hllj/quesmed huggingface dataset:
A 32-year-old woman presents to the Early Pregnancy Assessment unit with vaginal bleeding and some mild abdominal cramping. She is currently 10 weeks pregnant. She otherwise feels well and has had no other symptoms or abnormal vaginal discharge.

On examination, her abdomen is non tender and speculum examination reveals an open cervical os with ongoing vaginal bleeding. There is no offensive discharge.

An ultrasound scan is performed which shows some foetal parts that are still present in the uterus, but no foetal heartbeat.

Which of the following types of miscarriage best describes this scenario?

Options:
explanation: This answer is correct. In incomplete miscarriage, the cervical os is open, bleeding is ongoing and some foetal parts are visible in the uterus.
name: Incomplete
label: a
answer: yes
explanation: This answer is incorrect. In a threatened miscarriage, there is light, painless bleeding and the foetus is still present in the uterus on ultrasound. The cervical os is closed. Around 25% of these women will go on to miscarry.
name: Threatened
label: d
answer: no
explanation: This answer is incorrect. In a complete miscarriage, all of the foetal parts have been passed so on ultrasound the uterus is empty. The cervical os is usually closed.
name: Complete
label: c
answer: no
explanation: This answer is incorrect. In a septic miscarriage, the contents of the uterus is infected causing endometritis. The uterus will be tender and there will be offensive vaginal losses.
name: Septic
label: e
answer: no
explanation: This answer is incorrect. In a missed miscarriage, the uterus still contains foetal tissue but the foetus is not alive. The cervical os is closed and the woman usually has no pain or bleeding.
name: Missed
label: b
answer: no

Correct answer: a
A 28-year-old woman presents to Maternity Triage with painless vaginal bleeding. She is currently 32 weeks pregnant with her first baby.

Her blood pressure is 115/77 mmHg and urinalysis is normal.

She undergoes cardiotocography (CTG) which is normal and an ultrasound scan which shows a normal foetal heartbeat and the placenta covering the cervical os.

Which of the following conditions does this patient have?

Options:
explanation: This answer is incorrect. Pre-eclampsia is a condition characterised by maternal hypertension and proteinuria. It does not typically cause vaginal bleeding. This patient's normal blood pressure and urinalysis results rule out this condition.
name: Pre-eclampsia
label: e
answer: no
explanation: This answer is incorrect. Miscarriage is the loss of a pregnancy before 24 weeks gestation.
name: Threatened miscarriage
label: c
answer: no
explanation: This answer is incorrect. Uterine rupture typically occurs during labour and causes sudden, severe abdominal pain and a non-reassuring foetal heart rate tracing on CTG.
name: Uterine rupture
label: d
answer: no
explanation: This answer is incorrect. Placental abruption occurs when the placenta prematurely separates from the uterine wall. It typically causes severe abdominal pain, a 'woody' uterus and painful vaginal bleeding.
name: Placental abruption
label: b
answer: no
explanation: This answer is correct. Placenta praevia is a condition where the placenta partially or fully covers the cervical os. It typically causes painless vaginal bleeding.
name: Placenta praevia
label: a
answer: yes

Correct answer: a
A 42-year-old woman delivers her baby vaginally on the labour ward. During her pregnancy, she had diet-controlled gestational diabetes mellitus, but no other issues.

This is her first baby and she was in labour for 22 hours. She required an episiotomy to aid delivery of the fetal head, which was successfully sutured after delivery. She had an active third stage of labour and delivered the placenta shortly after delivery of the baby. The midwife checks the placenta and reports that is it complete.

In the 24 hours following delivery, she loses 1200ml blood.

Which of the following is the most likely cause of her postpartum haemorrhage (PPH)?

