hllj/quesmed huggingface dataset:
A 19-year-old female presents to her GP with low mood. She describes experiencing weight gain, particularly around her abdomen, over the last six months despite attempts to loose weight. On examination, you notice weakness in all four proximal limbs, as well as circular hump on the back and a circular-shaped face.

Which of the following investigations would confirm the most likely diagnosis?

Options:
explanation: This patient is presenting with Cushing's syndrome, and therefore a dexamethasone suppression test would be the diagnostic test of choice. You could conduct a HbA1c if you suspected diabetes mellitus, but the diagnosis of Cushing's Syndrome would be confirmed with a dexamethasone suppression test.
name: HbA1c
label: e
answer: no
explanation: This patient is presenting with the signs and symptoms of Cushing's syndrome. A fluid deprivation test would be the test of choice for diabetes insipidus. Diabetes insipidus would present with symptoms like excessive thirst and producing large amounts of urine.
name: Fluid deprivation test
label: d
answer: no
explanation: This is a typical presentation of a patient with Cushing's syndrome: low mood, weight gain, proximal myopathy and abdominal striae. Cushing's syndrome can also cause a moon-shaped face, a "buffalo hump" on the back, diabetes mellitus and hypokalaemia. The diagnostic investigation of choice for Cushing’s syndrome is a dexamethasone suppression test.
name: Dexamethasone suppression test
label: a
answer: yes
explanation: The patient in the question is presenting with with central obesity, proximal weakness, depression and abdominal striae are typical of Cushing’s syndrome. A short synacthen test is the test of choice for adrenal sufficiency, not Cushing’s disease. Adrenal insufficiency would present with symptoms like hypotension, fatigue and weakness, gastrointestinal symptoms, and skin pigmentation.
name: Short synacthen test
label: b
answer: no
explanation: The patient in the question is presenting with with central obesity, proximal weakness, depression and abdominal striae are typical of Cushing’s syndrome. 24-hour plasma metanephrines would be the correct test if you suspected a pheochromocytoma. This would present with episodes of hypertension, anxiety and headaches. Therefore, the correct answer to this question is to conduct a dexamethasone suppression test.
name: 24-hour plasma metanephrines
label: c
answer: no

Correct answer: a
An 18-year-old male is found unconscious by his parents after six hours of nausea and vomiting. His parents tell you he has been complaining of excessive thirst and passing urine more frequently for the last month. When you examine him, you notice a sweet acetone smell to his breath.

Which of the following is included in the diagnostic criteria for diabetic ketoacidosis?

Options:
explanation: Diabetic ketoacidosis requires acidosis with a pH of less than 7.3, not more than 7.3. Other criteria include hyperglycaemia (a blood glucose over 11mmol/L) and ketosis (blood ketones above 3mmol/L).
name: pH more than 7.3
label: e
answer: no
explanation: To diagnose diabetic ketoacidosis, there are three criteria. First, there must be hyperglycaemia, i.e a blood glucose above 11mmol/L. Next, there must be blood ketones above 3mmol/L. Finally, there should be acidosis with a pH of less than 7.3.
name: Hyperglycaemia over 11mmol/L
label: a
answer: yes
explanation: To diagnose diabetic ketoacidosis, there are three criteria. First, there must be hyperglycaemia, i.e a blood glucose above 11mmolL, not under 20mmol/L.  Next, there must be blood ketones above 3mmol/L and acidosis with a pH of less than 7.3.
name: Hyperglycaemia under 20mmol/L
label: c
answer: no
explanation: Diabetic ketoacidosis requires the production of blood ketones to be above 3mmol/L, not below.
name: Blood ketones under 3mmol/L
label: b
answer: no
explanation: Diabetic ketoacidosis requires there to be hyperglycaemia, i.e a blood glucose of 11mmol/L or above.
name: Hyperglycaemia under 11mmol/L
label: d
answer: no

Correct answer: a
A 90-year-old female is brought in to the emergency department after being found unconscious in her home. She does not open her eyes but is making incomprehensible sounds. She flexes to withdraw from pain.

What is her Glasgow Coma Scale score?

