hllj/quesmed huggingface dataset:
Which of the following is a potential complication to a baby if a mother is taking lithium during her pregnancy?

Options:
explanation: Edward's syndrome is a condition in which there is an extra copy of chromosome 18. It classically presents with low birth weight, micrognathia, low-set ears, and rocker-bottom feet, along with abnormal organ development. There is currently no known association between lithium use in pregnancy and Edward's syndrome development in newborns.
name: Edward's syndrome
label: e
answer: no
explanation: Retinoblastoma is a type of retinal cancer which can often be picked up on newborn examinations if there is an absent red reflex. There is currently no association between lithium use in pregnancy and retinoblastoma development.
name: Retinoblastoma
label: c
answer: no
explanation: Although some studies suggest an association between lithium usage in pregnancy and increased birth weight (macrosomia), there is currently no association between lithium and decreased birth weight (microsomia).
name: Microsomia
label: b
answer: no
explanation: Lithium use during pregnancy has been associated with the development of cardiac malformations (e.g. Ebstein's anomaly) in infants. Women taking lithium during pregnancy should have their serum lithium levels measured regularly, as well as regular thyroid and renal function tests.
name: Cardiac malformations
label: a
answer: yes
explanation: Down's syndrome is a condition in which there is an extra copy of chromosome 21. It typically results in physical changes, such as microcephaly, a flattened face, slanted eyes, and a single palmar crease. There may also be mild to moderate intellectual disability. There is currently no known association between lithium use in pregnancy and Down's syndrome development in newborns.
name: Down's syndrome
label: d
answer: no

Correct answer: a
Which of the following would be part of the active first stage of labour?

Options:
explanation: Delivery of the placenta would be part of the third stage of labour, as opposed to the first stage.
name: Active contractions forcing delivery of the placenta
label: b
answer: no
explanation: Mild, irregular contractions are usually seen in the passive first stage of labour, as opposed to the active first stage in which the contractions are stronger and more regular.
name: Mild, irregular contractions
label: e
answer: no
explanation: The mucus plug is responsible for blocking the cervical opening during pregnancy. As the cervix begins to open, the mucus plug may appear as clear pink or bloody discharge from the vagina. This usually occurs during the passive first stage of labour, as opposed to the active first stage.
name: Presence of the mucus plug
label: d
answer: no
explanation: The active first stage of labour involves the cervix dilating from roughly 6 centimetres to 10 centimetres at a rate of approximately 1 centimetre per hour. This is often associated with strong and regular contractions.
name: Cervical dilatation of 7 centimetres
label: a
answer: yes
explanation: Delivery of the baby would be part of the second stage of labour, as opposed to the first stage.
name: Active contractions forcing the delivery of the baby
label: c
answer: no

Correct answer: a
A 30-year-old female on the obstetrics ward is feeling confused after giving birth nearly a week ago. She complains of hearing the other patients on the ward talking about her behind her back, even though all of them deny this. She also accuses the nursing staff of attempting to steal her child. The patient has no previous psychiatric history.

What is the most likely diagnosis?

Options:
explanation: Bipolar disorder is a condition characterised by phases of elevated mood (mania/hypomania) and phases of depression. Given that this patient has no previous psychiatric history, and that her symptoms started soon after childbirth, a diagnosis of postpartum psychosis is more likely than bipolar disorder.
name: Bipolar disorder
label: d
answer: no
explanation: Postnatal post-traumatic stress disorder (PTSD) is occasionally seen after particularly traumatic births, such as prolonged labour or emergency deliveries. This can lead to mothers re-experiencing flashbacks of the traumatic birth process, as well as symptoms of postnatal depression. However, postnatal PTSD rarely leads to hallucinations or psychosis, unlike postpartum psychosis.
name: Postnatal post-traumatic stress disorder
label: e
answer: no
explanation: Baby blues are typically characterised by irritability, mood changes and anxiety in the first week following childbirth. However, it does not present with hallucinations or delusions.
name: Baby blues
label: c
answer: no
explanation: Postpartum psychosis is a serious mental health illness which can develop in mothers usually within the first 2 weeks after giving birth. It is characterised by hallucinations, delusions, confusion and spontaneous changes in mood. It is important to recognise and treat postpartum psychosis as soon as possible, as there may be a risk to both the mother and the child.
name: Postpartum psychosis
label: a
answer: yes
explanation: Postnatal depression is another condition which may develop in parents following the birth of a child. It is typically characterised by persistent low mood, anhedonia, lack of energy and difficulty sleeping in the weeks or months following labour.
name: Postnatal depression
label: b
answer: no

