hllj/quesmed huggingface dataset:
What drug is used first line for the chronic management of gout?

Options:
explanation: Colchicine is an anti-inflammatory drug that can be used to treat acute gout as well as reduce the frequency and severity of gout attacks but is not recommended for long-term use.
name: Colchicine
label: d
answer: no
explanation: The first-line treatment for the chronic management of gout is allopurinol. It works by reducing the production of uric acid which helps prevent gout attacks.
name: Allopurinol
label: a
answer: yes
explanation: Probenecid is a medication that is used to increase uric acid excretion and can help prevent gout attacks. However, it is not the first-line treatment for the chronic management of gout.
name: Probenecid
label: e
answer: no
explanation: NSAIDs, such as ibuprofen and naproxen, can be used to reduce pain and inflammation during an acute gout attack, but are not recommended for long-term use due to the risk of side effects, such as renal failure or peptic ulcers.
name: Non-steroidal anti-inflammatory drugs (NSAIDs)
label: b
answer: no
explanation: Corticosteroids, such as prednisone, can also be used to reduce inflammation and pain during an acute gout attack, but are not recommended for long-term use due to the risk of side effects, such as osteoporosis.
name: Corticosteroids
label: c
answer: no

Correct answer: a
A 60-year-old gentleman presents to A&E with shortness of breath and a high fever. He has been experiencing a progressively worsening cough and fatigue. He is diagnosed with pneumonia and further tests find him to be positive for *Chlamydia pneumoniae*.

Which of the following antibiotics is used first-line in the treatment of *Chlamydia pneumoniae* infection?

Options:
explanation: *Chlamydia pneumoniae* is penicillin-resistant, therefore amoxicillin is not an effective antibiotic treatment.
name: Amoxicillin
label: b
answer: no
explanation: Doxycycline is a tetracycline antibiotic which can be used for the treatment of *Chlamydia pneumoniae* but is not used first-line.
name: Doxycycline
label: c
answer: no
explanation: Ciprofloxacin is a fluoroquinolone antibiotic and can be used for the treatment of *Chlamydia pneumoniae* but is not used first-line.
name: Ciprofloxacin
label: d
answer: no
explanation: Clarithromycin is a macrolide antibiotic. Macrolides are effective against *Chlamydia pneumoniae*; they work by inhibiting the 50S ribosomal subunit, limiting bacterial protein synthesis.
name: Clarithromycin
label: a
answer: yes
explanation: Rifampicin is an ansamycin antibiotic used to treat several types of bacterial infections, including tuberculosis. It is not typically used to treat *Chlamydia pneumoniae* infection.
name: Rifampicin
label: e
answer: no

Correct answer: a
Which of the following best describes the changes to pH, ketones, bicarbonate and glucose levels in diabetic ketoacidosis (DKA)?

Options:
explanation: In DKA, pH levels are low due to the build-up of acidic ketones. Ketones are also high.
name: High pH, low ketones, low bicarbonate, high glucose
label: b
answer: no
explanation: In DKA, ketone and glucose levels are high. Patients with DKA are typically very dehydrated and present with nausea, vomiting and reduced consciousness.
name: Low pH, low ketones, low bicarbonate, low glucose
label: d
answer: no
explanation: In DKA, pH levels are low due to the accumulation of acidic ketones - therefore ketone levels are also high. Bicarbonate levels are low due to decreased production and increased consumption as the body tries to compensate for the low pH levels. Glucose levels are high as there is an insulin deficiency, leading to increased glucose levels in the blood which cannot enter cells to be utilised.
name: Low pH, high ketones, low bicarbonate, high glucose
label: a
answer: yes
explanation: In DKA, pH levels are low due to the build-up of acidic ketones. Bicarbonate is low due to increased consumption through compensatory mechanisms which try to normalise the low pH.
name: Normal pH, low ketones, high bicarbonate, high glucose
label: c
answer: no
explanation: Glucose levels are high in DKA, not low. pH is also low as a result of high ketones.
name: Normal pH, high ketones, high bicarbonate, low glucose
label: e
answer: no

Correct answer: a
Montelukast can be used in the management of asthma.

What is the mechanism of action of montelukast?

