hllj/quesmed huggingface dataset:
A 45 year old man attends his GP surgery with a 12 hour history of feeling generally unwell with fevers and extreme fatigue. He denies any diarrhoea or abdominal pain, and reports no rashes or skin changes.

The patient is two months into his recovery from a renal transplant, that he received due to end-stage kidney disease. The operation went well with no complications, and no evidence of transplant rejection thus far. He has been fully compliant with all immunosuppressive medications that he has been prescribed following his transplant. He is not currently sexually active and does not smoke or drink alcohol. He has not left the UK for the past 5 years.

Which of the following is the most likely underlying microbiological cause of this patient's symptoms?

Options:
explanation: This is a common opportunistic virus that healthcare teams need to be aware of concerning immunosuppressed individuals. As the patient has had a renal transplant, he will have been placed on immunosuppressive medications e.g., steroids and as a result be more susceptible to opportunistic microbes.
name: Cytomegalovirus
label: a
answer: yes
explanation: Norovirus is associated with vomiting and diarrhoea. It is one of the most common causes of gastroenteritis in the United Kingdom. It is not the best first for the clinical picture described above.
name: Norovirus
label: e
answer: no
explanation: This is the bacterium responsible for causing chancroid and is sexually transmitted. Typical symptoms include painful blistering lesions on the skin of the genitals and painful raised lymph glands.
name: Haemophilus ducreyi
label: d
answer: no
explanation: This is the bacterium responsible for causing syphilis and is associated with sexual transmission. Typical symptoms normally include solitary painless lesions within 90 days of being infected before the disease progresses to form maculopapular symmetrical rashes on the palms, legs, soles and face.
name: Treponema Pallidum
label: c
answer: no
explanation: Entamoeba histolytica is a parasitic organism, more common in tropical areas. Typical symptoms include bloody diarrhoea and abdominal pain, which this patient does not have.
name: Entamoeba histolytica
label: b
answer: no

Correct answer: a
A 22 year old woman asks her GP for support in reducing her alcohol intake. She is aware that she has developed binge drinking habits and wants to stop before she does any long-term damage to her body. The GP explores her average weekly drinking habits.

The patient reports that in a typical week, she will consume half a litre of 40% vodka alongside 6 pints of 5% beer.

Assuming 1 pint = 500 millilitres, what is the patient's average weekly alcohol consumption?

Options:
explanation: She is drinking 3 litres of 5% beer and 0.5 litres of 40% vodka , so using the formula, units = alcohol percentage x litres we get the following:

3 litres x 5 = 15 units

0.5 litres x 40 = 20 units

15 + 20 = 35 units

This is well above the NHS recommended maximal alcohol intake in a week which currently stands at 14 units.
name: 55 units
label: d
answer: no
explanation: She is drinking 3 litres of 5% beer and 0.5 litres of 40% vodka , so using the formula, units = alcohol percentage x litres we get the following:

3 litres x 5 = 15 units

0.5 litres x 40 = 20 units

15 + 20 = 35 units

This is well above the NHS recommended maximal alcohol intake in a week which currently stands at 14 units.
name: 15 units
label: c
answer: no
explanation: She is drinking 3 litres of 5% beer and 0.5 litres of 40% vodka , so using the formula, units = alcohol percentage x litres we get the following:

3 litres x 5 = 15 units

0.5 litres x 40 = 20 units

15 + 20 = 35 units

This is well above the NHS recommended maximal alcohol intake in a week which currently stands at 14 units.
name: 35 units
label: a
answer: yes
explanation: She is drinking 3 litres of 5% beer and 0.5 litres of 40% vodka , so using the formula, units = alcohol percentage x litres we get the following:

3 litres x 5 = 15 units

0.5 litres x 40 = 20 units

15 + 20 = 35 units

This is well above the NHS recommended maximal alcohol intake in a week which currently stands at 14 units.
name: 42 units
label: e
answer: no
explanation: She is drinking 3 litres of 5% beer and 0.5 litres of 40% vodka , so using the formula, units = alcohol percentage x litres we get the following:

3 litres x 5 = 15 units

0.5 litres x 40 = 20 units

15 + 20 = 35 units

This is well above the NHS recommended maximal alcohol intake in a week which currently stands at 14 units.
name: 25 units
label: b
answer: no

Correct answer: a
A 60 year old woman presents to the GP practice with painful urination. For the past three days, she has needed to pass urine a lot more frequently than usual. She reports the urge to pass urine can come on quite suddenly, but she has had no episodes of incontinence so far.