Correct answer: a
During embryonic development, which layer of the epiblast is responsible for producing cells of the skin and nervous system?

Options:
explanation: In general, the mesoderm is responsible for giving rise to cardiac muscle cells, smooth muscle cells, red blood cells and urogenital structures.
name: Mesoderm
label: c
answer: no
explanation: In general, the endoderm is responsible for giving rise to cells of the gastrointestinal tract, respiratory tract, urinary tract and endocrine organs.
name: Endoderm
label: b
answer: no
explanation: The morula is not a layer of the epiblast. Instead, the morula is the name given to the compacted layer of 8-16 cells formed after a zygote has divided multiple times.
name: Morula
label: e
answer: no
explanation: During embryonic development, the epiblast differentiates into three primary germ layers: the ectoderm, mesoderm and endoderm. In general, the ectoderm is responsible for giving rise to neural tissue, epithelial tissue and pigment cells.
name: Ectoderm
label: a
answer: yes
explanation: The hypoblast is not a part of the epiblast. It is responsible for giving rise to the yolk sac, which in turn gives rise to the chorion.
name: Hypoblast
label: d
answer: no

Correct answer: a
A 38-year-old female with type 2 diabetes presents to the fertility clinic as she wishes to become pregnant again. She mentions that her previous pregnancy was normal, apart from the baby being born with a larger birth weight than normal.

What advice should be given regarding folic acid intake for the mother?

Options:
explanation: While the dosage is correct in this instance, folic acid should be commenced approximately 4 weeks before planning to become pregnant, rather than waiting for a positive pregnancy test result.
name: Start taking 5 milligrams of folic acid every day after a positive pregnancy test result
label: c
answer: no
explanation: Folic acid should be commenced approximately 4 weeks before planning to become pregnant, rather than waiting for a positive pregnancy test result. Additionally, this patient requires 5 milligrams of folic acid as she has type 2 diabetes.
name: Start taking 400 micrograms of folic acid every day after a positive pregnancy test result
label: d
answer: no
explanation: As this patient has type 2 diabetes, a future child may have a slightly higher risk of developing a neural tube defect. For this reason, 5 milligrams of folic acid (as opposed to 400 micrograms normally), is recommended to be taken from 4 weeks before pregnancy, up until the 12th week of pregnancy.
name: Take 5 milligrams of folic acid 4 weeks before planning to become pregnant, up until 12 weeks of pregnancy
label: a
answer: yes
explanation: In most cases, 400 micrograms of folic acid is recommended to be taken in the weeks before pregnancy, up until the 12th week of pregnancy. However, as this patient has type 2 diabetes, a higher dose of 5 milligrams is recommended to reduce the risk of neural tube defects.
name: Take 400 micrograms of folic acid 4 weeks before planning to become pregnant, up until 12 weeks of pregnancy
label: b
answer: no
explanation: Folic acid should be recommended in all pregnancies to reduce the risk of neural tube defects in newborns.
name: No folic acid required
label: e
answer: no

Correct answer: a
Which of the following options is usually the first sign of puberty in males?

