hllj/quesmed huggingface dataset:
What is the most common causative organism of a bacterial urinary tract infection (UTI) in a 23-year-old woman who is normally fit and well?

Options:
explanation: Group B streptococci have been isolated and identified as a causative organism for uncomplicated UTIs in some women. However, this is a lot less common than E. coli.
name: Group B streptococci
label: d
answer: no
explanation: *Staph. aureus* is a commensal of the skin. It therefore has the potential to ascend the urethra and cause cystitis, but this is relatively uncommon.
name: *Staphylococcus aureus*
label: e
answer: no
explanation: Klebsiella species are also commensals on the colon so can cause UTIs if they ascend the urethra and reach the bladder to cause cystitis. This is less common than E. coli however.
name: *Klebsiella species*
label: b
answer: no
explanation: *E. coli* is identified as the causative organism in 70-95% of UTI cases. As E. coli is a colonic commensal bacteria, it is thought that it ascends the urethra to reach the bladder and causes cystitis. The female urethra is shorter than the male, so women are more likely to get urinary tract infections.
name: *Escherichia coli*
label: a
answer: yes
explanation: Candida is the main cause of fungal UTIs, but these typically only happen in patients who are immunocompromised for whatever reason. Hence, it is unlikely to be the case for an immunocompetent young woman. A simple E. coli UTI is much more likely.
name: *Candida albicans*
label: c
answer: no

Correct answer: a
A 95-year-old woman is reviewed in A+E. She is normally fit and well but has fallen a few times in the past few months. This morning she fell again and now her grandson is getting concerned. There are no obvious injuries but there are concerns she may have hit her head so a CT head is done. It shows a right-sided crescentic area of hypodensity lateral to the right parietal lobe.

What is the most likely source of bleeding?

Options:
explanation: The middle meningeal artery is damaged in an extradural haematoma. Typically the history follows a direct blow to the side of the head resulting in a lucid interval followed by deteriorating consciousness. Furthermore, the shape of the haematoma would be biconvex rather than crescentic as described above.
name: Middle meningeal artery
label: b
answer: no
explanation: This is the typical mechanism of a subarachnoid haemorrhage. It is normally described as a thunderclap headache, or a very severe sudden onset headache. On neuroimaging, the haematoma would appear almost spider-shaped (hence "arachnoid" in subarachnoid space!).
name: Ruptured berry aneurysm
label: e
answer: no
explanation: The middle meningeal vein follows the same route as the middle meningeal artery so could be damaged in a direct blow to the side of the head. However, it would not cause any significant intracranial haemorrhage.
name: Middle meningeal vein
label: c
answer: no
explanation: The most likely diagnosis for this patient is a chronic subdural haematoma. The history of multiple falls and the hypodensity suggests a chronic bleed. The shape of the haematoma suggests that the bridging veins have been damaged. This is more common in elderly people due to cerebral atrophy.
name: Bridging veins between cortex and venous sinus
label: a
answer: yes
explanation: The bridging veins are between the cortex and venous sinuses rather than the third ventricles. The sinuses drain away deoxygenated blood to the internal jugular vein whereas the ventricles are involved in maintaining and draining cerebrospinal fluid.
name: Bridging veins between cortex and third ventricle
label: d
answer: no

Correct answer: a
A three-year-old boy is seen after becoming very unwell. He is visibly jaundiced and more fatigued than usual. His parents are very worried as they also noted dark urine this morning. They say this seems to have started following eating a new dish containing broad beans. A blood film is done and the results help diagnose G6PD deficiency.

What was likely seen on the blood film?

