no
explanation: IM ceftriaxone is the first-line treatment for uncomplicated anogenital gonorrhoea infections in the community. The white discharge and absence of any other genito-urinary symptoms make BV the most likely diagnosis.
Doxycycline
name: IM ceftriaxone
label: d
answer: no
explanation: If measured, vaginal pH would be greater than 4.5 in BV. However, testing is not required if the history and examination findings suggest the diagnosis in non-pregnant women at low risk of having a sexually transmitted infection (STI)
name: Measure vaginal pH
label: c
answer: no
explanation: Microscopy of vaginal secretions may reveal "clue cells" in BV. However, testing is not required if the history and examination findings suggest the diagnosis in non-pregnant women at low risk of having a sexually transmitted infection (STI)
name: Send vaginal secretions for microscopy
label: b
answer: no

Correct answer: a


Learning point: Bacterial vaginosis is characterised by a fishy-smelling discharge and is treated with oral metronidazole.
Correctly identify the part of the organ labelled
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Options:
explanation: The uncinate process is an inferior projection which arises from the head of the pancreas. It extends medially to sit below the body of the pancreas.
name: Uncinate process
label: e
answer: no
explanation: The neck of the pancreas sits between the head and body of the pancreas. The neck of the pancreas is located at the level of L1 which corresponds to the transpyloric plane. The superior mesenteric vein and the splenic vein join to form the portal vein immediately behind the neck of the pancreas.
name: Neck
label: c
answer: no
explanation: This is the widest part of the pancreas and is normally located right to the midline. The “C-shaped” curve of the duodenum surrounds the head of the pancreas.
name: Head
label: b
answer: no
explanation: The body is the middle portion of the pancreas and lies closely behind the stomach. The body of pancreas crosses over the aorta and L2 vertebra. The anterior surface of the body of pancreas is covered by the peritoneum whilst the posterior surface is devoid of peritoneum.
name: Body
label: d
answer: no
explanation: The tail of the pancreas is labelled. This is the only portion of the pancreas that is intraperitoneal and it lies anterior to the left kidney and in close proximity to hilum of the spleen and the left colic flexure.
name: Tail
label: a
answer: yes

Correct answer: a
What does the labelled structure join with to form the ampulla of Vater?
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Options:
explanation: The structure labelled is the pancreatic duct. This joins with the common bile duct to form the ampulla of Vater. The ampulla of Vater allows for pancreatic juices and bile (required for the breakdown of food) to enter the duodenum. The splenic artery runs superior to the pancreas.
name: Splenic artery
label: c
answer: no
explanation: The structure labelled is the pancreatic duct. This joins with the common bile duct to form the ampulla of Vater. The ampulla of Vater allows for pancreatic juices and bile (required for the breakdown of food) to enter the duodenum.
name: Pancreatic duct
label: b
answer: no
explanation: The parotid duct, also termed the Stensen duct, drains saliva from the parotid gland into the *oral cavity*. Whilst not the correct answer here, the parotid duct is commonly examined in further exams, e.g., MRCS.
name: Parotid duct
label: e
answer: no
explanation: The common bile duct joins the pancreatic duct which is labelled to form the ampulla of Vater. The ampulla of Vater allows for pancreatic juices and bile (required for the breakdown of food) to enter the duodenum.
name: Common bile duct
label: a
answer: yes
explanation: The common hepatic duct carries bile from the liver. The common hepatic duct joins with the cystic duct to become the common bile duct. The common bile duct in turn joins the pancreatic duct which is labelled to form the ampulla of Vater. The ampulla of Vater allows for pancreatic juices and bile (required for the breakdown of food) to enter the duodenum.
name: Common hepatic duct
label: d
answer: no

Correct answer: a
Which of the following joins the labelled structure to allow passage of bile?
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Options:
explanation: The common hepatic duct is labelled, and is the means by which bile drains from the liver and into the gallbladder for storage. The cystic duct in turn allows bile to pass from the gallbladder into the common bile duct (From here, bile can then pass into the duodenum via the ampulla of Vater.)
name: Cystic duct
label: b
answer: no
explanation: The common hepatic duct is labelled, and is the means by which bile drains from the liver and into the gallbladder for storage.
name: Common hepatic duct
label: a
answer: yes
explanation: The common bile duct joins the pancreatic duct which is labelled to form the ampulla of Vater. The ampulla of Vater allows for pancreatic juices and bile (required for the breakdown of food) to enter the duodenum.
name: Pancreatic duct
label: d
answer: no
explanation: The parotid duct, also termed the Stensen duct, drains saliva from the parotid gland into the *oral cavity*. Whilst not the correct answer here, the parotid duct is commonly examined in further exams, e.g., MRCS.
name: Parotid duct
label: e
answer: no
explanation: The common bile duct is formed by the union of the cystic duct and common hepatic duct. The common bile duct in turn joins the pancreatic duct which is labelled to form the ampulla of Vater. The ampulla of Vater allows for pancreatic juices and bile (required for the breakdown of food) to enter the duodenum.
name: Common bile duct
label: c
answer: no