Options:
explanation: Menarche refers to the start of the first menstrual period in females, usually occurring at approximately 11-12 years of age.
name: Menarche
label: e
answer: no
explanation: Adrenarche refers to the onset of androgen-dependent body changes, including the development of pubic hair, body odour and acne. Although it may be a sign of puberty, it is usually preceded by an increase in testicular volume in males.
name: Adrenarche
label: c
answer: no
explanation: Pubarche refers to the first development of pubic hair. Although it may be a sign of puberty, it is usually preceded by an increase in testicular volume in males.
name: Pubarche
label: d
answer: no
explanation: Thelarche (the development of breast buds) is the first sign of puberty in females, as opposed to the first sign of puberty in males.
name: Thelarche
label: b
answer: no
explanation: In males, the first sign of puberty is the enlargement of the scrotum and testes, with testicular volume increasing to greater than 3 millilitres. In females, the first sign of puberty is the development of breast buds (thelarche).
name: Testicular volume increases to greater than 3 millilitres
label: a
answer: yes

Correct answer: a
A 72-year-old male presents to the Emergency Department with acute onset central crushing chest pain radiating to the left shoulder. He has a past medical history of hypertension, type 2 diabetes and hypercholesterolaemia.

The patient's observations are currently as follows: heart rate 83 bpm regular, blood pressure 138/78 mmHg, respiratory rate 18 breaths/minute, SpO2 95% on air, temperature 37.5 degrees Celsius.

An ECG is performed which reveals no regions of ST-elevation, although there is some T-wave inversion seen in leads I and avL.

Given the most likely diagnosis, which of the following scoring systems should be used to help determine the management plan?

Options:
explanation: This patient is presenting with signs and symptoms characteristic of acute coronary syndrome (ACS). As no regions of ST-elevation are seen on the ECG, this man is likely experiencing a non-ST-elevation myocardial infarction (NSTEMI). The most widely used scoring system for NSTEMIs is the GRACE score which takes into account the patient's age, heart rate/blood pressure, cardiac function, renal function, ECG findings and troponin levels to calculate the predicted 6-month mortality. If the GRACE score is greater than 3% (or if the patient is haemodynamically unstable), percutaneous coronary intervention should be the mainstay treatment. If the GRACE score is less than 3%, conservative management may be trialled, usually with ticagrelor in the first instance.
name: GRACE score
label: a
answer: yes
explanation: The CHA₂DS₂-VASc score is used to calculate the stroke risk in patients with atrial fibrillation. It is not useful in calculating the risk of 6-month mortality in patients with NSTEMIs.
name: CHA₂DS₂-VASc score
label: c
answer: no
explanation: The Duke criteria are a set of clinical criteria used to calculate the probability of a patient having infective endocarditis.
name: Duke criteria
label: e
answer: no
explanation: The HAS-BLED score is used to calculate the one-year risk of major bleeding in patients with atrial fibrillation who are taking anticoagulant therapy.
name: HAS-BLED score
label: d
answer: no
explanation: The Wells score is used to calculate the clinical probability of a patient having a pulmonary embolism. A pulmonary embolism would classically present with pleuritic chest pain, tachycardia and a history of recent physical inactivity. There may also be S1Q3T3 changes on an ECG, meaning a large S wave in lead I, a Q wave in lead III, and an inverted T wave in lead III.
name: Wells score
label: b
answer: no

Correct answer: a
A 58-year-old caucasian male presents to General Practice following a recent diagnosis of hypertension. Ambulatory blood pressure monitoring (ABPM) reveals a blood pressure of 158/94 mmHg. The patient has no other past medical history and is currently not taking any medication.

Which of the following antihypertensive medications should be offered first-line in this case?

Options:
explanation: Indapamide is an example of a thiazide-like diuretic. These diuretics are generally indicated as second or third-line treatments for hypertension if previous medications have proven to be ineffective at sufficiently reducing blood pressure.
name: Indapamide
label: c
answer: no
explanation: Candesartan is an example of an angiotensin receptor blocker (ARB). This (or an ACE inhibitor) would be the recommended first-line treatment option for patients under 55 years of age and of non-Afro-Caribbean origin.
name: Candesartan
label: d
answer: no
explanation: As this patient is over the age of 55, a calcium channel blocker is indicated as the first-line treatment for his essential hypertension. Amlodipine is an example of a dihydropyridine calcium channel blocker.
name: Amlodipine
label: a
answer: yes
explanation: Ramipril is an ACE inhibitor and would be the recommended first-line treatment option if the patient was under 55 years of age and of non-Afro-Caribbean origin.
name: Ramipril
label: b
answer: no
explanation: Spironolactone is an aldosterone antagonist which is considered in later stages of hypertension if other medications have proven to be ineffective at sufficiently reducing blood pressure.
name: Spironolactone
label: e
answer: no

Correct answer: a
A 67-year-old male presents to the Emergency Department complaining of chest pain. He recently suffered a myocardial infarction 3 weeks ago and had previously been well until today. He has a past medical history of hypertension and hypercholesterolaemia. His current medications include aspirin, clopidogrel, ramipril, bisoprolol and atorvastatin.