Options:
explanation: Heinz bodies are red blood cells with areas of dark staining within them. This is due to precipitated haemoglobin. Due to the lack of glucose 6-phosphate dehydrogenase, the red blood cells cannot cope with any increase in oxidative stress. In this case, the oxidative stress has come from the broad beans.
name: Heinz bodies
label: a
answer: yes
explanation: Howell-Jolly bodies describe red blood cells with inclusions of DNA or nuclear fragments. Normally these cells would be removed by the spleen, so they may be seen in someone post splenectomy.
name: Howell-Jolly bodies
label: d
answer: no
explanation: Target cells are typically seen in thalassaemia and after splenectomy. They are pale with an outer rim and central ring of staining, giving them a target appearance. Heinz bodies, which are seen in G6PD deficiency, are typically darker staining than normal due to precipitated haemoglobin.
name: Target cells
label: c
answer: no
explanation: Sickle cells are classic of sickle cell disease due to the presence of HbS rather than normal adult Hb. Heinz bodies, which are seen in G6PD deficiency, are a normal shape but darker in colour due to precipitated haemoglobin.
name: Sickle-shaped cells
label: b
answer: no
explanation: Hereditary spherocytosis and autoimmune haemolytic anaemia are causes of round red blood cells (spherocytes). In G6PD deficiency, Heinz bodies are normally seen, which are normally shaped red blood cells which are darker stained.
name: Spherocytes
label: e
answer: no

Correct answer: a
Which immunoglobulin can cross the placenta?

Options:
explanation: IgG is the only immunoglobulin that can cross the placenta.
name: IgE
label: c
answer: no
explanation: IgG is the only immunoglobulin that can cross the placenta.
name: IgA
label: d
answer: no
explanation: IgG is the only immunoglobulin that can cross the placenta.
name: IgG
label: a
answer: yes
explanation: IgG is the only immunoglobulin that can cross the placenta.
name: IgD
label: e
answer: no
explanation: IgG is the only immunoglobulin that can cross the placenta.
name: IgM
label: b
answer: no

Correct answer: a
What is the role of a phase 2 clinical trial?

Options:
explanation: This describes pre-clinical trials rather than any phases of clinical trials.
name: Animal testing to gather information about efficacy and toxicity
label: b
answer: no
explanation: This is not a stage of a clinical trial as it happens once the drug is already being widely used.
name: Surveillance of side effects after the release of the drug
label: e
answer: no
explanation: This is phase 1 of clinical trials. Finding appropriate dosing is the first step.
name: Testing of the drug on healthy volunteers to find appropriate dosing
label: d
answer: no
explanation: After finding appropriate dosing, the efficacy and safety of the drug needs to be confirmed.
name: Testing of a drug on a large group of patients to assess efficacy and safety
label: a
answer: yes
explanation: This describes a phase 3 clinical trial which is the stage after phase 2. At this point, the drug is considered to be generally safe so the comparison to existing treatments is needed.
name: Testing of the drug on a large group of patients to confirm effectiveness and safety, and comparing to existing interventions
label: c
answer: no

Correct answer: a
A 45-year-old woman is brought to A+E after becoming increasingly unwell. She complains of feeling feverish and has a red patch on her leg. She states she scratched the area while gardening last week. On examination, there is an erythematous, tender patch on her right shin. She tells you it has been getting bigger. The area is also warm to touch.
Her observations include a temperature of 38.7 degrees, a heart rate of 120/min, a blood pressure of 90/40 mmHg, a respiratory rate of 21 and oxygen saturation of 94%.
What is the first step in managing this patient?

Options:
explanation: This woman has sepsis from the cellulitis in her leg. It is important to recognise and treat sepsis quickly. The treatment for sepsis includes the sepsis 6: take lactate level, blood culture and urine output, and administer oxygen, IV fluid and IV antibiotics. In this case, IV fluids are most important because of her haemodynamic instability.
name: Start IV fluids
label: a
answer: yes
explanation: Oxygen does make up part of the sepsis 6, so is important to consider here. However, this woman's oxygen saturations are currently stable so oxygen is not currently indicated. It would be more important to start IV fluids as she is hypotensive.
name: Give Oxygen
label: d
answer: no
explanation: The origin of the infection for this woman is cellulitis in her leg. Therefore, a skin swab may help advise narrow-range antibiotics based on what is cultured. However, this woman is showing red flag signs of sepsis so needs to be stabilised and treated first. This will include broad-spectrum antibiotics.
name: Skin swab
label: b
answer: no
explanation: Paracetamol is used to treat pyrexia, but in this case, it is important to promptly treat the cause of the fever. The cellulitis this woman has is now causing sepsis which may be life-threatening if not treated quickly.
name: Prescribe paracetamol
label: c
answer: no
explanation: There is a bacterial infection going on so antibiotics would be important. However, she is acutely unwell with sepsis so these would need to be IV to act quickly and effectively.
name: Oral antibiotics
label: e
answer: no

Correct answer: a
A 32-year-old man presents to his GP with bleeding per rectum. He states that it is very painful to pass stools and on wiping there is bright red blood on the tissue. This has been going on for a few days. He is very worried and would like a colonoscopy to rule out bowel cancer, which his father has recently been diagnosed with.