Correct answer: a
Which part of the duodenum does the labelled structure pass posterior to?
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Options:
explanation: The common bile duct is labelled and passes posterior to the 1st part of the duodenum. It joins the pancreatic duct to form the ampulla of Vater.
name: 2nd part
label: b
answer: no
explanation: There is no 5th part of the duodenum. The common bile duct is labelled and passes posterior to the 1st part of the duodenum. It joins the pancreatic duct to form the ampulla of Vater.
name: 5th part
label: e
answer: no
explanation: The common bile duct is labelled and passes posterior to the 1st part of the duodenum. It joins the pancreatic duct to form the ampulla of Vater.
name: 3rd part
label: c
answer: no
explanation: The common bile duct is labelled and passes posterior to the 1st part of the duodenum. It joins the pancreatic duct to form the ampulla of Vater.
name: 1st part
label: a
answer: yes
explanation: The common bile duct is labelled and passes posterior to the 1st part of the duodenum. It joins the pancreatic duct to form the ampulla of Vater.
name: 4th part
label: d
answer: no

Correct answer: a
What is the structure labelled by the blue arrow?
[lightgallery]

Options:
explanation: Mucosa in the anal canal is organised into longitudinal folds, termed anal columns. At their inferior ends, these folds are joined by anal valves. The anal valves collectively form the pectinate (dentate) line which divides the anal canal into upper and lower parts. Just superior to these valves lie small pouches termed anal sinuses, which contain mucus secreting glands.
name: Pectinate line
label: c
answer: no
explanation: Mucosa in the anal canal is organised into longitudinal folds, termed anal columns. At their inferior ends, these folds are joined by anal valves. The anal valves collectively form the pectinate (dentate) line which divides the anal canal into upper and lower parts. Just superior to these valves lie small pouches termed anal sinuses, which contain mucus secreting glands.
name: Anal valve
label: a
answer: yes
explanation: Mucosa in the anal canal is organised into longitudinal folds, termed anal columns. At their inferior ends, these folds are joined by anal valves. The anal valves collectively form the pectinate (dentate) line which divides the anal canal into upper and lower parts. Just superior to these valves lie small pouches termed anal sinuses, which contain mucus secreting glands.
name: Anal column
label: b
answer: no
explanation: Mucosa in the anal canal is organised into longitudinal folds, termed anal columns. At their inferior ends, these folds are joined by anal valves. The anal valves collectively form the pectinate (dentate) line which divides the anal canal into upper and lower parts. Just superior to these valves lie small pouches termed anal sinuses, which contain mucus secreting glands. The internal anal sphincter is muscle under involuntary control, which surrounds the upper 2/3rds of the anal canal.
name: Internal anal sphincter
label: e
answer: no
explanation: Mucosa in the anal canal is organised into longitudinal folds, termed anal columns. At their inferior ends, these folds are joined by anal valves. The anal valves collectively form the pectinate (dentate) line which divides the anal canal into upper and lower parts. Just superior to these valves lie small pouches termed anal sinuses, which contain mucus secreting glands.
The external anal sphincter is a voluntary muscle that surrounds the lower anal canal.
name: External anal sphincter
label: d
answer: no

Correct answer: a
Which statement correctly describes the labelled structure?
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Options:
explanation: This describes the anal columns which are folds of epithelium with anal valves located at the bottom of each column.
name: It is longitudinal folds of epithelium which are joined by anal valves at the inferior ends.
label: d
answer: no
explanation: This statement describes the external anal sphincter which is labelled by the blue arrow. The external anal sphincter is innervated by the pudendal nerve and acts to constrict the anal canal thereby keeping the anal canal closed and maintaining faecal continence.
name: It is a voluntary muscle that surrounds the lower 2/3rds of the anal canal.
label: a
answer: yes
explanation: This describes the internal anal sphincter which is made of involuntary circular smooth muscle. The internal anal sphincter is responsible for maintaining approximately 70% of resting anal tone and keeping the anal canal closed. There is some anatomical overlap between the internal and external anal sphincter.
name: It is an involuntary muscle that surrounds the upper 2/3rds of the anal canal.
label: b
answer: no
explanation: This describes the pectinate (dentate) line which divides the anal canal into upper and lower parts. Clinically, the anal canal below the dentate line is innervated by the inferior rectal nerve, which means that pain can be felt. The autonomic nervous system innervates the area above the dentate line.
name: It is formed by the anal valves which divides the anal canal into upper and lower parts.
label: c
answer: no
explanation: The anal valves collectively form the pectinate (dentate) line. Just superior to these valves lie small pouches termed anal sinuses, which contain mucus secreting glands.
name: It is a mucus secreting area located just superior to the anal columns
label: e
answer: no

