hllj/quesmed huggingface dataset:
A 65-year-old man presents to his GP with a 3-month history of blood in his stools and on wiping, feeling unable to completely empty his bowels. Upon further questioning, the patient reveals he has also lost some weight recently.

What is the most likely diagnosis?

Options:
explanation: Whilst Crohn's disease is a relevant differential given the haematochezia and weight loss, it is generally not associated with tenesmus, therefore this answer is incorrect.
name: Crohn's Disease
label: d
answer: no
explanation: Whilst haematochezia and tenesmus are common symptoms of haemorrhoids, the weight loss indicates a more serious diagnosis, therefore this answer is incorrect.
name: Haemarrhoids
label: b
answer: no
explanation: This is incorrect, as given the history, diverticulitis is an unlikely differential.
name: Diverticulitis
label: c
answer: no
explanation: The haematochezia reported, combined with the tenesmus and weight loss immediately point to a sinister diagnosis and colorectal cancer is the most likely given the symptoms experienced.
name: Colorectal Cancer
label: a
answer: yes
explanation: An anal fissure is incorrect, as the only clinical feature associated with it in the history is the haematochezia. The tenesmus and weight loss would not explain an anal fissure.
name: Anal fissure
label: e
answer: no

Correct answer: a
A 63-year-old female visits her GP for a follow-up appointment, following abnormal results after being screened for breast cancer.

What describes the screening programme for Breast Cancer in the UK?

Options:
explanation: This is incorrect.
name: Every 3 years between the ages of 60 and 74
label: d
answer: no
explanation: This is incorrect. Breast Screening starts as early as 50 and ends at aged 71 unless requested by the patient to continue.
name: Every 3 years between the ages of 53 and 70
label: b
answer: no
explanation: This is incorrect. This is the screening programme for colorectal cancer.
name: Every 2 years between the ages of 60 and 74
label: c
answer: no
explanation: This is correct. Anyone registered with a GP as a female will be invited for NHS breast screening every 3 years when they are between the ages of 50 and 71.
name: Every 3 years between the ages of 50 and 71
label: a
answer: yes
explanation: This is incorrect.
name: Every 3 years between the ages of 45 and 75
label: e
answer: no

Correct answer: a
A 57-year-old man with known colorectal cancer affecting the sigmoid colon visits his oncologist. The cancer was observed to invade the submucosa, have no distant metastatic spread, but has spread to 3 regional lymph nodes.

What is the staging?

Options:
explanation: This answer is correct.
T1 indicates the tumour has invaded the submucosa.
N1b indicates there is metastasis in 2/3 regional lymph nodes.
M0 indicates there is no evidence of distant metastasis based upon imaging.
name: T1 N1b M0
label: a
answer: yes
explanation: This answer is incorrect.
Tis indicates the tumour is in situ
NX indicates the regional lymph nodes cannot be assessed
M0 is correct as it indicates no distant metastasis
name: This NX M0
label: e
answer: no
explanation: This answer is incorrect.
T1 is correct as it indicates the tumour has invaded through the submucosa.
N2a is incorrect as it indicates there is metastasis in 4-6 regional lymph nodes.
M1a indicates there is metastasis to 1 organ
name: T1 N2a M1a
label: c
answer: no
explanation: This answer is incorrect.
T2 indicates the tumour invades the muscularis propria.
N1a indicates there is metastasis in only 1 regional lymph node.
M0 is correct as it indicates no distant metastasis.
name: T2 N1a M0
label: b
answer: no
explanation: T3 is incorrect as this indicates the tumour invades through the muscularis propria into the per colorectal tissues.
N1a is incorrect as it indicates there is metastasis to only one regional lymph node.
M0 is correct as it indicates no distant metastasis.
name: T3 N1a M0
label: d
answer: no

Correct answer: a
A 56-year-old female who had recently emigrated to the UK, presents to the Emergency Department with a 5-month history of diarrhoea and a bilateral, photsensitve rash on her neck and arms. Her son who is accompanying her also notes she is struggling to remember things in recent weeks.

What is the underlying cause?