What is the most appropriate management?

Options:
explanation: This man likely has an anal fissure due to the pain and presence of bright red blood when opening his bowels. Although there is a family history of bowel cancer, there are no red flags that would indicate the need for a colonoscopy or further investigation at the moment.
name: Refer non-urgently for a colonoscopy
label: d
answer: no
explanation: This is a very acute history for Crohn's which makes it unlikely. It would be inappropriate to refer to gastroenterology as an anal fissure would likely have healed by the appointment with appropriate management from primary care.
name: Refer to gastroenterology for suspected Crohn's disease
label: b
answer: no
explanation: This man likely has an anal fissure due to the pain and presence of bright red blood when opening his bowels. Although there is a family history of bowel cancer, there are no red flags that would indicate the need for a colonoscopy or further investigation at the moment.
name: Refer via 2-week wait pathway for suspected colorectal cancer
label: c
answer: no
explanation: This man likely has an anal fissure due to the pain and presence of bright red blood when opening his bowels. Although there is a family history of bowel cancer, there are no red flags that would indicate the need for a colonoscopy or further investigation at the moment. Topical analgesics such as lidocaine are used alongside increased dietary fibre and fluid intake to soften the stools.
name: Advise use of topical analgesics
label: a
answer: yes
explanation: This man likely has an anal fissure due to the pain and presence of bright red blood when opening his bowels. There are some surgical management options for anal fissures, including sphincterotomy, but this is reserved for chronic anal fissures that have not responded to conservative management options.
name: Refer to general surgeons
label: e
answer: no

Correct answer: a
A 77-year-old woman is admitted with suspected community-acquired pneumonia. A sputum culture is collected. Given that the most likely cause of her community-acquired pneumonia is *Streptococcus pneumoniae*

what will be seen on the gram-staining slide?

Options:
explanation: Pink cocci represent gram-negative cocci, such as *Neisseria meningitides*.
name: Pink-coloured cocci
label: d
answer: no
explanation: This describes gram-positive Staphylococcus such as *Staph. aureus*.
name: Purple-coloured clusters of cocci
label: b
answer: no
explanation: Purple rods represent gram-positive bacilli, such as *Clostridium difficile*.
name: Purple-coloured rods
label: e
answer: no
explanation: Pink on gram staining means that the bacteria are gram-negative. Therefore, pink rods represent gram-negative bacilli such as *Treponema pallidum* which causes syphilis.
name: Pink-coloured rods
label: c
answer: no
explanation: *Streptococcus pneumonia* is an example of a gram-positive cocci, so will appear purple. Streptococci means that the cocci are arranged in chains.
name: Purple-coloured chains of cocci
label: a
answer: yes

Correct answer: a
A five-year-old girl is brought to the GP by her mother. Her mother states that the girl's face looks swollen, despite no trauma or bruising. She has now noticed a similar effect around the girl's ankles. A urine sample is taken and shows marked proteinuria but no blood.

What is the most likely diagnosis?