Correct answer: a
What is the specific embryological origin of the labelled structure?
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Options:
explanation: The urogenital septum is an early structure that divides into the cloaca and rectum posteriorly and the urogenital sinus anteriorly.
name: Urogenital septum
label: c
answer: no
explanation: The pronephros is a rudimentary kidney which is an early structure and this degenerates by the 5th week of embryological development.
name: Pronephros
label: d
answer: no
explanation: The ureters more specifically develop from the ureteric bud which arises from the mesonephric duct.
name: Mesonephric duct
label: e
answer: no
explanation: The nephrons develop from the metanephric mesoderm.
name: Metanephric mesoderm
label: b
answer: no
explanation: The ureteric bud, which is derived from the mesonephric duct, is the embryological origin of the ureters.
name: Ureteric bud
label: a
answer: yes

Correct answer: a
Where does the labelled structure drain into?
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Options:
explanation: The right gonadal vein is labelled here. The right gonadal vein drains directly into the IVC. The *left* gonadal vein drains into the left renal vein, which in turn drains into the IVC.
name: Aorta
label: b
answer: no
explanation: The right gonadal vein drains directly into the IVC. The *left* gonadal vein drains into the left renal vein, which in turn drains into the IVC.
name: Inferior vena cava (IVC)
label: a
answer: yes
explanation: The right gonadal vein is labelled here. The right gonadal vein drains directly into the IVC. The *left* gonadal vein drains into the left renal vein, which in turn drains into the IVC. The superior vena cava drains venous blood from the upper half of the body and empties into the right atrium.
name: Superior vena cava (SVC)
label: c
answer: no
explanation: The right gonadal vein is labelled here. The right gonadal vein drains directly into the IVC. The *left* gonadal vein drains into the left renal vein, which in turn drains into the IVC. The superior mesenteric artery arises directly from the aorta at the level of L1 and supplies the midgut structures.
name: Superior mesenteric artery (SMA)
label: d
answer: no
explanation: The right gonadal vein is labelled here. The right gonadal vein drains directly into the IVC. The right renal vein also drains directly into the IVC. The *left* gonadal vein drains into the left renal vein, which in turn drains into the IVC.
name: Right renal vein
label: e
answer: no

Correct answer: a
Identify the structure labelled by the blue arrow.
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Options:
explanation: Anatomically, the liver is composed of four lobes: the right, left, caudate and quadrate lobes. The quadrate and caudate lobe are often termed accessory lobes. The quadrate lobe is the smallest of the four and is located on the inferior surface of the right lobe between the gallbladder and a fossa produced by the ligamentum teres.
name: Quadrate lobe
label: a
answer: yes
explanation: Anatomically, the liver is composed of four lobes: the right, left, caudate and quadrate lobes. Here the quadrate lobe is labelled. The left and right lobes are divided anteriorly by the falciform ligament. The left triangular lobe attaches the left lobe of the liver to the diaphragm.
name: Left lobe
label: e
answer: no
explanation: Anatomically, the liver is composed of four lobes: the right, left, caudate and quadrate lobes. Here the quadrate lobe is labelled. The right lobe is the largest of all four lobes. The right lobe is attached to the diaphragm by the right triangular ligament.
name: Right lobe
label: d
answer: no
explanation: Anatomically, the liver is composed of four lobes: the right, left, caudate and quadrate lobes. Here, the quadrate lobe is labelled.
name: Middle lobe
label: c
answer: no
explanation: Anatomically, the liver is composed of four lobes: the right, left, caudate and quadrate lobes. The quadrate and caudate lobe are often termed accessory lobes. Here, the quadrate lobe is labelled. The caudate lobe is located on the upper aspect of the visceral surface, located between the IVC and a fossa produced by the ligamentum venosum.
name: Caudate lobe
label: b
answer: no

Correct answer: a
Identify the organ which leaves the impression labelled on the posterior surface of the liver.
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Options:
explanation: The renal impression is labelled. This is a deep impression located posterior to the colic impression. It is formed by the right kidney and adrenal gland. The stomach is located in the epigastrium, it leaves a gastric impression on the inferior surface of the *left* lobe of the liver.
name: Stomach
label: d
answer: no
explanation: The renal impression is labelled. This is a deep impression located posterior to the colic impression. It is formed by the right kidney and adrenal gland. The duodenum leaves a small impression on the liver, medial to the renal impression.
name: Duodenum
label: e
answer: no
explanation: The renal impression is labelled. This is a deep impression located posterior to the colic impression. It is formed by the right kidney and adrenal gland. The spleen does not leave an impression of the liver.
name: Spleen
label: c
answer: no
explanation: The renal impression is labelled. This is a deep impression located posterior to the colic impression. It is formed by the right kidney and adrenal gland.
name: Right kidney
label: a
answer: yes
explanation: The renal impression is labelled. This is a deep impression located posterior to the colic impression. It is formed by the right kidney and adrenal gland. The left kidney does not leave an impression on the liver.
name: Left kidney
label: b
answer: no

Correct answer: a