Options:
explanation: Montelukast is not a corticosteroid. This description fits drugs such as beclomethasone, which can be used in asthma management.
name: Montelukast is a corticosteroid that works to inhibit inflammatory cells and the release of inflammatory mediators
label: d
answer: no
explanation: This is the mechanism of action for montelukast. It targets CysLT1 leukotriene receptors found on eosinophils, mast cells and airway smooth muscle cells.
name: Montelukast is a CysLT1 leukotriene receptor antagonist that decreases eosinophil migration, bronchoconstriction and inflammation-induced oedema
label: a
answer: yes
explanation: This is the mechanism of theophylline. Inhibition of phosphodiesterases leads to the reduced breakdown of cyclic AMP in smooth muscle cells. This is thought to result in bronchodilation and relaxed smooth muscle. Theophylline can be used to manage asthma and COPD.
name: Montelukast inhibits type III and IV phosphodiesterase, which leads to bronchodilation and relaxed smooth muscle in the bronchial airways
label: e
answer: no
explanation: This is the mechanism of action for salbutamol, which is a different drug used in asthma treatment. It is more commonly used in asthma management than montelukast.
name: Montelukast is a B2-receptor agonist. Once these receptors are activated, Ca2+ entry is reduced which prevents smooth muscle contraction
label: b
answer: no
explanation: This is the mechanism of action of fluticasone and mometasone. Alongside targeting eosinophils and monocytes, they also target mast cells, macrophages and dendritic cells.
name: Montelukast has multiple actions on different cell types - it directly decreases inflammatory cells like eosinophils and monocytes and also reduces the number of cytokines produced by these cells
label: c
answer: no

Correct answer: a
Achalasia is a condition characterised by the loss of ganglion cells, leading to oesophageal hypermotility.

Where are the lost ganglion cells in achalasia normally found?

Options:
explanation: The carotid plexus is located near the carotid arteries and innervates the head and neck. It is not the location of the ganglion cells lost in achalasia.
name: Carotid plexus
label: e
answer: no
explanation: The adrenal plexus is located near the adrenal glands and controls the sympathetic nervous system, and is not the location of the ganglion cells lost in achalasia.
name: Adrenal plexus
label: d
answer: no
explanation: The coeliac plexus is located near the coeliac artery and controls digestion, and is not the location of the ganglion cells lost in achalasia.
name: Coeliac plexus
label: c
answer: no
explanation: The pathophysiology of achalasia involves inflammation of the myenteric plexus within the oesophageal with the destruction of ganglion cells. The myenteric plexus is located between the inner and outer layers of the muscularis propria.
name: Myenteric plexus
label: a
answer: yes
explanation: Meissner's plexus is located in the submucosal layer and regulates secretions and blood flow within the gastrointestinal tract. It is not the location of the ganglion cells lost in achalasia.
name: Meissner's plexus
label: b
answer: no

Correct answer: a
Which of the following best describes a sliding hiatus hernia?

Options:
explanation: This best describes a femoral hernia. This is a rare type of hernia and may present as a lump, which can appear with coughing/straining and disappear when the patient lies down.
name: A hernia that occurs when part of the small intestine protrudes through the femoral canal into the thigh
label: d
answer: no
explanation: This best describes a rolling hiatus hernia, also known as a para-oesophageal hernia. The location of the lower oesophageal sphincter does not change n rolling hiatus hernias; instead, a portion of the stomach slides up into the chest. These are less common than sliding hiatus hernias.
name: A hernia that occurs when part of the stomach protrudes into the chest through a weakened opening in the diaphragm, adjacent to the oesophagus
label: e
answer: no
explanation: This correctly describes a sliding hiatus hernia which is the most common type of hiatus hernia. In sliding hiatus hernias, the location of the lower oesophageal sphincter changes and it rises into the chest. As a result, the sphincter may not be able to close efficiently which can lead to acid reflux.
name: A hernia that occurs when the stomach intermittently slides up into the chest through a weakened opening in the diaphragm
label: a
answer: yes
explanation: This best describes an umbilical hernia which does not involve the lower oesophageal sphincter at all.
name: A hernia that occurs when part of the stomach protrudes through a weakness in the abdominal wall near the umbilicus
label: b
answer: no
explanation: This best describes an inguinal hernia. This may present as a lump, which can appear with coughing/straining and disappear when the patient lies down.
name: A hernia that occurs when part of the intestine protrudes through the inguinal canal into the scrotum in males or labia majora in females
label: c
answer: no

Correct answer: a
In which stage of diabetic retinopathy are 'cotton wool spots' typically first seen?