Options:
explanation: Rapidly progressive glomerulonephritis causes nephritic syndrome so the main presentation features would be haematuria and hypertension. Furthermore, it primarily affects adults aged 20 to 50 years old.
name: Rapidly progressive glomerulonephritis
label: e
answer: no
explanation: IgA nephropathy is a cause of nephritic syndrome so would cause haematuria and hypertension rather than oedema and proteinuria. IgA nephropathy is also associated with previous respiratory or gastrointestinal infection which is not mentioned in this case.
name: IgA nephropathy
label: c
answer: no
explanation: This patient is presenting with oedema and proteinuria, which are signs of nephrotic syndrome. The most common cause of nephrotic syndrome in this age group is minimal change disease.
name: Minimal change disease
label: a
answer: yes
explanation: This would present with features of nephritic syndrome due to the inflammation in the glomerulus (i in nephritic for inflammation). There would likely be blood in the urine and no oedema in the face or peripheries. For post-streptococcus glomerulonephritis, there would also be a previous history of an infection or being generally unwell.
name: Post-streptococcus glomerulonephritis
label: b
answer: no
explanation: Membranous glomerulonephritis typically presents with nephrotic syndrome so would fit with this case. This is because of proteinuria and oedema. However, membranous glomerulonephritis affects adults aged 30-50 whereas minimal change disease typically affects children.
name: Membranous glomerulonephritis
label: d
answer: no

Correct answer: a
A 65-year-old presents with difficulty walking. On examination, you notice a high-stepping gait and difficulty dorsiflexing the right foot.

Which nerve has been affected?

Options:
explanation: The sural nerve is a purely sensory nerve of the lower limb and supplies the skin of the lateral ankle and lateral border of the foot. Any damage to the sural nerve will result in loss of sensation in those areas.
name: Sural nerve
label: e
answer: no
explanation: The tibial nerve is a terminal branch of the sciatic nerve. It arises at the superior aspect of the popliteal fossa. It innervates the posterior compartment of the leg and many of the intrinsic muscles of the foot. Therefore, the motor deficit if the tibial nerve was affected would be loss of plantarflexion. These patients would not be able to walk on tip-toes.
name: Tibial nerve
label: b
answer: no
explanation: The common peroneal nerve is a terminal branch of the sciatic nerve. It arises at the superior aspect of the popliteal fossa where the sciatic nerve splits into the common peroneal and the tibial nerves. The common peroneal nerve innervates the short head of the biceps femoris and muscles in the lateral and anterior compartments of the leg. Due to the loss of these muscles, the patient is unable to dorsiflex the affected foot which results in a high steppage gait.
name: Common peroneal nerve
label: a
answer: yes
explanation: The femoral nerve innervates the anterior thigh muscles and the skin of the anteromedial thigh medial leg and foot. While femoral nerve injuries are uncommon, we know that the functions of those muscles as well as sensation in that area will be lost. Patients may have weakness in hip flexion and active knee extension. Some hip flexion will remain intact due to the action of psoas major and minor in particular.
name: Femoral nerve
label: d
answer: no
explanation: The sciatic nerve is the largest nerve in the body so has many functions. If the sciatic nerve were damaged, a patient may complain of pain down the entire posterior lower limb as well as weakness in dorsiflexion, plantarflexion, inversion and eversion of the ankle. The common peroneal and tibial nerves are branches of the sciatic nerve so make up those functions.
name: Sciatic nerve
label: c
answer: no

Correct answer: a
Due to its mechanism of action, which anti-emetic is contraindicated in patients with Parkinson's disease?

Options:
explanation: Cyclizine is a histamine (H1) receptor antagonist. Therefore, it is safe to use in Parkinson's disease as it does not affect the dopamine levels in the brain.
name: Cyclizine
label: c
answer: no
explanation: Ondansetron is the first-line anti-emetic drug. It is a serotonin (5HT3) receptor antagonist and acts centrally in the chemotherapy trigger zone. As it is not affecting the dopamine levels in the brain, it is safe to use with Parkinson's disease.
name: Ondansetron
label: b
answer: no
explanation: Hyoscine hydrobromide is an example of an anti-muscarinic. It is an antagonist of the muscarinic receptors in the chemoreceptor trigger zone in the brain. It is safe for use in Parkinson's disease as it is not affecting dopamine levels in the brain.
name: Hyoscine hydrobromide
label: d
answer: no
explanation: Metaclopramide is a dopamine (D2) receptor antagonist. This will worsen Parkinson's symptoms as Parkinson's is caused by a lack of dopamine.
name: Metoclopramide
label: a
answer: yes
explanation: Dexamethasone is a corticosteroid that is used as an anti-emetic alongside some chemotherapy agents. It is safe for use in Parkinson's disease as dopamine is not suppressed in the brain.
name: Dexamethasone
label: e
answer: no

Correct answer: a
What is the scoring system used in the diagnosis of depression?

