hllj/quesmed huggingface dataset:
A 72-year-old man with a 37-pack-year smoking history presents to his GP with a troublesome cough and dyspnoea that is worse on exertion.

The GP suspects COPD and arranges for further tests, including a chest x-ray.

The chest x-ray shows hyperinflated lungs.

Which of the following is the normal total lung capacity in healthy individuals?

Options:
explanation: Total lung capacity is about 6L in healthy individuals. Total lung capacity tends to be increased in obstructive conditions (such as COPD) and decreased in restrictive conditions (such as pulmonary fibrosis).
name: 500ml
label: b
answer: no
explanation: Total lung capacity is about 6L in healthy individuals. Total lung capacity tends to be increased in obstructive conditions (such as COPD) and decreased in restrictive conditions (such as pulmonary fibrosis).
name: 3L
label: c
answer: no
explanation: Total lung capacity is about 6L in healthy individuals. Total lung capacity tends to be increased in obstructive conditions (such as COPD) and decreased in restrictive conditions (such as pulmonary fibrosis).
name: 10L
label: d
answer: no
explanation: This is the correct answer. Total lung capacity tends to be increased in obstructive conditions (such as COPD) and decreased in restrictive conditions (such as pulmonary fibrosis).
name: 6L
label: a
answer: yes
explanation: Total lung capacity is about 6L in healthy individuals. Total lung capacity tends to be increased in obstructive conditions (such as COPD) and decreased in restrictive conditions (such as pulmonary fibrosis).
name: 1L
label: e
answer: no

Correct answer: a
A 54-year-old female attends the Emergency Department after experiencing a panic attack 1 hour ago. Her respiratory rate is currently 28 breaths per minute.

What is the most likely acid-base finding?

Options:
explanation: Metabolic acidosis is characterised by an increase in the concentration of H+, with an associated decrease in bicarbonate. This can be caused by a gain of acid, or loss of bicarbonate. The anion gap is important in differentiating between these two causes. A high anion gap is associated with a gain of acid (such as in renal failure, diabetic ketoacidosis or lactic acidosis) whilst a normal/reduced anion gap is associated with loss of bicarbonate (such as severe diarrhoea or renal tubular acidosis).
name: Metabolic acidosis
label: c
answer: no
explanation: A mixed respiratory and metabolic acidosis would have a reduced pH, high CO2 and low bicarbonate. This can be caused by cardiac arrest or multi-organ failure.
name: Mixed respiratory and metabolic acidosis
label: e
answer: no
explanation: Metabolic alkalosis is caused by an increase in bicarbonate intake (eg excessive antacid use) or a loss of acid from the body (eg severe vomiting). This causes a rise in pH and an alkalosis.
name: Metabolic alkalosis
label: d
answer: no
explanation: Respiratory alkalosis is most commonly seen in panic attacks. Hyperventilation causes CO2 to be blown off which results in a decrease in the concentration of H+ ions in the blood, and therefore an increase in pH above normal limits.
name: Respiratory alkalosis
label: a
answer: yes
explanation: Respiratory acidosis results from failure of the respiratory system, causing a decrease in respiratory rate or a decrease in respiratory volume. This results in increased retention of CO2 and an increase in the concentration of H+ ions and subsequent acidosis. This can be caused by chronic respiratory conditions such as COPD.
name: Respiratory acidosis
label: b
answer: no

Correct answer: a
A 32-year-old male attends the Emergency Department with a severe asthma exacerbation. He is dyspnoeic and wheezy and unable to complete full sentences.

Which of the following parts of the respiratory tract provides the most total resistance to airflow?