Options:
explanation: Background retinopathy is characterised by the presence of at least one microaneurysm. It falls under the category of non-proliferative retinopathy.
name: Background retinopathy
label: b
answer: no
explanation: This is incorrect as acute retinal necrosis is not a stage of diabetic retinopathy at all. It is a separate condition, which may present as panuveitis and can be viral in origin.
name: Acute retinal necrosis
label: e
answer: no
explanation: Cotton wool spots are a hallmark feature of non-proliferative retinopathy and typically appear when the disease is at a moderate stage. Indeed, one of the diagnostic criteria for moderate non-proliferative retinopathy is cotton wool spots, as well as retinal haemorrhages, hard exudates and venous beading.
name: Moderate non-proliferative retinopathy
label: a
answer: yes
explanation: Whilst cotton wool spots can be seen here, this is a much more advanced stage of diabetic retinopathy (cotton wool spots would likely have been present for a long time). Proliferative diabetic retinopathy is characterised by new vessels on the optic disc and generalised neovascularisation.
name: Proliferative retinopathy
label: c
answer: no
explanation: Cotton wool spots are usually seen in non-proliferative retinopathy, but are most likely to first appear during the moderate stage. The diagnostic criteria for severe non-proliferative retinopathy include intraretinal haemorrhages, venous beading in two or more quadrants and multiple intraretinal microvascular abnormalities.
name: Severe non-proliferative retinopathy
label: d
answer: no

Correct answer: a
Which of the following endocrine disorders is characterised by centripetal obesity, a moon face, and a buffalo hump?

Options:
explanation: Hypopituitarism is characterised by decreased production of multiple pituitary hormones, leading to symptoms such as fatigue, decreased libido, and menstrual abnormalities. It does not typically cause centripetal obesity, a moon face, or a buffalo hump.
name: Hypopituitarism
label: d
answer: no
explanation: Hyperparathyroidism is characterised by high levels of parathyroid hormone, leading to symptoms such as osteoporosis, kidney stones, and mood changes. It does not typically cause centripetal obesity, a moon face, or a buffalo hump.
name: Hyperparathyroidism
label: b
answer: no
explanation: Cushing's disease is characterised by excessive production of cortisol, leading to clinical signs such as centripetal obesity, moon face, buffalo hump, easy bruising, and muscle weakness.
name: Cushing's disease
label: a
answer: yes
explanation: Hyperthyroidism is characterised by high levels of thyroid hormone, leading to symptoms such as weight loss, tachycardia and sweating. It does not typically cause centripetal obesity, a moon face, or a buffalo hump.
name: Hyperthyroidism
label: c
answer: no
explanation: Addison's disease is characterised by decreased production of adrenal hormones, leading to symptoms such as fatigue, weight loss, and low blood pressure. It does not typically cause centripetal obesity, a moon face, or a buffalo hump.
name: Addison's disease
label: e
answer: no

Correct answer: a
Disseminated intravascular coagulation (DIC) is a disorder of coagulation in which changes to D dimer and fibrinogen levels are seen.

Which of the following best describes the D dimer and fibrinogen profile seen in DIC?

Options:
explanation: DIC is a rare but serious condition characterised by inappropriate, systemic activation of coagulation pathways. Raised D dimer levels, reduced fibrinogen concentration, low platelet count and prolonged prothrombin time can therefore be seen. It is caused by the inappropriate activation of clotting pathways which causes widespread coagulation. In turn, this depletes coagulation factors which then results in excessive bleeding.
name: Elevated D dimer levels, reduced fibrinogen concentration, low platelet count, prolonged prothrombin time
label: a
answer: yes
explanation: A high fibrinogen concentration is not seen in DIC: excessive widespread coagulation depletes fibrinogen levels. A high platelet count is not typical in DIC, and prothrombin time is prolonged.
name: Elevated D-dimer levels, high fibrinogen concentration, high platelet count, normal prothrombin time
label: e
answer: no
explanation: In DIC, the platelet count is typically low, not high. Furthermore, D dimer is high, and prothrombin time (PT) is prolonged due to a depletion in coagulation factors.
name: Reduced D-dimer levels, reduced fibrinogen concentration, high platelet count, reduced prothrombin time
label: c
answer: no
explanation: A high fibrinogen concentration is not seen in DIC: excessive widespread coagulation depletes fibrinogen levels. A prolonged prothrombin time would also be seen due to the depletion of coagulation factors. D dimer is also raised.
name: Reduced D-dimer levels, high fibrinogen concentration, low platelet count, normal prothrombin time
label: b
answer: no
explanation: A high fibrinogen concentration is not seen in DIC: excessive widespread coagulation depletes fibrinogen levels.
name: Elevated D-dimer levels, high fibrinogen concentration, low platelet count, prolonged prothrombin time
label: d
answer: no

Correct answer: a
A patient's ECG shows peaked T-waves, prolonged PR interval, widened QRS complexes and flattened P waves.