Options:
explanation: This patient's GCS is 7, not 5. She scores a 1 in eye opening response, a 2 in verbal response (due to incomprehensible sounds) and a 4 in motor response.
name: 5
label: d
answer: no
explanation: This patient's GCS is 7, not 6. She scores a 1 in eye opening response, a 2 in verbal response (due to incomprehensible sounds) and a 4 in motor response.
name: 6
label: c
answer: no
explanation: This patient's GCS is 7. She scores a 1 for eye opening response as she does not open her eyes. She is making incomprehensible sounds, scoring a 2 for verbal response. She flexes to withdraw from pain, meaning she scores a 4 in motor response.
name: 7
label: a
answer: yes
explanation: This patient's GCS is 7, not 8. She scores a 1 in eye opening response, a 2 in verbal response (due to incomprehensible sounds) and a 4 in motor response.
name: 8
label: b
answer: no
explanation: This patient's GCS is 7, not 4. She scores a 1 as she does not open her eyes, a 2 in verbal response (due to incomprehensible sounds) and a 4 in motor response.
name: 4
label: e
answer: no

Correct answer: a
You are called to see a 17-year-old girl who has been having a seizure for nine minutes. She has been given two doses of IV lorazepam, but her seizures have not stopped.

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

Options:
explanation: This patient remains in status epilepticus despite two doses of IV lorazepam. Therefore, she requires a second-line treatment in the form of phenytoin.
name: Phenytoin
label: a
answer: yes
explanation: This patient is in status epilepticus and has already had two doses of lorazepam. This patient therefore requires a second-line treatment in the form of phenytoin.
name: A further dose of lorazepam
label: b
answer: no
explanation: This patient requires a second-line drug for treatment of her status epilepticus. Sodium valproate would not be an appropriate drug to give in this scenario. This is for stabilising patients with epilepsy, not for use in the acute phase.
name: Sodium valproate
label: d
answer: no
explanation: Diazepam can be given instead of lorazepam in the initial treatment of status epilepticus. It is usually given if there is no intravenous access as it can be given rectally.
name: Diazepam
label: e
answer: no
explanation: Midazolam can be given instead of lorazepam in the initial treatment of status epilepticus. It is usually given if there is no intravenous access as it can be given via the buccal route.
name: Midazolam
label: c
answer: no

Correct answer: a
A 40-year-old male presents to his GP with yellowing of his eyes. The GP conducts a thorough abdominal examination in which he notes a palpable gallbladder. The patient does not complain of any pain.

Which of the following is the most likely diagnosis?

Options:
explanation: Pancreatic cancer would be the most important diagnosis to exclude in this case. It presents with the classic symptoms of painless jaundice and a palpable gallbladder.
name: Pancreatic cancer
label: a
answer: yes
explanation: You would expect pancreatitis to present with symptoms like epigastric pain radiating to the back, pain relived by sitting forward and associated symptoms like nausea and vomiting. Bloods may show an extremely high amylase level. This patient does not present with any pain, nausea or vomiting. Therefore, acute pancreatitis is not a likely diagnosis. This patient's symptoms are more likely to be due to pancreatic cancer.
name: Acute pancreatitis
label: c
answer: no
explanation: You would expect Gilbert’s syndrome to cause intermitted jaundice in relation to stress, infection or exercise. It would not account for the palpable gallbladder and therefore is not the most likely diagnosis in this case.
name: Gilbert's syndrome
label: e
answer: no
explanation: Colorectal cancer would be an important diagnosis to exclude if the patient was over 60 and reported a change in bowel habit. However, this patient's symptoms are more suggestive of pancreatic cancer, so this would be the most important diagnosis to exclude.
name: Colorectal Cancer
label: b
answer: no
explanation: Gastric cancer would present with symptoms such as persistent reflux, bloating and weight loss. This patient is more likely to be suffering from pancreatic cancer.
name: Gastric Cancer
label: d
answer: no

Correct answer: a
A 55-year-old man attends his GP with constipation and tiredness. He also reports gaining some weight recently and feeling low in mood. His thyroid function tests show a high thyroid-stimulating hormone (TSH) and low T4.

Which of the following drugs is most likely to have caused this presentation?