The patient's observations are as follows: heart rate 78 bpm regular, blood pressure 135/78 mmHg, respiratory rate 16 breaths/minute, SpO2 97% on air, temperature 37.6 degrees Celsius. Cardiovascular examination reveals normal I and II heart sounds, with no added sounds.

An ECG is conducted and is shown below:

[lightgallery]

What is the most likely diagnosis?

Options:
explanation: Cardiac tamponade characteristically presents with a triad of hypotension, muffled heart sounds and a raised JVP. Additionally, the ECG would typically show electrical alternans (variation in the height of QRS complexes).
name: Cardiac tamponade
label: d
answer: no
explanation: This patient is presenting with signs and symptoms suggestive of Dressler syndrome, particularly given the history of myocardial infarction 3 weeks ago. Dressler's syndrome is a type of pericarditis which is thought to be immune-mediated, whereby antibodies are produced against damaged cardiomyocytes. This results in inflammation and symptoms of chest pain.
name: Dressler syndrome
label: a
answer: yes
explanation: Although a ventricular septal defect is a potential complication following myocardial infarction, it usually presents as acute heart failure with a pan-systolic murmur.
name: Ventricular septal defect
label: e
answer: no
explanation: Infective endocarditis would classically present with a fever and the presence of a new murmur on cardiovascular examination.
name: Infective endocarditis
label: b
answer: no
explanation: Although it is possible for patients to experience another myocardial infarction following a previous one, the ECG shows widespread ST-elevation (as opposed to ST-elevation in specific leads), which is more suggestive of Dressler syndrome.
name: Myocardial infarction
label: c
answer: no

Correct answer: a
A 64-year-old male presents to the Emergency Department complaining of severe chest pain. He has a past medical history of myocardial infarction, hypertension and hypercholesterolaemia. His current medications include aspirin, clopidogrel, ramipril, bisoprolol and atorvastatin.

The patient's observations are as follows: heart rate 112 bpm regular, blood pressure 88/62 mmHg, respiratory rate 18 breaths/minute, SpO2 94% on air, temperature 37.6 degrees Celsius. Cardiovascular examination reveals muffled heart sounds and raised jugular venous pressure (JVP).

Given the most likely diagnosis, what is the definitive emergency management for this condition?

Options:
explanation: Transcatheter aortic valve insertion is one of the definitive management options for patients presenting with aortic stenosis. This would classically present with an ejection systolic murmur, dyspnoea on exertion, as well as angina symptoms.
name: Transcatheter aortic valve insertion (TAVI)
label: c
answer: no
explanation: This patient is presenting with signs and symptoms suggestive of cardiac tamponade, particularly given the triad of muffled heart sounds, raised JVP and hypotension. Cardiac tamponade involves blood (or other fluid) accumulating in the pericardial space leading to reduced ventricular filling and reduced cardiac output. The emergency management for cardiac tamponade is pericardiocentesis, in which a needle is inserted into the pericardial space under ultrasound guidance to drain the excess fluid.
name: Pericardiocentesis
label: a
answer: yes
explanation: Balloon angioplasty involves a balloon being used to stretch open a narrowed coronary artery. This may be performed to improve coronary blood flow in patients with severe angina.
name: Balloon angioplasty
label: d
answer: no
explanation: Percutaneous coronary intervention would be the definitive management for ST-elevation myocardial infarction (STEMI), as opposed to cardiac tamponade.
name: Percutaneous coronary intervention (PCI)
label: b
answer: no
explanation: An endovascular aneurysm repair is a treatment option for abdominal aortic aneurysms (AAA), as opposed to cardiac tamponade. AAAs would typically present with hypotension, severe abdominal pain and a pulsatile abdominal mass.
name: Endovascular aneurysm repair (EVAR)
label: e
answer: no

Correct answer: a
A 34-year-old female presents to the Emergency Department complaining of chest pain which is worse when breathing in. She recently travelled abroad and mentions that her left leg felt quite sore when she arrived back in the UK. The patient has no relevant past medical history and is currently taking the combined oral contraceptive pill (COCP) for contraception.