Which of the following abnormalities are these ECG findings consistent with?

Options:
explanation: Hypokalaemia is characterised by flattened/inverted T waves, QT prolongation and occasionally U waves.
name: Hypokalaemia
label: b
answer: no
explanation: Hypercalcaemia, especially in its severe form, may present with ST-segment elevation, biphasic T waves and prominent U waves.
name: Hypercalcaemia
label: e
answer: no
explanation: Pulmonary embolism usually presents on ECG with sinus tachycardia, but may also present with a new right bundle branch block, rightward shift of the QRS axis or an S1Q3T3 phenomenon.
name: Pulmonary embolism
label: c
answer: no
explanation: Hypocalcaemia is more likely to present with QT interval prolongation secondary to a prolonged ST segment.
name: Hypocalcaemia
label: d
answer: no
explanation: Peaked T waves and signs of slow conduction, e.g. prolonged PR interval and widened QRS complexes, are all suggestive of hyperkalaemia.
name: Hyperkalaemia
label: a
answer: yes

Correct answer: a
A 56-year-old female presents to A&E with shortness of breath, wheeze and a fever. She is suspected to have a COVID-19 infection. Further investigations are conducted.

Her observations are: O2 saturation 89% on BiPAP, heart rate 78bpm, respiratory rate 22 breaths/minute, blood pressure 152/85mmHg and temperature 38.4 degrees Celsius.

A Schwanz ganz catheter indicates her end-diastolic volume (EDV) to be 248 mL and end-systolic volume (ESV) to be 109 mL.

Which of the following describes her cardiac output (CO), ejection fraction (EF) and mean arterial blood pressure (MAP)?

Options:
explanation: It is important to know the equations for calculating cardiac output, ejection fraction and mean arterial blood pressure for this question. They are listed below:

MAP = DP + 1/3(SP-DP)
SV = EDV – ESV
CO = HR x SV
EF = SV/EDV x 100

SV = stroke volume, SP = systolic pressure, DP = diastolic pressure, HR = heart rate
name: CO: 10.8L, EF: 56%, MAP: 107mmHg
label: a
answer: yes
explanation: None of the above is correct. It is important to know the equations for calculating cardiac output, ejection fraction and mean arterial blood pressure for this question. They are listed below:

MAP = DP + 1/3(SP-DP)
SV = EDV – ESV
CO = HR x SV
EF = SV/EDV x 100

SV = stroke volume, SP = systolic pressure, DP = diastolic pressure, HR = heart rate
name: CO: 11.5L, EF: 67%, MAP: 93mmHg
label: e
answer: no
explanation: None of the above is correct. It is important to know the equations for calculating cardiac output, ejection fraction and mean arterial blood pressure for this question. They are listed below:

MAP = DP + 1/3(SP-DP)
SV = EDV – ESV
CO = HR x SV
EF = SV/EDV x 100

SV = stroke volume, SP = systolic pressure, DP = diastolic pressure, HR = heart rate
name: CO: 11.5L, EF: 62%, MAP: 103mmHg
label: d
answer: no
explanation: Whilst EF and MAP are correct here, CO is not. Calculate cardiac output using this equation: HR x SV
name: CO: 11.5L, EF: 56%, MAP: 107mmHg
label: c
answer: no
explanation: Whilst the cardiac output and MAP are correct here, the ejection fraction is not. Calculate ejection fraction using this equation: SV/EDV x 100
name: CO: 10.8L, EF: 62%, MAP: 103mmHg
label: b
answer: no

Correct answer: a
Which of the following is a clinical sign of a lower motor neuron lesion?