Options:
explanation: This is correct. Niacin (Vitamin B3) deficiency causes pellagra which typically presents with 3Ds: Diarrhoea, Dermatitis and Dementia.
name: Niacin Deficiency
label: a
answer: yes
explanation: This is incorrect. Kwashiorkor is a very rare condition caused by insufficient protein intake. Whilst Kwashiorkor can present with dermatitis, the most common presentation is with bilateral pitting oedema in the feet. On examination an enlarged fatty liver would be palpable. Kwashiorkor only affects children under the age of 5.
name: Kwashiorkor
label: e
answer: no
explanation: This is incorrect. Whilst UC is an important differential to have in chronic diarrhoea, it is incorrect in this case as the patient is also sufferring from a rash and memory loss.
name: Ulcerative Collitis
label: d
answer: no
explanation: This is incorrect. Thiamine (Vitamin B1) deficiency presents with a triad of: Ophthalmoplegia, Ataxia and Confusion.
name: Thiamine Deficiency
label: b
answer: no
explanation: This is incorrect. Ascorbic Acid (Vitamin C) Deficiency causes Scurvy, which presents with bleeding gums, severe joint or leg pain and a feeling of tiredness all of the time.
name: Ascorbic Acid Deficiency
label: c
answer: no

Correct answer: a
On the pre-operative surgical ward round in the morning, you speak to a 45-year-old female who is about to undergo bariatric surgery. She cannot remember the name of the procedure but describes it as a pouch being created from her stomach to small intestine.

What procedure is this woman about to undergo?

Options:
explanation: This is correct. The Roux-en-Y or gastric bypass works by dividing the stomach and forming a small gastric pouch which then joins onto the small intestine around 1m away from the caecum.
name: Roux-en-Y bypass
label: a
answer: yes
explanation: This is incorrect. A Hartmann's procedure is used to treat either cancer or inflammation of the rectosigmoid colon. It involves resection of the rectosigmoid colon, closure of the anorectal stump and creates a colostomy.
name: Hartmann's Procedure
label: e
answer: no
explanation: This is incorrect. A Nissen Fundoplication is a treatment for GORD, whereby the gastric fundus is wrapped around the lower oesophagus to prevent reflux.
name: Nissen Fundoplication
label: d
answer: no
explanation: This is incorrect. A gastric band works by placing a restrictive band around the stomach, which restricts the size the stomach can expand to.
name: Gastric Band
label: c
answer: no
explanation: This is incorrect. The sleeve gastrectomy works by removing a section of the stomach proximal to the greater curvature, causing the total gastric volume to be reduced.
name: Sleeve Gastrectomy
label: b
answer: no

Correct answer: a
A 52-year-old male with a long standing history of alcohol abuse is brought into the Emergency Department as he is unable to maintain balance and has speech changes. His partner who is accompanying him remarks that he often makes events up, however he genuinely believes these things to be true. On examination, you notice the patient struggles to move his eyes.

What is the underlying diagnosis?

Options:
explanation: Thiamine Deficiency is correct. This patient is presenting with the classical symptoms of Wernicke-Korsakoff syndrome: Ataxia, Confabulation and Ophthalmoplegia. Chronic alcohol abuse is a major risk factor for thiamine deficiency and thus Wernicke's encephalopathy.
name: Thiamine Deficiency
label: a
answer: yes
explanation: Whilst CJD is a good differential to have in mind, it is extremely rare now and does not present with Ophthalmoplegia, instead it presents with visual loss and/or blindness.
name: Creutzfeldt-Jakob disease
label: e
answer: no
explanation: Whilst Delirium Tremens is an important differential given the confusion seen in this patient, and the history of alcohol abuse, it is incorrect as there are no typical features of DT, such as shaking or seizures. Also, DT is not associated with ataxia or Ophthalmoplegia.
name: Delirium Tremens
label: b
answer: no
explanation: This is incorrect, as whilst HE is associated with confusion. It is not associated with both Ophthalmoplegia. Furthermore, there are no factors indicative of hepatic involvement, i.e., jaundice.
name: Hepatic Encephalopathy
label: c
answer: no
explanation: This is incorrect, as the patient would be presenting with symptoms such as anxiety, shakiness, sweating, vomiting and tachycardia.
name: Alcohol Withdrawal Syndrome
label: d
answer: no

Correct answer: a
A 48-year-old female with diagnosed relapsing-remitting multiple sclerosis is observed to have difficulty lifting up her left foot.

What nerve is responsible?