The patient's observations are as follows: heart rate 112 bpm regular, blood pressure 130/92 mmHg, respiratory rate 21 breaths/minute, SpO2 96% on air, temperature 37.6 degrees Celsius. Respiratory examination appears normal.

Given the most likely diagnosis, what is the most appropriate treatment option for this patient?

Options:
explanation: According to the updated NICE guidelines, direct oral anticoagulants (DOACs) are now the mainstay treatment for pulmonary embolism.
name: Oral warfarin for 3 months
label: c
answer: no
explanation: This patient is presenting with signs and symptoms suggestive of pulmonary embolism, particularly given her pleuritic chest pain, the recent long-haul flight and concurrent COCP use. A pulmonary embolism involves a blood clot (usually from a deep vein thrombosis) clogging up an artery in the lungs, resulting in impeded blood flow. The mainstay management of a pulmonary embolism with an obvious trigger (in this case, the history of recent travel) is to offer a direct oral anticoagulant (DOAC), such as oral apixaban, for 3 months.
name: Oral apixaban for 3 months
label: a
answer: yes
explanation: Although oral apixaban is the mainstay treatment for pulmonary emboli, it should only be offered for 3 months as this patient had a provoked pulmonary embolism (triggered by her recent air travel). However, if there was no obvious trigger behind her pulmonary embolus, oral apixaban would need to be given for 6 months.
name: Oral apixaban for 6 months
label: b
answer: no
explanation: According to the updated NICE guidelines, direct oral anticoagulants (DOACs) are now the mainstay treatment for pulmonary embolism.
name: Oral warfarin for 6 months
label: d
answer: no
explanation: According to the updated NICE guidelines, direct oral anticoagulants (DOACs) are now the mainstay treatment for pulmonary embolism, rather than low molecular weight heparin.
name: Subcutaneous low molecular weight heparin for 6 months
label: e
answer: no

Correct answer: a
A 15-year-old male presents to the respiratory clinic with worsening symptoms of asthma. He mentions that he often feels breathless, especially in cold weather or when about to fall asleep at night. He has found that he is taking his salbutamol inhaler more often than usual. Aside from asthma, his past medical history includes eczema and hay fever. He is currently taking no other medications apart from salbutamol when required.

What is the next best step in the medical management of this patient's asthma?

Options:
explanation: Adding a long-acting beta-agonist would be a later management step if his asthma symptoms did not improve. A low-dose inhaled corticosteroid should be trialled before this.
name: Add a long-acting beta-agonist
label: c
answer: no
explanation: This patient is presenting with signs of worsening asthma. According to British Thoracic Society guidelines, the next best medical management, in this case, would be to add an inhaled corticosteroid medication alongside his salbutamol inhaler.
name: Add low-dose inhaled corticosteroid
label: a
answer: yes
explanation: As this patient is already on salbutamol when required, there is likely to be no additional effect of adding another short-acting beta agonist. Instead, a low-dose inhaled corticosteroid should be trialled to see if symptoms improve.
name: Add a short-acting beta agonist
label: e
answer: no
explanation: Adding an LTRA medication would be the third step in the management of uncontrolled asthma. A low-dose inhaled corticosteroid should be trialled before this to see if it improves symptoms.
name: Add a leukotriene receptor antagonist (LTRA)
label: b
answer: no
explanation: Theophylline is a bronchodilator which is used in later stages of asthma, as opposed to low-dose inhaled corticosteroids which are usually used second-line.
name: Add theophylline
label: d
answer: no

Correct answer: a