The patient's relevant urine dip results can be seen below:

* Leukocytes +
* Nitrites +
* Blood ++

Which of the following organisms is the most likely cause of this patient's presentation?

Options:
explanation: The vignette describes a typical presentation of a lower urinary tract infection (UTI). According to NICE CKS, the most commonly identified causative pathogen is Escherichia coli, which is detected in more than 70% of lower UTI cases. Therefore, this is the single best answer.
name: Escherichia coli
label: a
answer: yes
explanation: The vignette describes a typical presentation of a lower urinary tract infection (UTI). Although Proteus mirabilis is occasionally implicated, it is a less common cause of a UTI than Escherichia coli. Proteus mirabilis is also more common in males than females, making it less likely in this case.
name: Proteus mirabilis
label: c
answer: no
explanation: The vignette describes a typical presentation of a lower urinary tract infection (UTI). Although Klebsiella is occasionally implicated, it is a less common cause of a UTI than Escherichia coli.
name: Klebsiella pneumoniae
label: e
answer: no
explanation: The vignette describes a typical presentation of a lower urinary tract infection (UTI). Although Staphylococcus saprophyticus is occasionally implicated, it is a less common cause of a UTI than Escherichia coli. According to NICE CKS Staphylococcus saprophyticus is present in only 5-10% of cases.
name: Staphylococcus saprophyticus
label: b
answer: no
explanation: The vignette describes a typical presentation of a lower urinary tract infection (UTI). Whilst Staphyloccous aureus is a common cause of skin and soft tissue infections, it is not the most common cause of UTIs.
name: Staphyloccous aureus
label: d
answer: no

Correct answer: a
A 2 year old child is brought to the GP surgery by his mother, who is enquiring about the UK vaccination schedule. He has lived in the UK all his life and has had all of the recommended vaccinations for his age.

Which of the following vaccinations has the child already had?

Options:
explanation: The Pneumococcal vaccine protects against Streptococcus pneumoniae. It is received first at 12 weeks, as well as a booster at 12 months in the current NHS vaccination schedule: [link](https://www.nhs.uk/conditions/vaccinations/nhs-vaccinations-and-when-to-have-them/).
name: Pneumococcal vaccine
label: a
answer: yes
explanation: The chickenpox vaccine is not part of the NHS Vaccination schedule and is therefore incorrect.
name: Chickenpox vaccine
label: e
answer: no
explanation: The MenACWY vaccine protects against 4 strains of the meningococcal bacteria. It is received at 14 years in the NHS vaccine schedule, so a 2 year old child would not yet have had it.
name: MenACWY vaccine
label: d
answer: no
explanation: This 4-in-1 pre-school booster vaccine offers protection against diphtheria, tetanus, whooping cough and
polio. It is received at 3 years and 4 months as per the NHS vaccination schedule, so a 2 year old child would not yet have had it.
name: 4-in-1 pre-school booster vaccine
label: b
answer: no
explanation: The HPV vaccine protects against the human papillomavirus. It is received at 12 to 13 years in the NHS vaccination schedule, so a 2 year old child would not yet have had it.
name: Human paipillomavirus  (HPV) vaccine
label: c
answer: no

Correct answer: a
A 55 year old female patient attends the GP surgery to discuss the results of her recent endoscopy. She has chronic dyspepsia and has smoked one packet of cigarettes a day for the last 35 years.

The report identifies a change in the epithelial lining of the lower oesophagus from squamous to columnar epithelium. The GP explains these changes are consistent with a diagnosis of Barrett's oesophagus.

Which of the following best describes the cellular changes identified on endoscopy?

Options:
explanation: Hypertrophy refers to an increase in the size of cells. It does not describe the cellular changes seen in Barrett's oesophagus.
name: Hypertrophy
label: e
answer: no
explanation: Neoplasia refers to the autonomous and uncontrolled growth of cells. This may be benign, or malignant in the case of cancer. It involves the growth of new tissue, whereas Barrett's oesophagus refers to a change in the cellular constituents of tissue. This answer is therefore incorrect.
name: Neoplasia
label: c
answer: no
explanation: Dysplasia is the replacement of a mature cell type with an immature or abnormal cell type. Although Barrett's oesophagus can become dysplastic, the above endoscopy report identifies a change to columnar epithelium; a mature cell type. This answer is therefore incorrect.
name: Dysplasia
label: b
answer: no
explanation: Hypoplasia describes a lack of cells in tissues. It does not describe the cellular changes seen in Barrett's oesophagus.
name: Hypoplasia
label: d
answer: no
explanation: Metaplasia is the replacement of one mature cell type with another and is pathognomonic of Barrett's oesophagus
name: Metaplasia
label: a
answer: yes