Options:
explanation: This is incorrect as the tibial nerve compression will cause tarsal tunnel syndrome. This results in sensory changes in the sole of the foot and motor function may also be affected, causing weakness of the intrinsic foot muscles.
name: Tibial Nerve
label: b
answer: no
explanation: The common peroneal nerve is correct as it is most likely to cause foot drop because loops over the head of the fibula on the lateral side of the knee joint, meaning it is likely to be affected by disease and trauma.
name: Common Peroneal Nerve
label: a
answer: yes
explanation: This is incorrect as damage to the obturator nerve results in sensory loss and weakness of the medial thigh and weakness in thigh adduction.
name: Obturator Nerve
label: c
answer: no
explanation: This is incorrect. Damage to the pudendal nerve can cause pelvic pain, the urgency to urinate or defecate and dyspareunia.
name: Pdendeal Nerve
label: e
answer: no
explanation: This is incorrect. The saphenous nerve is a branch of the femoral nerve which can be damaged during surgery. Damage to the saphenous nerve can cause weakness and sensory loss of the medial lower leg.
name: Saphenous Nerve
label: d
answer: no

Correct answer: a
An 82-year-old male fell over in his garden. On examination, his left leg is shortened and externally rotated. On imaging, you see a fracture between the greater and lesser trochanter of the femur.

What is the classification of this type of fracture?

Options:
explanation: This is incorrect. Garden Type fracture classification is for intra-capsular fractures only. Garden Type II fracture is where the fracture is non-displaced but a completed fracture.
name: Garden Type II
label: c
answer: no
explanation: This is incorrect. Garden Type fracture classification is for intra-capsular fractures only. Garden Type III fracture is where the fracture is completed but only partially displaced.
name: Garden Type III
label: d
answer: no
explanation: This answer is correct. This fracture is in -fact extra-capsular as it is outside of the capsule. As this fracture is between the greater and lesser trochanter, it can be further sub-classified into an Inter-trochanteric neck of femur fracture.
name: None of the above
label: a
answer: yes
explanation: This is incorrect. Garden Type fracture classification is for intra-capsular fractures only. Garden Type I fracture is where the fracture is non-displaced and an incomplete fracture.
name: Garden Type I
label: b
answer: no
explanation: This is incorrect. Garden Type fracture classification is for intra-capsular fractures only. Garden type IV fracture is where the fracture is completed and fully displaced.
name: Garden Type IV
label: e
answer: no

Correct answer: a
An 82-year-old male fell over in his garden. On examination his left leg is shortened and externally rotated. On imaging, you see a fracture between the greater and lesser trochanter of the femur.

What is the best management option for this patient?

Options:
explanation: This is correct. DHS is the best option for treating an inter-trochanteric neck of femur fracture.
name: Dynamic Hip Screw
label: a
answer: yes
explanation: This is incorrect as an Anterograde Intramedullary Femoral Nail is indicated in sub-trochanteric fractures.
name: Anterograde Intramedullary Femoral Nail
label: e
answer: no
explanation: This is incorrect. Hemiarthroplasty is reserved for Garden Type III/IV fractures.
name: Hemiarthroplasty
label: c
answer: no
explanation: This is incorrect as Total-Hip replacement is reserved for Garden Type III/IV fractures.
name: Total-Hip Replacement
label: d
answer: no
explanation: This is incorrect. Cannulated Hip Screws are only indicated in Garden Type I/II fractures.
name: Cannulated Hip Screws
label: b
answer: no

Correct answer: a
The blood-brain barrier is a crucial feature of the central nervous system as it is a highly selective semipermeable border formed of epithelial cells around the central nervous system that prevents certain molecules and pathogens in the blood from entering the central nervous system.

Which of these molecules below does not passively diffuse across the blood-brain barrier?

Options:
explanation: This is correct, glucose is a large molecule so has to cross the BBB via a GLUT1 glucose transporter via facilitated diffusion.
name: Glucose
label: a
answer: yes
explanation: This is incorrect, water is a small molecule that easily diffuses across the BBB.
name: Water
label: e
answer: no
explanation: This is incorrect, Nitrous Oxide is a small molecule which readily diffuses across the BBB.
name: Nitrous Oxide
label: c
answer: no
explanation: This is incorrect. Carbon Dioxide is a small inorganic molecule which readily diffuses across the BBB.
name: Carbon Dioxide
label: d
answer: no
explanation: This is incorrect, oxygen is a small molecule which readily diffuses across the BBB.
name: Oxygen
label: b
answer: no

Correct answer: a
Cerebrospinal fluid (CSF) is a clear fluid found within the subarachnoid space and the central canal of the spinal cord.

Which cells of the central nervous system produce cerebrospinal fluid?