Options:
explanation: Bisoprolol is not the most likely drug to have caused this patient's presentation. Amiodarone is most likely to be the cause of this patients symptoms as their symptoms are are suggestive of hypothyroidism. Bisoprolol can cause symptoms such as bradycardia, diarrhoea and erectile dysfunction.
name: Bisoprolol
label: d
answer: no
explanation: Amiodarone is most likely to be the cause of this patients symptoms as they are suggestive of hypothyroidism. Amiodarone can also less commonly cause patients to present with hyperthyroidism.
name: Amiodarone
label: a
answer: yes
explanation: Omeprazole is not a cause of hypothyroidism. The most likely drug that has caused this patients symptoms is amiodarone.
name: Omeprazole
label: e
answer: no
explanation: This patient's symptoms are most likely to be caused by amiodarone. An important side effect of carbamazepine is agranulocytosis.
name: Carbamazepine
label: c
answer: no
explanation: Simvastatin is not the most likely cause of this patients symptoms. The most likely cause of this patients hypothyroidism is amiodarone. Simvastatin can cause symptoms such as arthralgia and muscle pain.
name: Simvastatin
label: b
answer: no

Correct answer: a
An 80-year-old male presents to the emergency department with central crushing chest pain. An ECG shows ST elevation in leads II,III and aVF.

Which coronary artery is the most likely site of occlusion?

Options:
explanation: The proximal left anterior descending artery would cause changed in leads V1-6 as well as leads I and AVL. The ECG changes in this question correlate to the right coronary artery.
name: Proximal left anterior descending artery
label: e
answer: no
explanation: An occlusion in the left circumflex artery would cause changes in leads I and aVL.
name: Left circumflex artery
label: c
answer: no
explanation: The ECG changes described represent an occlusion in the right coronary artery, not the right marginal artery.
name: Right marginal artery
label: d
answer: no
explanation: An occlusion in the left anterior descending artery would cause changes in leads V1-V4.
name: Left anterior descending artery
label: b
answer: no
explanation: An occlusion in the right coronary artery correspond to leads II,III and aVF. These leads represent the inferior region of the heart.
name: Right coronary artery
label: a
answer: yes

Correct answer: a
A 23-year-old female presents to her GP with a one-month history of tiredness and weight loss. On closer inspection, you notice her skin looks bronze in colour.  Her blood tests results show low sodium and high potassium levels.

Which of the following is the most likely diagnosis?

Options:
explanation: This patient is presenting with the typical signs and symptoms of Addison's disease: fatigue, weakness, weight loss, bronze skin pigmentation, and low sodium and high potassium on blood results.
name: Addison's disease
label: a
answer: yes
explanation: This patient is presenting with the typical signs and symptoms of Addison's disease: fatigue, weakness, weight loss and bronze skin pigmentation. Blood tests also show a low sodium and high potassium which is typical of Addison's disease.
name: Anxiety
label: e
answer: no
explanation: Cushing's disease would present with symptoms such as depression, proximal myopathy and central obesity. Furthermore, Cushing's disease would show a hypokalaemia, rather than hyperkalaemia. The patient in this question is more likely to have Addison's disease.
name: Cushing's disease
label: b
answer: no
explanation: Diabetes insipidus usually presents with producing large volumes of dilute urine, nocturia and excessive thirst.
name: Diabetes Insipidus
label: c
answer: no
explanation: Pheochromocytoma usually presents as episodes of hypertension, anxiety, palpitations headaches, as well as signs like tremor and hypertensive retinopathy.
name: Pheochromocytoma
label: d
answer: no

Correct answer: a
A 25-year-old male presents to the emergency department with right upper quadrant pain for the last six hours. On further questioning, he tells you his urine has looked quite dark and his stools are pale. You notice yellowing of the eyes. On examination, he looks jaundice and has a temperature of 37.4 degree Celsius.

Which of the following is the most likely diagnosis?