Correct answer: a
A 60 year old man is admitted to the respiratory ward for treatment of a lower respiratory tract infection. An antibiotic is commenced which acts on the ribosomal 50s subunit of the bacterium to inhibit bacterial protein synthesis.

Which of the following antibiotics is prescribed?

Options:
explanation: Vancomycin is a glycopeptide antibiotic and exerts its effect by binding to cell wall proteins, which prevents the formation of cross-links in the peptidoglycan cell wall. They do not act on the ribosomal 50s subunit of the bacterium to inhibit bacterial protein synthesis, making this answer incorrect.
name: Vancomycin
label: d
answer: no
explanation: Amoxicillin belongs to the penicillin class of antibiotics. Penicillins exert their antimicrobial effect through the inhibition of penicillin-binding proteins. These are key in catalysing the reaction to make bacterial cell walls. They do not act on the ribosomal 50s subunit of the bacterium to inhibit bacterial protein synthesis, making this answer incorrect.
name: Amoxicillin
label: b
answer: no
explanation: Clarithromycin is a macrolide antibiotic. Macrolides exert their effects through the inhibition of protein synthesis, by binding to the 50s subunit of the ribosome. This is therefore the correct answer.
name: Clarithromycin
label: a
answer: yes
explanation: Cefotaxime belongs to the cephalosporin class of antibiotics. Cephalosporins exert their effect through inhibiting the cross-linking of peptidoglycans in the cell wall. They do not act on the ribosomal 50s subunit of the bacterium to inhibit bacterial protein synthesis, making this answer incorrect.
name: Cefotaxime
label: c
answer: no
explanation: Gentamicin is an aminoglycoside which inhibits bacterial protein synthesis by binding to the **30S subunit** of the ribosome. They do not act on the ribosomal 50s subunit of the bacterium to inhibit bacterial protein synthesis, making this answer incorrect.
name: Gentamicin
label: e
answer: no

Correct answer: a
A 4 year old child is rushed to A&E by his worried mum after he tried a peanut for the first time and began wheezing. On the journey, he also developed an itchy rash.

On examination the child has an increased respiratory rate and wheeze. He also has widespread erythematous wheals with well-defined borders.

The doctor administers IM adrenaline which resolves the symptoms.

Which of the following types of hypersensitivity reaction has occurred?

Options:
explanation: The clinical vignette describes a typical case of anaphylaxis. This is a type 1 hypersensitivity reaction in which mast-cells are activated via IgE antibody binding. When a person then encounters this antigen again, mediators such as histamine and leukotrienes are released, resulting in widespread vasodilation and bronchoconstriction. This bronchoconstriction is what gives rise to the wheeze that this patient demonstrates.
name: Type 1 hypersensitivity reaction
label: a
answer: yes
explanation: The clinical vignette describes a typical case of anaphylaxis, which is a type 1 hypersensitivity reaction. In type 2 sensitivity reactions antigens on the cell surface are targeted by antibodies, triggering an immune response when these antigens are presented to T-cells. An example of this would be an acute transfusion reaction.
name: Type 2 hypersensitivity reaction
label: b
answer: no
explanation: The clinical vignette describes a typical case of anaphylaxis, which is a type 1 hypersensitivity reaction. Type 5 hypersensitivity reaction involves antibodies against hormone-producing cells. An example is Graves' disease.
name: Type 5 hypersensitivity reaction
label: e
answer: no
explanation: The clinical vignette describes a typical case of anaphylaxis, which is a type 1 hypersensitivity reaction. Type 4 hypersensitivity reactions are mediated by T-cell activation and usually occur over days as opposed to minutes. An example is contact dermatitis.
name: Type 4 hypersensitivity reaction
label: d
answer: no
explanation: The clinical vignette describes a typical case of anaphylaxis, which is a type 1 hypersensitivity reaction. Type 3 hypersensitivity reactions involve antigen-antibody complexes that may eventually damage tissues. An example is rheumatoid arthritis.
name: Type 3 hypersensitivity reaction
label: c
answer: no

Correct answer: a
A 65 year old patient with hypertension which has failed to be controlled by first-line therapy is prescribed bendroflumethazide.