Options:
explanation: Presence of clonus indicates an upper motor neuron lesion. It is most commonly assessed in the ankle joint through brisk dorsiflexion of the foot.
name: Presence of clonus
label: b
answer: no
explanation: Flaccid tone is a sign of lower motor neuron lesions. This can be elucidated on examination - passive movement of the patient's joints will be very easy and they will feel 'floppy'.
name: Flaccid tone
label: a
answer: yes
explanation: This is a sign of an upper motor neuron lesion. In a lower motor neuron lesion, reflexes will typically be reduced or absent.
name: Brisk reflexes
label: c
answer: no
explanation: This is a sign of an upper motor neuron lesion. Flaccid tone is more commonly seen in lower motor neuron lesions.
name: Spastic tone
label: d
answer: no
explanation: This is a sign of an upper motor neuron lesion. A positive Babinski sign is an extensor plantar response, whereby stroking the sole of the foot causes the big toe to bend upwards and the other toes to fan outward. This is normal in children under 2 years old and pathological if seen in adults.
name: Positive Babinski sign
label: e
answer: no

Correct answer: a
During early foetal development, the different germ layers begin to develop into what will eventually become the organs of the body.

Which germ layer does the gastrointestinal tract develop from?

Options:
explanation: The GI tract develops from the endoderm germ layer, alongside the liver, pancreas, lung and thyroid.
name: Endoderm
label: a
answer: yes
explanation: The somites are paired blocks of paraxial mesoderm that flank the neural tube and notochord. They do not partake in the development of the GI tract.
name: Somites
label: e
answer: no
explanation: The notochord functions as an organising centre for neurulation and mesoderm development. It does not partake in the development of the GI tract.
name: Notochord
label: d
answer: no
explanation: The GI tract does not develop from the ectoderm. However, the CNS and neural crest, skin epithelia and tooth enamel all develop from the ectoderm.
name: Ectoderm
label: b
answer: no
explanation: The GI tract does not develop from the mesoderm. However, the blood, muscle and gonads all develop from the mesoderm.
name: Mesoderm
label: c
answer: no

Correct answer: a
Late foetal development involves the maturation of body organs.

Which substance is responsible for coordinating foetal organ maturation?

Options:
explanation: Progesterone is key for the maintenance of pregnancy but does not directly coordinate the maturation of organs in the late stages of foetal development.
name: Progesterone
label: e
answer: no
explanation: Insulin produced by the foetus helps to facilitate the transfer of glucose from the mother's bloodstream to the foetus for its energy needs. It also stimulates glucose uptake into foetal tissues, allowing it to be used as an energy source for growth and development. However, it does not directly coordinate organ maturation in late foetal development.
name: Insulin
label: c
answer: no
explanation: The insulin-like growth factors have a similar action to insulin and are key for the growth and survival of the foetus. However, in late foetal development, they do not directly coordinate organ maturation.
name: IGF-1
label: d
answer: no
explanation: Cholesterol is a key component in the synthesis of cell membranes, hormones and bile acids in a developing foetus, but does not directly coordinate organ maturation in late foetal development.
name: Cholesterol
label: b
answer: no
explanation: Foetal corticosteroids are responsible for organ maturation during late foetal development. They increase in concentration towards the end of pregnancy to facilitate this.
name: Corticosteroids
label: a
answer: yes

Correct answer: a
Which of the following is a cutaneous manifestation of dermatomyositis?

Options:
explanation: This is a sign of Stevens-Johnson syndrome which is a dermatological emergency with a high mortality rate. It is not a cutaneous manifestation of dermatomyositis.
name: Extensive, full-thickness mucocutaneous necrosis
label: e
answer: no
explanation: Livedo reticularis is a vascular condition that causes a mottled, net-like pattern on the skin. It may be associated with underlying autoimmune, connective tissue or vascular diseases, but is not typically associated with dermatomyositis.
name: Livedo reticularis
label: c
answer: no
explanation: Dermatomyositis is an autoimmune disease that affects the muscles and skin. It is characterised by muscle weakness and skin rashes. One of the classic skin manifestations of dermatomyositis is a heliotrope rash, which is a purplish-red rash around the eyes and on the eyelids. This rash is called heliotrope because it resembles the colour of the heliotrope flower. Other skin manifestations of dermatomyositis may include Gottron's papules (small, scaly, raised patches on the knuckles and finger joints), periungual telangiectasias (spider-like blood vessels around the nail beds), and a "shawl sign" rash (a red, scaly rash on the upper back, shoulders, and chest).
name: Heliotrope rash
label: a
answer: yes
explanation: Periorbital purpura is bruising around the eyes and is often called the 'racoon sign'. It is a cutaneous manifestation of systemic amyloidosis, not dermatomyositis.
name: Periorbital purpura
label: d
answer: no
explanation: Psoriasis is a different skin condition that is not typically associated with dermatomyositis. Psoriasis is characterised by scaly, red, and itchy patches on the skin.
name: Psoriasis-like rash
label: b
answer: no

Correct answer: a