Options:
explanation: The biggest factor contributing to airway resistance is airway diameter, with narrower airways typically having greater airway resistance. The trachea contributes the most to total airway resistance. Individually, the smaller airways contribute more to airway resistance than the trachea, however, the branching of the airway system results in lots of smaller airways in parallel. When you consider the flow through these smaller airways as a whole, the total resistance is less than that of the trachea.
name: Trachea
label: a
answer: yes
explanation: The trachea contributes the most to total airway resistance. Individually, the smaller airways contribute more to airway resistance than the trachea, however, the branching of the airway system results in lots of smaller airways in parallel. When you consider the flow through these smaller airways as a whole, the total resistance is less than that of the trachea.
name: Segmental bronchi
label: e
answer: no
explanation: The trachea contributes the most to total airway resistance. Individually, the smaller airways contribute more to airway resistance than the trachea, however, the branching of the airway system results in lots of smaller airways in parallel. When you consider the flow through these smaller airways as a whole, the total resistance is less than that of the trachea.
name: Alveoli
label: c
answer: no
explanation: The trachea contributes the most to total airway resistance. Individually, the smaller airways contribute more to airway resistance than the trachea, however, the branching of the airway system results in lots of smaller airways in parallel. When you consider the flow through these smaller airways as a whole, the total resistance is less than that of the trachea. Most airway diseases affect the bronchioles first, and as bronchioles don't contribute much towards airway resistance, their resistance can increase a lot before the total resistance of the respiratory tract is affected.
name: Bronchioles
label: b
answer: no
explanation: The trachea contributes the most to total airway resistance. Individually, the smaller airways contribute more to airway resistance than the trachea, however, the branching of the airway system results in lots of smaller airways in parallel. When you consider the flow through these smaller airways as a whole, the total resistance is less than that of the trachea.
name: Alveolar ducts
label: d
answer: no

Correct answer: a
A 45-year-old man attends his General Practitioner for a follow-up after wearing an ambulatory blood pressure monitor to provide an accurate measurement of his blood pressure. His daytime average blood pressure is 145/95. He is started on Lisinopril.

Which of the following electrolyte disturbances is he most likely to develop on this medication?

Options:
explanation: Lisinopril is an ACE inhibitor and hyperkalaemia, not hypokalaemia, is an adverse effect of this class of medications. ACE inhibitors block the action of angiotensin II, reducing the secretion of aldosterone. Aldosterone acts to remove potassium from the body whilst retaining sodium and water. Drugs such as loop diuretics (eg furosemide) can cause hypokalaemia.
name: Hypokalaemia
label: b
answer: no
explanation: Lisinopril is an ACE inhibitor and hyperkalaemia, not hypocalcaemia, is an adverse effect of this class of medications. ACE inhibitors block the action of angiotensin II, reducing the secretion of aldosterone. Aldosterone acts to remove potassium from the body whilst retaining sodium and water. Drugs such as bisphosphonates and denosumab (both of which are used to treat osteoporosis) can cause hypocalcaemia.
name: Hypocalcaemia
label: e
answer: no
explanation: Lisinopril is an ACE inhibitor and hyperkalaemia, not hyponatraemia, is an adverse effect of this class of medications. ACE inhibitors block the action of angiotensin II, reducing the secretion of aldosterone. Aldosterone acts to remove potassium from the body whilst retaining sodium and water. Drugs such as diuretics (especially thiazide diuretics) and carbamazepine (an anti-epileptic) can cause hyponatraemia.
name: Hyponatraemia
label: c
answer: no
explanation: This is the correct answer. Lisinopril is an ACE inhibitor and hyperkalaemia is an adverse effect of this class of medications. ACE inhibitors block the action of angiotensin II, reducing the secretion of aldosterone. Aldosterone acts to remove potassium from the body whilst retaining sodium and water.
name: Hyperkalaemia
label: a
answer: yes
explanation: Lisinopril is an ACE inhibitor and hyperkalaemia, not hypernatraemia, is an adverse effect of this class of medications. ACE inhibitors block the action of angiotensin II, reducing the secretion of aldosterone. Aldosterone acts to remove potassium from the body whilst retaining sodium and water. Drugs such as NSAIDs can cause hypernatraemia.
name: Hypernatraemia
label: d
answer: no

Correct answer: a
A 60-year-old male attends his GP and is found to have stage 2 hypertension. He does not have diabetes.

Which of the following is the first-line anti-hypertensive medication for this patient?