Which of the following parts of the nephron does this class of diuretic act upon?

Options:
explanation: Bendroflumethazide belongs to the thiazide class of diuretics. The sodium/amino acid symporter plays no role in the mechanism of action of thiazide diuretics but is instead responsible for the reabsorption of amino acids.
name: Sodium/amino acid symporter in the proximal convoluted tubule
label: e
answer: no
explanation: Bendroflumethazide belongs to the thiazide class of diuretics. The sodium/glucose linked transporter is not involved in the mechanism of action of thiazide diuretics but is the target of SGLT2 inhibitors such as empagliflozin, which is used in diabetes treatment.
name: Sodium glucose linked transporter in the proximal convoluted tubule
label: c
answer: no
explanation: Bendroflumethazide belongs to the thiazide class of diuretics. These drugs block the sodium-chloride symporter in the distal convoluted tubule. By contrast, sodium-potassium-chloride co-transporters are the target of loop diuretics. Whilst they work similarly to thiazide diuretics by stopping the reabsorption of sodium and thus reducing water reabsorption, they act upon a different transporter, making this option incorrect.
name: Sodium-potassium-chloride co-transporters of the thick ascending limb
label: d
answer: no
explanation: Bendroflumethazide belongs to the thiazide class of diuretics. Whilst thiazide diuretics do block the sodium-chloride symporter, this blockade occurs in the distal convoluted tubule not the proximal, meaning this option is incorrect.
name: Sodium-chloride symporter in the proximal convoluted tubule
label: b
answer: no
explanation: Bendroflumethazide belongs to the thiazide class of diuretics. These drugs block the sodium-chloride symporter in the distal convoluted tubule, preventing the reabsorption of sodium and chloride. Remember water follows sodium so less water is also reabsorbed, reducing the circulating blood volume which in turn decreases cardiac pre-load and thus blood pressure.
name: Sodium-chloride symporter in the distal convoluted tubule
label: a
answer: yes

Correct answer: a
A 48 year old caucasian male patient presents to his GP to review the results of his daily home blood pressure readings. He is subsequently diagnosed with hypertension and is prescribed ramipril as first-line therapy.

Which of the following components of the Renin-Angiotensin-Aldosterone system (RAAS) is inhibited by this drug?

Options:
explanation: Ramipril is an angiotensin-converting enzyme (ACE) inhibitor. These drugs inhibit ACE, which mediates the conversion of angiotensin I to angiotensin II. Angiotensin II causes vasoconstriction, meaning that inhibition of this system via ACE inhibitors brings about vasodilation, thus lowering blood pressure. This answer is therefore correct.
name: The conversion of angiotensin I to angiotensin II in the lungs
label: a
answer: yes
explanation: Ramipril is an angiotensin-converting enzyme (ACE) inhibitor. By contrast, angiotensin II stimulates aldosterone release from the zona glomerulosa of the adrenal cortex. Ramipril does not directly inhibit this process.
name: The release of aldosterone
label: d
answer: no
explanation: Ramipril is an angiotensin-converting enzyme (ACE) inhibitor. Angiotensinogen is cleaved by renin to form angiotensin I. This conversion happens independently of the action of ACE, making this option incorrect.
name: The conversion of angiotensinogen to angiotensin I
label: c
answer: no
explanation: Ramipril is an angiotensin-converting enzyme (ACE) inhibitor. Whilst ACE is responsible for the conversion of angiotensin I to angiotensin II, this occurs mainly in the lungs rather than in the kidney. Therefore this is not the single best answer.
name: The conversion of angiotensin I to angiotensin II in the kidney
label: e
answer: no
explanation: Ramipril is an angiotensin-converting enzyme (ACE) inhibitor. By contrast, renin is released from the juxtaglomerular apparatus in response to the action of macula densa cells, baroreceptors or beta-1 adrenoreceptors. This option is therefore incorrect.
name: The release of renin
label: b
answer: no

Correct answer: a
A 70 year old man presents to A&E with a cough productive of green sputum and increased shortness of breath on exertion. He was diagnosed with chronic obstructive pulmonary disease (COPD) 3 years ago and has previously been noted to retain carbon dioxide. The following arterial blood gas (ABG) is obtained:


||||
|--------------|:-------:|------------------|
|pH|7.30|7.35 - 7.45|
|PaO₂|9.5 kPa|11 - 15|
|PaCO₂|7.2 kPa|4.6 - 6.4|
|Bicarbonate|34 mmol/L|22 - 30|


Which of the following compensatory mechanisms has been carried out by the kidney over the course of his **chronic** COPD.