Options:
explanation: This is incorrect. Astrocytes are responsible for glycogen storage, uptake of neurotransmitters and modulation of synaptic transmission.
name: Astrocytes
label: e
answer: no
explanation: This is incorrect. Microglia are responsible for the immune function in the brain. They can recognise foregin antigens and can perform phagocytosis.
name: Microglia
label: d
answer: no
explanation: This is correct. Ependymal cells produce cerebrospinal fluid.
name: Ependymal Cells
label: a
answer: yes
explanation: This is incorrect. Oligodendrocytes insulate the axons in the central nervous system as they produce a myelin sheath that wraps around the axon.
name: Oligodendrocytes
label: b
answer: no
explanation: This is incorrect. Schwann cells insulate axons in the peripheral nervous system by wrapping a myelin sheath around them.
name: Schwann Cells
label: c
answer: no

Correct answer: a
A 34-year-old female presents are referred to a neurologist as she lost her vision in her left eye for 5 days 2 months ago. Around 1 year ago, she had also lost all sensation and movement in her left leg for around 2 weeks which spontaneously resolved. She described the loss of sensation as first starting as pins and needles then progressing to full sensory loss over a few days.  MRI of her brain and spinal cord showed multiple lesions throughout the CNS. The patient has no past medical history or family history.

What is the most likely underlying diagnosis?

Options:
explanation: Multiple sclerosis is correct, this patient has had optic neuritis as well as paraesthesia and ataxia due to her left limb. The diagnosis of multiple sclerosis is further supported by the lesions found on imaging.
name: Multiple Sclerosis
label: a
answer: yes
explanation: This is incorrect as stroke symptoms have a sudden onset and do not spontaneously resolve unless the undelrying cause is treated. Furthermore, stroke patients often suffer from long-term complications, however, these patients' symptoms spontaneously resolved.
name: Stroke
label: d
answer: no
explanation: Whilst GBS is an important differential diagnosis to have, it does not typically affect the eyes and tends to affect the body bilaterally, therefore in this case it is incorrect.
name: Guillain-Barré Syndrome
label: e
answer: no
explanation: As this patient has history of diabetes, this is incorrect.
name: Diabetic Neuropathy
label: b
answer: no
explanation: This is incorrect as due to the chronic nature of the presenting complaint a diagnosis of MS is more likely than TIA. TIA symptoms resolve within 24 hours.
name: Transient Ischaemic Attack
label: c
answer: no

Correct answer: a
A 19-year-old man presents to his GP as he noticed he is unable to straighten his wrist and has noticed this has also affected his fingers as his grip strength is weak. He explains he noticed this occured one weak ago after returning home from a night out and explains he slept with his head on his upper arm.

What is the affected nerve?

Options:
explanation: Radial nerve is correct as it causes wrist drop when compressed. Colloquially, the patient has 'saturday night palsy' caused by sleeping on the upper arm, resulting in pressure on the radial nerve.
name: Radial Nerve
label: a
answer: yes
explanation: This is incorrect. Ulnar nerve palsy results in the patient being unable to adduct their thumb to hold a piece of paper between their thumb and index finger.
name: Ulnar Nerve
label: b
answer: no
explanation: This is incorrect. Damage to the axillary nerve causes inabilty to abduct the shoulder and loss of sensation over the inferior deltoid.
name: Axillary Nerve
label: d
answer: no
explanation: This is incorrect, damage to the musculocutaneous nerve causes weakened flexion of the shoulder and elbow and weak supination of the forearm. There is also sensory loss over the lateral side of the forearm.
name: Musculocutaneous Nerve
label: e
answer: no
explanation: This is incorrect. Compression of the median nerve can cause carpal tunnel syndrome which causes numbness, tingling and pain throughout the anterolateral 3 and a half fingers.
name: Median Nerve
label: c
answer: no

Correct answer: a
A 77-year-old female has pain in her left knee and both of her hands. She says that her left knee and hands are stiff for 30 minutes in the morning, but get better as the day goes on. The pain is exacerbated by movement throughout the day. The pain and stiffness has lasted for around the past 15 years and have progressively gotten worse. On examination, the joint is not red or warm to the touch.

What is the most likely diagnosis?