Options:
explanation: Spironolactone is an aldosterone antagonist and can be added as a 4th-line agent for hypertension management, along with an ACE inhibitor or Angiotensin II receptor blocker, a calcium channel blocker and a thiazide-like diuretic. This can only be done if the blood potassium is ≤4.5mmol/L as spironolactone is a potassium-sparing agent. For the patient in this question, the first-line antihypertensive is a calcium channel blocker such as amlodipine.
name: Spironolactone
label: e
answer: no
explanation: Candesartan is an Angiotensin II Receptor Blocker (ARB) and is only used as a first-line antihypertensive treatment (along with ACE inhibitors, but not together) in patients with Type 2 diabetes, or those who are under 55 and not from a Black African or African-Carribean family origin. For the patient in this question, the first line antihypertensive is a calcium channel blocker such as amlodipine.
name: Candesartan
label: c
answer: no
explanation: Indapamide is a thiazide-like diuretic and can be used second or third-line in hypertension management. It can be added to an ACE inhibitor or Angiotensin II receptor blocker, or a calcium channel blocker as second-line management. For third-line management, it is used in conjunction with either an ACE inhibitor or Angiotensin II receptor blocker, as well as a calcium channel blocker. For the patient in this question, the first-line antihypertensive is a calcium channel blocker such as amlodipine.
name: Indapamide
label: d
answer: no
explanation: Lisinopril is an ACE inhibitor and is only used as a first-line antihypertensive treatment (along with Angiotensin II receptor blockers, but not together) in patients with type 2 diabetes or those who are under 55 and not from a Black African or African-Carribean family origin. For the patient in this question, the first-line antihypertensive is a calcium channel blocker such as amlodipine.
name: Lisinopril
label: b
answer: no
explanation: Amlodipine is a calcium-channel blocker, and this class of medications is used first-line for hypertension in patients aged over 55, or from a Black African or African-Carribean family origin (provided they do not have Type 2 diabetes). ACE inhibitors, angiotensin II receptor blockers or thiazide-like diuretics can be added to the calcium-channel blocker as second-line management.
name: Amlodipine
label: a
answer: yes

Correct answer: a
A 54-year-old man is brought to the Emergency Department by ambulance with central crushing chest pain. His ECG shows ST-segment elevation. He is given 300mg aspirin.

In which of the following groups of patients is aspirin contraindicated?

Options:
explanation: Patients under the age of 16 should not be given aspirin due to the risk of Reye's syndrome, a poorly understood neurological condition. Kawasaki disease, however, is one exception when aspirin can be given to children.
name: Patients aged under 16
label: a
answer: yes
explanation: Patients with diabetes can take aspirin. In this question, the correct answer is patients aged under 16, due to the risk of Reye's syndrome.
name: Patients with diabetes
label: b
answer: no
explanation: Patients with anaemia can take aspirin. In this question, the correct answer is patients aged under 16, due to the risk of Reye's syndrome.
name: Patients with anaemia
label: e
answer: no
explanation: Patients on beta blockers can take aspirin. In this question, the correct answer is patients aged under 16, due to the risk of Reye's syndrome.
name: Patients on beta blockers
label: c
answer: no
explanation: Although aspirin is cautioned in elderly patients, it is not contraindicated. In this question, the correct answer is patients aged under 16, due to the risk of Reye's syndrome.
name: Patients aged over 85
label: d
answer: no

Correct answer: a
A 54-year-old woman is on the cardiology ward after suffering from a recent myocardial infarction. A week later she complains of severe muscle aches throughout her body. She also notes her urine is cola-coloured.

Which of the following drugs should be stopped?

Options:
explanation: This patient presents with symptoms consistent with rhabdomyolysis after starting a statin post-myocardial infarction. Rhabdomyolysis is a rare side effect of statins, such as simvastatin. If muscular symptoms are severe, treatment should be discontinued.
name: Simvastatin
label: a
answer: yes
explanation: Clopidogrel is not associated with the symptoms described. The severe muscle aches and cola-coloured urine is consistent with rhabdomyolysis secondary to starting a statin post-myocardial infarction.
name: Clopidogrel
label: e
answer: no
explanation: Lisinopril is not associated with the symptoms described. The severe muscle aches and cola-coloured urine is consistent with rhabdomyolysis secondary to starting a statin post-myocardial infarction.
name: Lisinopril
label: b
answer: no
explanation: Aspirin is not associated with the symptoms described. The severe muscle aches and cola-coloured urine is consistent with rhabdomyolysis secondary to starting a statin post-myocardial infarction.
name: Aspirin
label: d
answer: no
explanation: Bisoprolol is not associated with the symptoms described. The severe muscle aches and cola-coloured urine is consistent with rhabdomyolysis secondary to starting a statin post-myocardial infarction.
name: Bisoprolol
label: c
answer: no

Correct answer: a
A 72-year-old female is admitted to the stroke ward after having an ischaemic stroke. She receives thrombolysis and 24 hours later and is started on 300mg aspirin for 14 days.