Options:
explanation: This is an example of respiratory compensation for metabolic alkalosis. The ABG shows respiratory acidosis, meaning a reduced respiratory rate would be an inappropriate response. Furthermore, this would be an example of respiratory compensation, rather than renal compensation.
name: Slowing the respiratory rate to retain CO2
label: e
answer: no
explanation: In the type B intercalated cells of the distal convoluted tubule of the nephron, HCO3- can be secreted and hydrogen ions reabsorbed. This function is important in the response to **alkalosis**. By contrast, the ABG in this case shows a respiratory **acidosis**, making this option incorrect.
name: The elimination of bicarbonate (HCO3-) and reabsorption of hydrogen ions
label: b
answer: no
explanation: The kidney plays a key role in acid-base balance. The intercalated cells of the distal convoluted tubule secrete hydrogen ions whilst reabsorbing HCO3- in an attempt to make blood pH more alkaline. As you can see in the ABG, HCO3- is raised, indicating the kidney has attempted to compensate for the chronic increase in CO2 secondary to COPD.
name: The elimination of hydrogen ions and reabsorption of bicarbonate (HCO3-)
label: a
answer: yes
explanation: An increase in respiratory rate acts to increase carbon dioxide, thus making the blood more alkalotic. This this a more acute mechanism of compensation for acidosis, whereas the vignette refers to chronic respiratory acidosis. Furthermore, an increase in respiratory rate is a respiratory method of compensation, whereas the question specifically asks for renal compensation. This is therefore not the single best answer to this question.
name: Increasing respiratory rate to exhale more carbon dioxide
label: c
answer: no
explanation: This is incorrect. Increased reabsorption of hydrogen ions in the kidney occurs in response to blood alkalosis, while increased reabsorption of HCO3- occurs in response to blood acidosis. Reabsorption of both hydrogen ions and HCO3- does not typically occur together. Another important consideration is that many of the transporters responsible for acid-base balance in the kidney can either reabsorb HCO3- and secrete hydrogen ions or vice versa.
name: Reabsorption of both hydrogen ions and bicarbonate (HCO3-)
label: d
answer: no

Correct answer: a
A 40 year old man attends his GP surgery requesting a blood test to measure his kidney function. He was discharged from hospital the previous week, after receiving a course of intravenous medications for a severe pseudomonas infection. He is unable to remember which medication he received but recalls one of the doctors warned him it could damage his kidneys.

Which of the following medications is most commonly associated with nephrotoxicity?

Options:
explanation: Paracetamol is not associated with nephrotoxicity. However, in large doses or prolonged use, it can cause hepatic damage.
name: Paracetamol
label: c
answer: no
explanation: Amoxicillin is not commonly associated with nephrotoxicity and is therefore not the single best answer. Penicillins are often associated with gastrointestinal upset and allergy. There is some association between beta-lactams and acute interstitial nephritis, however, this is less common than the nephrotoxic effect of gentamycin. Furthermore, the antibiotic in this case was prescribed to treat a pseudomonas infection, which amoxicillin does not cover.
name: Amoxicillin
label: b
answer: no
explanation: Clarithromycin is a macrolide antibiotic and is often used when a patient has a penicillin allergy. It is associated with QT interval prolongation, gastrointestinal upset and ototoxicity, but not nephrotoxicity. This is therefore not the single best answer.
name: Clarithromycin
label: e
answer: no
explanation: Whilst intravenous sodium chloride may have been used in the treatment of a severe infection, it is not commonly associated with nephrotoxicity. Therefore this is not the single best answer.
name: Intravenous sodium chloride
label: d
answer: no
explanation: Gentamicin belongs to the aminoglycoside class of antibiotics. These drugs are associated with nephrotoxicity and ototoxicity. It is important to measure renal function regularly whilst on this medication.  They cause kidney damage through toxicity to tubular cells, causing acute tubular necrosis. Additionally, they are often used in severe infections caused by pseudomonas.
name: Gentamicin
label: a
answer: yes

Correct answer: a