Options:
explanation: This answer is incorrect. Gestational diabetes mellitus is not a recognised cause of PPH.
name: Gestational diabetes mellitus
label: e
answer: no
explanation: This answer is incorrect. Retained placental tissue more commonly causes secondary PPH (24 hours - 12 weeks postpartum). As the placenta was complete on examination following delivery, this makes retained placental tissue unlikely.
name: Retained placental tissue
label: c
answer: no
explanation: This answer is incorrect. Whilst she had an episiotomy, it was successfully sutured after delivery, making vaginal trauma the cause of her PPH less likely.
name: Vaginal trauma
label: b
answer: no
explanation: This answer is correct. Uterine atomy is the most common cause of primary PPH. This patient's advanced maternal age, long labour and first baby are all risk factors for uterine atony.
name: Uterine atony
label: a
answer: yes
explanation: This answer is incorrect. Infection more commonly causes secondary PPH (24 hours - 12 weeks postpartum).
name: Infection
label: d
answer: no

Correct answer: a
A 24-year-old woman is 21 weeks pregnant with monozygotic twins.

An ultrasound scan reveals that the twins are dichorionic and diamniotic.

At what stage of development did the zygote separate?

Options:
explanation: This answer is incorrect. Cleavage of the embryo at the blastocyst stage (days 4-8) results in monozygotic twins that are monochorionic and diamniotic.
name: Blastocyst
label: b
answer: no
explanation: This answer is incorrect. Cleavage of the embryo when the embryonic disc has formed (days 13-15) results in conjoined twins.
name: Formed embryonic disc
label: d
answer: no
explanation: This answer is incorrect. Cleavage of the embryo at the implanted blastocyst stage (days 8-13) results in monozygotic twins that are monochorionic and monoamniotic.
name: Implanted blastocyst
label: c
answer: no
explanation: This answer is correct. Cleavage of the embryo at the morula stage (day 1-3) results in monozygotic twins that are dichorionic and diamniotic.
name: Morula
label: a
answer: yes
explanation: This answer is incorrect. Division of the zygote at fertilisation is normal and does not result in twins.
name: Fertilisation
label: e
answer: no

Correct answer: a
A 36-year-old woman attends the fertility clinic with her partner after struggling to conceive for three years.

Which of the following is not a recognised cause of infertility?

Options:
explanation: This answer is incorrect. Fibroids are a recognised cause of infertility. Large fibroids inside the uterus can prevent sperm reaching the egg, or prevent a fertilised egg from implanting in the uterus.
name: Fibroids
label: e
answer: no
explanation: This answer is incorrect. PCOS is a recognised cause of infertility as it causes infrequent ovulations which reduces the chance of conception.
name: Polycystic ovarian syndrome (PCOS)
label: b
answer: no
explanation: This answer is incorrect. Endometriosis is a recognised cause of infertility. In endometriosis, endometrial tissue grows in abnormal places such as the ovaries or fallopian tubes which can block the fallopian tubes or form scar tissue that makes it harder to conceive.
name: Endometriosis
label: c
answer: no
explanation: This answer is correct. Prior use of the combined oral contraceptive pill does not affect fertility, even if it was taken for many years. Once a woman stops taking the combined pill, her fertility returns to normal.
name: Prior long term combined oral contraceptive pill use
label: a
answer: yes
explanation: This answer is incorrect. Pelvic inflammatory disease is a recognised cause of infertility as it can cause the formation of scar tissue in the fallopian tube which makes it harder for the sperm and egg to meet.
name: Pelvic inflammatory disease
label: d
answer: no

Correct answer: a
A 23-year-old woman attends a booking appointment with her midwife shortly after finding out she is pregnant. At the appointment, the midwife measures her observations.

Which of the following is a normal physiological cardiovascular adaptation in pregnancy?

Options:
explanation: This answer is incorrect. Systemic vascular resistance decreases by around 50% during pregnancy which contributes to the lowering of blood pressure.
name: Increased systemic vascular resistance
label: b
answer: no
explanation: This answer is incorrect. In pregnancy, there is a dilutional anaemia as the haemoglobin concentration drops due to the increase in plasma volume.
name: Increased haemoglobin concentration
label: e
answer: no
explanation: This answer is correct. An increase in heart rate of around 25% is a normal physiological response in pregnancy. Increases in both heart rate and stroke volume contribute to an increase in cardiac output.
name: Increase in heart rate
label: a
answer: yes
explanation: This answer is incorrect. Blood pressure decreases in early pregnancy and is restored to pre-pregnancy levels in the late second trimester. Blood pressure should not rise past that of the pre-pregnant state; new-onset hypertension in pregnancy is always abnormal.
name: Increase in blood pressure
label: c
answer: no
explanation: This answer is incorrect. In pregnancy, the plasma volume increases by up to 45% compared to the non-pregnant state.
name: Decreased plasma volume
label: d
answer: no

Correct answer: a
A 6-year-old girl is brought to the GP with her mother who is concerned that she only opens her bowels once or twice a week. This has been the case for the last 6 months.