Options:
explanation: Malaria would be accompanied with symptoms such as fevers, headache, muscle aches and tiredness. This patient has more specific symptoms of right upper quadrant pain and jaundice which fits better with a diagnosis of hepatitis.
name: Malaria
label: c
answer: no
explanation: Infective endocarditis usually presents with a new heart murmur, fever, tachycardia and specific nail signs like splinter haemorrhages. This patient is more likely to have hepatitis given the position of his abdominal pain, his jaundice, and pale stools and dark urine.
name: Infective endocarditis
label: d
answer: no
explanation: Yellow fever usually presents with a sudden onset fever, followed by a headache, muscle aches, vomiting and tiredness. This patient's symptoms fit more with a diagnosis of hepatitis.
name: Yellow fever
label: e
answer: no
explanation: This patient is presenting with classic symptoms of hepatitis: right upper quadrant pain, jaundice, dark urine and pale stools. Hepatitis A is the most common type of hepatitis in the world, but is quite rare in the UK.
name: Hepatitis A
label: a
answer: yes
explanation: Coeliac Disease is a possible differential for a presentation of abdominal pain and weight loss. However, this patient has a typical presentation of hepatitis with right upper quadrant pain, jaundice, pale stools and dark urine.
name: Coeliac Disease
label: b
answer: no

Correct answer: a
A 21-year-old male attends his GP with dysuria that began eight days ago. He also reports some increased urinary frequency and foul smelling urine. A urine dipstick is positive for nitrites and leucocytes. All other observations are within the normal range.

Which of the following is the most appropriate management?

Options:
explanation: This medication would not be an appopiate first-line choice for a urinary tract infection. Pivmecillinam may be an option there is no improvement with a first choice antimicrobial or if a first choice is not suitable.
name: Pivmecillinam for three days
label: c
answer: no
explanation: For a male with a suspected urinary tract infection, the correct treatment would be treatment with nitrofurantoin for seven days. A single dose of Nitrofurantoin is not enough.
name: Single dose of nitrofurantoin
label: e
answer: no
explanation: This patient is presenting with symptoms of a urinary tract infection. IV cephalosporin would be the appropriate management if the patient was presenting with symptoms of pyelonephritis, such as pyrexia and loin or flank tenderness.
name: IV cephalosporin for five days
label: d
answer: no
explanation: The correct treatment for a male with a suspected lower urinary tract infection is nitrofurantoin for seven days, not five days.
name: Nitrofurantoin for five days
label: b
answer: no
explanation: This patient is presenting with a suspected urinary tract infection. The correct treatment for a male with a suspected lower urinary tract infection is nitrofurantoin for seven days.
name: Nitrofurantoin for seven days
label: a
answer: yes

Correct answer: a
A 30-year-old female is incidentally found to have an HbA1c of 58mmol/mol. She has no previous diagnosis of Type 2 diabetes. She does not report experiencing any polyuria or polydipsia.

Which of the following is the most appropriate next step?

Options:
explanation: This is an asymptomatic patient with a HbA1c above diagnostic level. In order to be diagnosed with diabetes, this patient requires a second HbA1c reading above 48mmol/mol in one weeks time.
name: Commence pioglitazone
label: c
answer: no
explanation: Gliclazide is an option in the management of diabetes. However, in order to be diagnosed with diabetes and to commence treatment, patients with no symptoms need to have to at least two separate HbA1c readings above 48mmol/mol a week apart.  This patient therefore requires a second HbA1c in one weeks time to confirm a diagnosis.
name: Commence gliclazide
label: d
answer: no
explanation: Diabetes can be diagnosed with a HbA1c greater than or equal to 48mmol/mol as long as the patient has symptoms of diabetes alongside this. However, this patient does not have any symptoms of diabetes and therefore cannot be diagnosed based on this one HbA1c reading.
name: Commence metformin
label: b
answer: no
explanation: Diabetes can be diagnosed with a HbA1c greater than or equal to 48mmol/mol as long as the patient has symptoms of diabetes alongside this. However, this patient does not have any symptoms of diabetes and this reading was found incidentally. Therefore, this patient requires a repeat HbA1c in one weeks time in order to confirm a diagnosis of diabetes.
name: Repeat HbA1c in 1 week
label: a
answer: yes
explanation: Diabetes can be diagnosed with a HbA1c greater than or equal to 48mmol/mol as long as the patient has symptoms of diabetes alongside this. However, this patient does not have any symptoms of diabetes. Therefore, this patient  cannot be diagnosed based on this HbA1c reading. The HbA1c needs to be repeated in one weeks time to confirm diagnosis.
name: Commence Insulin
label: e
answer: no

Correct answer: a
You are called to the neurology ward to review a 60-year-old male who has had a seizure. Before his seizure began, he complained of numbness and weakness in the right side of his body.