Options:
explanation: This is correct. This patient has a typical presentation of osteoarthritis as the stiffness in her joints resolve within 30 mins but resolves as the day goes on, however the pain increases with movement throughout the day.
name: Osteoarthritis
label: a
answer: yes
explanation: This is incorrect as pseudogout typically has an acute attack and then resolves within a few weeks. However, this patient has had this condition constantly for the past 15 years.
name: Pseudogout
label: b
answer: no
explanation: Whilst a good differential, this is not rheumatoid arthritis as the morning stiffness resolved in 30 minutes.
name: Rheumatoid Arthritis
label: d
answer: no
explanation: This is incorrect as the patient has not reported any signs of infection, such as a red or warm joint. There are no systemic symptoms such as fever, indicating an infection is the cause.
name: Septic Arthritis
label: c
answer: no
explanation: This is incorrect. Psoriatic Arthritis is generally associated with warm-to-the-touch joints. Furthermore, psoriatic arthritis is associated with skin changes consistent with psoriasis.
name: Psoriatic Arthritis
label: e
answer: no

Correct answer: a
A 54-year-old presents to her GP with pain and stiffness in both of her hands. The patient also remarks the pain gets better throughout the day and lasts for around 2 hours in the morning. On examination, the GP notes the joint most affected are the proximal interphalangeal and the metacarpophalangeal joints. They are not red or warm to the touch. The GP notes there is pain on joint palpation and a reduced range of motion. On further questioning, the patient reveals she had community-acquired pneumonia 6 months ago, but has not been ill since then.

What is the underlying diagnosis?

Options:
explanation: Rheumatoid Arthritis is correct as the pain the patient experiences takes greater than 30 mins in the morning to resolve, however movement eases the pain, indicative of an inflammatory condition.
name: Rheumatoid Arthritis
label: a
answer: yes
explanation: This is incorrect as the patient has not reported any signs of infection, such as a red or warm joint. There are no systemic symptoms such as fever, indicating an infection is a cause.
name: Septic Arthritis
label: d
answer: no
explanation: Osteoarthritis is incorrect as OA is associated with short morning stiffness, and pain at the end of the day.
name: Osteoarthritis
label: b
answer: no
explanation: This is incorrect. Psoriatic Arthritis is generally associated with warm-to-the-touch joints. Furthermore, psoriatic arthritis is associated with skin changes consistent with psoriasis.
name: Psoriatic Arthritis
label: c
answer: no
explanation: This is incorrect as reactive arthritis occurs within 4 weeks of an infection and this patient stated she has not been ill recently.
name: Reactive Arthritis
label: e
answer: no

Correct answer: a
A 14-year-old male presents to his GP as he brokeup with his girlfriend around 3 weeks ago. Since then he has noticed low mood, problems falling asleep at night, tiredness all of the time. His mother also states he is eating less than usual and is not taking interest in his hobbies that he used to.

What is the most appropriate management for this patient?

Options:
explanation: This is incorrect. Monoamine Oxidase Inhibitors (MAOIs) should only be prescribed when other options such as SSRIs have been tried and the patient is sufferring from major depression.
name: Tranylcypromine
label: c
answer: no
explanation: Fluoxetine is correct as it is an SSRI and this patient is exhibiting clear signs of clinical depression.
name: Fluoxetine
label: a
answer: yes
explanation: Sertraline is incorrect. Sertraline is an effective SSRI used in treating adults with depression, however it has been shown to increase self-harm when prescribed to patients under the age of 18, therefore it is inappropriate.
name: Sertraline
label: b
answer: no
explanation: This is incorrect. Benzodizepines are indicated in anxiety disorders, insomnia and seizures.
name: Diazepam
label: d
answer: no
explanation: This is incorrect. Mirtazipine is only indicated in major depression and generally not a first line therapy.
name: Mirtazipine
label: e
answer: no

Correct answer: a
A 21-year-old male with a 4-year history of generalised anxiety disorder visits his GP, after sufferring from palpitations, panick attacks, and tingling in his fingers for the past four weeks. He has already tried CBT with little effect.

What is the best first-line treatment?

Options:
explanation: This is incorrect, Priadel (lithium carbonate) is not indicated in GAD. It is used to treat mania, bipolar disorder, and recurrent depression.
name: Priadel
label: e
answer: no
explanation: Sertraline is correct. It is the best step-up treatment to offer this patient as he has already tried CBT>
name: Sertraline
label: a
answer: yes
explanation: This is incorrect. Pregabalin is only offered if the patient is unable to tolerate SSRIs/SNRIs.
name: Pregabalin
label: d
answer: no
explanation: Benzodiazepines should not be prescribed for GAD in primary care unless as a short-term measure during crises.
name: Diazepam
label: c
answer: no
explanation: CBT would be inappropriate as he has already tried it with little effect.
name: CBT
label: b
answer: no

Correct answer: a