Which of the following findings indicates the presence of an underlying organic cause of her constipation?

Options:
explanation: This answer is incorrect. Faecal incontinence is common in functional constipation where children retain stool, leading to overflow diarrhoea and soiling.
name: Faecal incontinence
label: e
answer: no
explanation: This answer is incorrect. Children with functional constipation often have ongoing symptoms for many weeks or months. A history of constipation in the neonatal period is more concerning and points towards an underlying organic cause.
name: Ongoing constipation for 6 months
label: c
answer: no
explanation: This answer is correct. Faltering growth in children is always a red flag. Children with constipation and faltering growth are more likely to have an underlying organic disease that is causing the constipation.
name: Faltering growth
label: a
answer: yes
explanation: This answer is incorrect. An empty rectum on PR examination is more likely to indicate an underlying organic disease, such as Hirshprung's disease.
name: Stool in the rectum on PR exam
label: b
answer: no
explanation: This answer is incorrect. The presence of a distended abdomen in a child with constipation is more concerning and points towards an underlying organic cause.
name: Non-distended abdomen
label: d
answer: no

Correct answer: a
A newborn baby is found to have elevated levels of immunoreactive trypsin on his heel prick test.

Which of the following diseases is the child most likely to have?

Options:
explanation: This answer is incorrect. Glutaric aciduria type 1 (GA1) is one of the 9 conditions screened for in the newborn heel prick test. Babies found to have high acylcarnitine levels on heel prick testing are likely to have GA1. High levels of immunoreactive trypsin are found in babies with cystic fibrosis.
name: Glutaric aciduria type 1
label: e
answer: no
explanation: This answer is incorrect. Congenital hypothyroidism is one of the 9 conditions screened for in the newborn heel prick test. Babies found to have high TSH levels on heel prick testing are likely to have congenital hypothyroidism. High levels of immunoreactive trypsin are found in babies with cystic fibrosis.
name: Congenital hypothyroidism
label: b
answer: no
explanation: This answer is incorrect. Phenylketonuria (PKU) is one of the 9 conditions screened for in the newborn heel prick test. Babies found to have high phenylalanine levels on heel prick testing are likely to have PKU. High levels of immunoreactive trypsin are found in babies with cystic fibrosis.
name: Phenylketonuria
label: c
answer: no
explanation: This answer is incorrect. Maple syrup urine disease (MSUD) is one of the 9 conditions screened for in the newborn heel prick test. Babies found to have high leucine levels on heel prick testing are likely to have MSUD. High levels of immunoreactive trypsin are found in babies with cystic fibrosis.
name: Maple syrup urine disease
label: d
answer: no
explanation: This answer is correct. Cystic fibrosis is one of the 9 conditions screened for in the newborn heel prick test. Babies found to have high immunoreactive trypsin on heel prick testing are likely to have cystic fibrosis.
name: Cystic fibrosis
label: a
answer: yes

Correct answer: a
A one day old baby has his routine newborn examination by the paediatric registrar before being discharged home.

Examination findings:

* Upper limb oxygen saturation - 99%
* Lower limb oxygen saturation - 91%
* Femoral pulses - not palpable
* Auscultation of heart - systolic murmur present

Which of the following congenital heart conditions is this baby most likely to have?