What is the mechanism of action of aspirin?

Options:
explanation: Aspirin achieves its anti-platelet effect by inhibiting the COX-1 enzyme. The mechanism of action of warfarin, an anticoagulant, is inhibiting vitamin K epoxide reductase. This prevents the regeneration of reduced Vitamin K which is needed for clotting factor synthesis.
name: Vitamin K epoxide reductase inhibitor
label: d
answer: no
explanation: Aspirin inhibits the COX-1 enzyme. This prevents the conversion of arachidonic acid to prostaglandins. Prostaglandins produced by COX-1 are involved in platelet aggregation. Hence, aspirin reduces platelet aggregation.
name: COX-1 inhibitor
label: a
answer: yes
explanation: Aspirin achieves its anti-platelet effect by inhibiting the COX-1 enzyme. However, another anti-platelet agent, dipyridamole, achieves part of its anti-platelet effect by inhibiting phosphodiesterase. This increases cAMP levels, causing vasodilation and inhibiting platelet activation and aggregation.
name: Phosphodiesterase inhibitor
label: c
answer: no
explanation: Aspirin achieves its anti-platelet effect by inhibiting the COX-1 enzyme. Other anti-platelets, such as clopidogrel and ticagrelor, are P2Y12 receptor antagonists, preventing ADP-mediated platelet aggregation.
name: P2Y12 receptor antagonist
label: b
answer: no
explanation: Aspirin achieves its anti-platelet effect by inhibiting the COX-1 enzyme. The mechanism of action of dabigatran, a DOAC, is directly inhibiting thrombin IIa.
name: Direct Thrombin IIa inhibitor
label: e
answer: no

Correct answer: a
A 42-year-old man is admitted to the Coronary Care Unit after experiencing central crushing chest pain. His ECG showed ST elevation.

He received percutaneous coronary intervention and was started on secondary prevention medications. He soon complains of breathlessness.

Which of the following drugs is the most likely cause of his breathlessness?

Options:
explanation: Ticagrelor is associated with causing breathlessness, not prasugrel. Prasugrel is also an anti-platelet agent and can be used alongside aspirin in patients undergoing percutaneous coronary intervention (PCI).
name: Prasugrel
label: b
answer: no
explanation: Ticagrelor is associated with causing breathlessness, not simvastatin. Simvastatin is a statin and can be used for the secondary prevention of myocardial infarctions along with other drugs. Statins reduce cholesterol in the blood.
name: Simvastatin
label: e
answer: no
explanation: Ticagrelor is associated with causing breathlessness, not bisoprolol. Bisoprolol is a beta-blocker and can be used for the secondary prevention of myocardial infarctions along with other drugs.
name: Bisoprolol
label: d
answer: no
explanation: Ticagrelor is associated with causing breathlessness, not lisinopril. Lisinopril is an ACE inhibitor and can be used for the secondary prevention of myocardial infarctions along with other drugs.
name: Lisinopril
label: c
answer: no
explanation: Ticagrelor is an anti-platelet agent and breathlessness is a common side effect associated with it due to the impaired clearance of adenosine. Adenosine can stimulate sensory nerve fibres in the lungs, causing the sensation of breathlessness.
name: Ticagrelor
label: a
answer: yes

Correct answer: a
A 65-year-old female attends her General Practitioner after being diagnosed with stage 1 hypertension. Her GP discusses lifestyle changes the patient could make to help manage her condition.

Which of the following blood vessels contribute the most towards vascular resistance?

Options:
explanation: Arterioles contribute the most to vascular resistance. Veins have a very low resistance to flow due to their ability to distend.
name: Vein
label: d
answer: no
explanation: Arterioles contribute the most to vascular resistance. Muscular arteries are distributing vessels. In comparison to elastic arteries, the tunica media in muscular arteries is smaller (less elastic tissue).
name: Muscular artery
label: e
answer: no
explanation: Arterioles contribute the most to vascular resistance. Metarterioles are also capable of increasing their resistance to blood flowing into capillaries, but their effect is not as significant as arterioles.
name: Metarterioles
label: c
answer: no
explanation: Arterioles contribute the most to vascular resistance. Elastic arteries are conducting vessels, such as the aorta and other large vessels. The aorta has minimal resistance to flow compared to the arterioles.
name: Elastic artery
label: b
answer: no
explanation: Arterioles provide the most vascular resistance as they have abundant sympathetic nerve endings which can cause the smooth muscle to contract or relax.
name: Arteriole
label: a
answer: yes

Correct answer: a
A 72-year-old female attends her GP with symptoms of breathlessness on exertion. She also complains of waking up in the middle of the night gasping for breath. On examination, she has a raised JVP and her ankles have pitting oedema.