In which of the following brain regions did his seizure most likely originate?

Options:
explanation: Seizures that affect the occipital lobe of the brain are often associated with visual symptoms. This can include seeing flashes of colour or shapes before a seizure occurs.
name: Occipital lobe
label: c
answer: no
explanation: Seizures that originate in the Parietal Lobe can cause sensory symptoms such as numbness and weakness.
name: Parietal lobe
label: a
answer: yes
explanation: The frontal lobe is associated with motor symptoms, including a type of seizure called a Jacksonian march. This is a seizure where shaking or tingling begins in one area of the body and gradually spreads its way to another area.
name: Frontal Lobe
label: b
answer: no
explanation: Seizures that originate in the temporal lobe are  associated with emotional disturbances such as sudden terror or déjà vu. Temporal lobe seizures can also involve auditory or olfactory hallucinations.
name: Temporal lobe
label: e
answer: no
explanation: The seizure in this question is most likely to originate in the parietal lobe as this is most associated with sensory symptoms like numbness and weakness.
name: Cerebellum
label: d
answer: no

Correct answer: a
A 25-year-old builder presents to the GP with leg pain for the last two months. He describes a unilateral shooting pain that travels down the back of his left leg below the knee. He also has pins and needles in this area.

Which of the following is the most likely diagnosis?

Options:
explanation: Polymyalgia rheumatica would typically present with shoulder and hip girdle stiffness. It can also be associated with more systemic symptoms such as fever, anorexia, muscle pains and tiredness.
name: Polymyalgia rheumatica
label: e
answer: no
explanation: Cauda equina syndrome can cause bilateral sciatica symptoms, as well as other symptoms like perianal anaesthesia, urinary incontinence or sexual dysfunction. This would be an important differential to rule out in all patients with back pain. However, this is not the most likely diagnosis in this patient's case.
name: Cauda equina syndrome
label: b
answer: no
explanation: This clinical picture makes sciatica the most likely diagnosis in this patient. The unilateral shooting pain down the leg associated with tingling and weakness is typical of sciatica. Patients can often have back pain alongside this, but it is not typically as bad as the pain in their legs or feet.
name: Sciatica
label: a
answer: yes
explanation: Myeloma can present with back pain, but the patient describes the pain going down the back of his leg. This is more typical of sciatica.
name: Multiple myeloma
label: c
answer: no
explanation: This option would be more likely with a history of trauma, such as involvement in a road traffic collision. This patient is more likely to be experiencing symptoms of sciatica.
name: Vertebral fracture
label: d
answer: no

Correct answer: a
A 66-year-old male presents to his GP with a painful, swollen left knee. On examination, it feels hot to touch. Joint fluid analysis shows rhomboid-shaped crystals that are positively birefringent.

Which of the following is the most likely diagnosis?

Options:
explanation: Septic arthritis will produce similar symptoms to the ones described: joint pain, swelling, redness and warmth. However, individuals with septic arthritis will be be systemically unwell and have a fever, tachycardic or be hypotensive. Additionally, the joint fluid analysis results are more suggestive of pseudogout.
name: Septic arthritis
label: c
answer: no
explanation: Rheumatoid arthritis can produce an inflammatory joint effusion that gives patients warm, swollen joints. These effusions would consist of mainly neutrophils and the gram-stain would be negative.
name: Rheumatoid arthritis
label: e
answer: no
explanation: This is a typical presentation of pseudogout: a single red, hot swollen joint, most commonly affecting the wrist or the shoulder. Pseudogout causes rhomboid-shaped crystals that are positively birefringent to be seen on aspiration.
name: Pseudogout
label: a
answer: yes
explanation: Paget's disease of the bone would usually present as an isolated rise in alkaline phosphatase (ALP) levels alongside bone pain. This description of a single hot and swollen joint with rhomboid-shaped crystals on joint fluid analysis is more typical of pseudogout.
name: Paget's disease of the bone
label: d
answer: no
explanation: Gout would also present with a single red, hot swollen joint. However, on joint fluid analysis gout would show negatively birefringent crystals that are needle-shaped, rather than rhomboid-shaped.
name: Gout
label: b
answer: no

Correct answer: a