Options:
explanation: This answer is correct. Coarctation of the aorta is an acyanotic congenital heart condition where there is narrowing of the aortic arch. It presents with a systolic murmur, differences in oxygen saturations between the upper and lower limb, and weak or absent femoral pulses.
name: Coarctation of the aorta
label: a
answer: yes
explanation: This answer is incorrect. Tetralogy of Fallot is a cyanotic congenital heart condition that causes cyanosis and low oxygen saturations in all four limbs. It does not cause absent femoral pulses. It is usually identified on antenatal scans.
name: Tetralogy of Fallot
label: c
answer: no
explanation: This answer is incorrect. Aortic valve stenosis restricts blood flow from the left ventricle to the aorta. Whilst it causes a systolic murmur, aortic stenosis does not account for the absent femoral pulses and difference in oxygen saturation between the upper and lower limbs.
name: Aortic valve stenosis
label: b
answer: no
explanation: This answer is incorrect. Ventricular septal defects are often asymptomatic but can produce a systolic murmur. However, it does not cause differences in oxygen saturation between the upper and lower limbs or absent femoral pulses.
name: Ventricular septal defect
label: e
answer: no
explanation: This answer is incorrect. Transposition of the great arteries is a cyanotic congenital heart condition that causes cyanosis and low oxygen saturations in all four limbs. It does not cause absent femoral pulses. It is usually identified on antenatal scans.
name: Transposition of the great arteries
label: d
answer: no

Correct answer: a
A 12-week-old girl is brought to the GP by her father for her routine immunisations.

According to the UK immunisation schedule, which of the following vaccines should be given at 12 weeks?

Options:
explanation: This answer is incorrect. The influenza vaccine is given as a nasal spray annually to children from 2 years to the end of primary school.
name: Influenza
label: d
answer: no
explanation: This answer is incorrect. Two doses of the MMR vaccine are given at 1 year and 3 years and 4 months (preschool).
name: Measles, mumps and rubella (MMR)
label: c
answer: no
explanation: This answer is correct. Two doses of the rotavirus vaccine are given at 8 and 12 weeks of age.
name: Rotavirus
label: a
answer: yes
explanation: This answer is incorrect. One dose of the meningitis ACWY vaccine is given to children at 14 years of age.
name: Meningitis ACWY
label: e
answer: no
explanation: This answer is incorrect. Three doses of the meningitis B vaccine are given at 8 weeks, 16 weeks and 1 year.
name: Meningitis
label: b
answer: no

Correct answer: a
A 4-week-old boy with Down's Syndrome is brought to children's A&E by his mother as she is concerned that he is projectile vomiting after all of his feeds and not gaining weight.

When his length and weight are plotted on a growth chart, it is noted that he has fallen by two centile lines.

On examination, a hard olive-sized lump is felt in the child's upper abdomen.

Which of the following conditions is the most likely cause of his vomiting?

Options:
explanation: This answer is incorrect. Whilst babies with Down's Syndrome are at increased risk of Hirschprung's disease, it typically presents with delayed passage of meconium after birth rather than vomiting.
name: Hirschprung's disease
label: c
answer: no
explanation: This answer is correct. Babies with Down's Syndrome are at increased risk of pyloric stenosis. It presents with projectile vomiting and inadequate weight gain. The hypertrophied pylorus can sometimes be felt as a hard, olive-shaped lump on examination of the abdomen.
name: Pyloric stenosis
label: a
answer: yes
explanation: This answer is incorrect. Whilst babies with Down's Syndrome are at increased risk of duodenal atresia, it typically presents with projectile vomiting within the first 24-36 hours after birth. Projectile vomiting at 4 weeks, with a palpable abdominal mass, is more likely to be pyloric stenosis.
name: Duodenal atresia
label: b
answer: no
explanation: This answer is incorrect. Whilst babies with Down's Syndrome are at increased risk of hypothyroidism, it does not present with vomiting, making this diagnosis unlikely.
name: Hypothyroidism
label: e
answer: no
explanation: This answer is incorrect. Whilst babies with Down's Syndrome are at increased risk of GORD, the presence of a palpable abdominal mass and faltering growth make a diagnosis of pyloric stenosis more likely.
name: Gastroesophageal reflux disease (GORD)
label: d
answer: no

Correct answer: a
A 3-month-old girl is admitted to the Paediatrics ward with difficulty breathing and wheezing. She is diagnosed with bronchiolitis.

Which of the following is the most likely causative pathogen?