She is referred for echocardiography to assess her left ventricular function.

Which of the following describes how to calculate cardiac output?

Options:
explanation: Cardiac output is the volume of blood pumped out of the left ventricle per minute and is measured in litres per minute (L/min). It can be calculated by heart rate x stroke volume. Normal cardiac output is 5-6 L/min at rest. Stroke volume can be calculated by subtracting the end-systolic volume from the end-diastolic volume (end-diastolic volume – end-systolic volume).
name: Stroke volume x total peripheral resistance
label: e
answer: no
explanation: Cardiac output is the volume of blood pumped out of the left ventricle per minute and is measured in litres per minute (L/min). It can be calculated by heart rate x stroke volume. Normal cardiac output is 5-6 L/min at rest. Mean arterial pressure can be calculated by cardiac output x total peripheral resistance.
name: Heart rate x mean arterial pressure
label: d
answer: no
explanation: Cardiac output is the volume of blood pumped out of the left ventricle per minute and is measured in litres per minute (L/min). It can be calculated by heart rate x stroke volume. Normal cardiac output is 5-6 L/min at rest.
name: Heart rate x total peripheral resistance
label: b
answer: no
explanation: Cardiac output is the volume of blood pumped out of the left ventricle per minute and is measured in litres per minute (L/min). It can be calculated by heart rate x stroke volume. Normal cardiac output is 5-6 L/min at rest. Mean arterial pressure can be calculated by cardiac output x total peripheral resistance. Stroke volume can be calculated by subtracting the end-systolic volume from the end-diastolic volume (end-diastolic volume – end-systolic volume).
name: Stroke volume x mean arterial pressure
label: c
answer: no
explanation: Cardiac output is the volume of blood pumped out of the left ventricle per minute and is measured in litres per minute (L/min). Normal cardiac output is 5-6 L/min at rest. Stroke volume is the volume of blood pumped out of the left ventricle with each contraction. Stroke volume can be calculated by subtracting the end-systolic volume from the end-diastolic volume (end-diastolic volume – end-systolic volume).
name: Heart rate x stroke volume
label: a
answer: yes

Correct answer: a
A 92-year-old woman attends her GP after experiencing syncopal episodes when standing up from a seated or lying position. The GP checks her seated and standing blood pressure and finds there is a systolic drop of 35mmHg.

Which of the following will cause a rise in blood pressure?

Options:
explanation: Increased stimulation of the baroreceptors in the aortic arch and carotid bodies results in the increased firing of the afferent nerve fibres from the baroreceptors. These fibres synapse in the cardiac vasomotor centre of the medulla resulting in an increase in parasympathetic and a decrease in sympathetic stimulation to the heart, thereby reducing blood pressure.
name: Increased baroreceptor stimulation
label: e
answer: no
explanation: Decreased total peripheral resistance means that the blood vessels are less constricted, and will therefore cause a fall in blood pressure.
name: Decreased total peripheral resistance
label: d
answer: no
explanation: Sympathetic stimulation increases cardiac contractility, increasing cardiac output and blood pressure. Therefore a decrease in sympathetic stimulation will cause a fall in blood pressure.
name: Decreased sympathetic stimulation to the heart
label: b
answer: no
explanation: Increased cardiac output results in increased stimulation of the baroreceptors in the aortic arch and carotid bodies. This results in the increased firing of the afferent nerve fibres from the baroreceptors. These fibres synapse in the cardiac vasomotor centre of the medulla and cause an increase in parasympathetic and a decrease in sympathetic stimulation to the heart, thus reducing blood pressure.
name: Increased cardiac output
label: c
answer: no
explanation: This patient has presented with postural hypotension. The vagus nerve provides parasympathetic stimulation to the heart, reducing blood pressure. Therefore decreased vagal tone will cause a compensatory increase in blood pressure.
name: Decreased vagal tone
label: a
answer: yes

Correct answer: a