Options:
explanation: The Wells' score is used to assess the probability of a DVT. It guides the need for further investigation and urgent treatment.
name: Wells' criteria
label: e
answer: no
explanation: The GAD7 questionnaire is used as a screening and severity assessment tool for generalised anxiety disorder.
name: GAD7
label: b
answer: no
explanation: The New York (NYHA) classification has classes of heart failure based on the severity of dyspnoea.
name: NYHA
label: d
answer: no
explanation: This is used to assess the severity of pneumonia and therefore guide treatment.
name: CURB-65
label: c
answer: no
explanation: The PHQ9 is a questionnaire that is used to assess the severity of depression. It includes questions about losing interest in doing things, feeling down and changes to sleep and appetite
name: PHQ9
label: a
answer: yes

Correct answer: a
A 23-year-old man presents with a swelling and aching feeling in his testicles. It is worst at the end of the day when he feels "heavy". He is concerned about the swelling and thinks he may have a testicular tumour. On examination, there are visibly enlarged veins in the scrotum.

What is the most likely diagnosis?

Options:
explanation: Although it is very important to address the patient's concerns, a diagnosis of a cancer is very unlikely. There is no discrete lump firstly, but there are also features of varicocele which is more common.
name: Testicular tumour
label: c
answer: no
explanation: The enlarged veins and aching pain at the end of the day indicates a diagnosis of varicocele. Typically, the enlarged veins may be described as a "bag of worms".
name: Varicocele
label: a
answer: yes
explanation: Epididymo-orchitis is an infection of the epididymis and testes. It can cause pain and swelling. However, the pain is usually severe and sudden onset which is not the description of pain in the case above. As this is an infection, the patient may also have a fever and other signs of infection such as urethral discharge.
name: Epididymo-orchitis
label: e
answer: no
explanation: Hydrocoele is the accumulation of fluid within the tunica vaginalis. This presents with a swelling in the scrotum, but this is normally painless rather than the aching pain that is described in this case.
name: Hydrocoele
label: b
answer: no
explanation: Testicular torsion is a urological emergency so is very important to rule it out. Typically, the pain in testicular torsion is very severe and sudden onset. There may also be nausea and vomiting. In this case, there are no features of being acutely unwell so we can rule out testicular torsion.
name: Testicular torsion
label: d
answer: no

Correct answer: a
A 75-year-old woman presents with severe abdominal pain. It is thought she has acute mesenteric ischaemia. She has a history of diabetes, atrial fibrillation, hypertension and a myocardial infarction four years ago.

What is the most likely origin site of the embolus causing the mesenteric ischaemia?

Options:
explanation: A ventricular thrombus can form as a complication of an acute ST-elevation myocardial infarction (STEMI), but this is unlikely in this patient as her myocardial infarction was four years ago.
name: Cardiac ventricles
label: c
answer: no
explanation: Endocarditis is a potential source of emboli in mesenteric ischaemia. In this case, there are no indications of this as an underlying diagnosis. These features might include a fever, Osler's nodes and Roth spots.
name: Heart valves
label: e
answer: no
explanation: Deep vein thrombosis typically causes pulmonary embolism, rather than emboli in the mesenteries.
name: Veins of the leg
label: d
answer: no
explanation: The most common cause of acute mesenteric ischaemia is atrial fibrillation, which this woman has. This is due to the stasis of blood in the atria which allows a thrombus to form. This can lead to an emboli which can block the blood supply to the mesenteries in the bowel. This is the same process for ischaemic strokes caused by atrial fibrillation.
name: Cardiac atrium
label: a
answer: yes
explanation: Atherosclerosis in the arteries, such as the abdominal aorta, can create a thrombus which then embolises to a distant site. However, this embolus is more likely to lodge in the peripheries causing acute limb ischameia rather than lodging in the mesenteries.
name: Abdominal aorta
label: b
answer: no

Correct answer: a