Options:
explanation: This answer is incorrect. Whilst adenovirus can cause bronchiolitis, it is more commonly caused by respiratory syncytial virus.
name: Adenovirus
label: d
answer: no
explanation: This answer is correct. Respiratory syncytial virus is the most common pathogen causing bronchiolitis.
name: Respiratory syncytial virus
label: a
answer: yes
explanation: This answer is incorrect. Whilst human metapneumovirus can cause bronchiolitis, it is more commonly caused by respiratory syncytial virus.
name: Human metapneumovirus
label: e
answer: no
explanation: This answer is incorrect. Whilst rhinovirus can cause bronchiolitis, it is more commonly caused by respiratory syncytial virus.
name: Rhinovirus
label: c
answer: no
explanation: This answer is incorrect. The parainfluenza virus can cause bronchiolitis, but less commonly than respiratory syncytial virus. The parainfluenza virus is the most common pathogen causing croup.
name: Parainfluenza virus
label: b
answer: no

Correct answer: a
A 70-year-old male attends the GP as he is worried about a new skin lesion. He has a small pink nodule with a central depression on the side of his neck. He does not report any pain or bleeding from the lesion. On closer examination, you can see telangiectasia on the surface of the nodule.

Which of the following is the most likely diagnosis?

Options:
explanation: A keloid scar would present as a hard smooth growth at a site of trauma. They can form on any body part but are most commonly found after injury to the upper chest, sternum, shoulder, face, earlobes, and lower legs.
name: Keloid scar
label: e
answer: no
explanation: Features of malignant melanoma follow the ABCDE pattern. Look for a lesion with asymmetry, a scalloped border, multiple colours, a diameter greater than 6mm, and a lesion that evolves over time.
name: Malignant Melanoma
label: c
answer: no
explanation: This is the classic description of a basal cell carcinoma (BCC), the most common type of skin cancer. Look out for a skin-coloured or pink nodule with a central depression, pearly rolled edge, and surface telangiectasia. BCC's are unlikely to cause any pain or bleeding and are very slow growing. They are usually located on sun-exposed areas of skin, hence the lesion in this question appearing on the patient's neck.
name: Basal cell carcinoma
label: a
answer: yes
explanation: Actinic keratoses are premalignant lesions that often appear before the development of squamous cell carcinoma. Unlike BCCs, they present as a thickened papule or plaque with surrounding erythematous skin. They have a rough warty surface and can cause pruritus. They are also typically found on sun-exposed skin.
name: Actinic keratosis
label: d
answer: no
explanation: Squamous cell carcinomas (SCCs) appear as irregular, ill-defined red nodules. They often appear scaly and ulcerated. They can cause pain and bleeding and can grow over weeks to months. Similarly to BCC's, they typically appear on sun-exposed skin such as on the face, scalp, ears, and hands.
name: Squamous cell carcinoma
label: b
answer: no

Correct answer: a
A 21-year-old female attends the GP surgery as she has noticed well-defined patches of hair loss across her scalp. On closer examination, you notice the surrounding hairs are narrower near the base, forming an exclamation mark shape.

Which of the following other conditions is this patient most likely to have?

Options:
explanation: Acne is an inflammatory disease of the pilosebaceous unit (which is made up of the hair follicle and sebaceous gland). Acne vulgaris is not an autoimmune disease and therefore is not the most likely condition to appear alongside alopecia areata.
name: Acne Vulgaris
label: c
answer: no
explanation: Osteoarthritis results from the gradual wear and tear of joints over time. It is not an autoimmune disease and therefore is not the most likely condition to appear alongside alopecia areata.
name: Osteoarthritis
label: d
answer: no
explanation: Glaucoma is an optic neuropathy that causes the death of optic nerve fibres. It is not an autoimmune condition and therefore is not the most likely condition to appear alongside alopecia areata.
name: Glaucoma
label: e
answer: no
explanation: This patient shows well-defined patches of hair loss, with the surrounding hairs showing characteristic ‘exclamation mark’ hairs. This is a classic picture of alopecia areata, an autoimmune disease. This question asks which other condition is likely to appear alongside alopecia areata. The answer is another autoimmune disease, in this case hypothyroidism, as patients with one autoimmune disease are more likely to develop additional autoimmune disorders.
name: Hypothyroidism
label: a
answer: yes
explanation: In type 2 diabetes mellitus, repeated excess exposure to glucose leads to deficient insulin secretion from the pancreatic beta cells. This is not an autoimmune condition and therefore is not the most likely condition to occur alongside alopecia areata.
name: Type 2 Diabetes Mellitus
label: b
answer: no

Correct answer: a