hllj/quesmed huggingface dataset:
A 58-year-old man presents to his GP experiencing moderate back pain from prostate metastases. He is taking paracetamol and ibuprofen for the pain, but these are not helping.

According to the WHO pain ladder, what is a potential side effect of the medication he should try next?

Options:
explanation: Constipation is a common side effect associated with opioid medications prescribed for moderate-to-severe pain, including cancer-related pain.
name: Constipation
label: a
answer: yes
explanation: Fatigue can be a side effect of various medications, including some antihistamines and sedatives. Whilst opioids can cause drowsiness, it is typically different from the generalised fatigue associated with other medications.
name: Fatigue
label: d
answer: no
explanation: Weight gain can occur as a side effect of certain medications, such as antidepressants, antipsychotics, or corticosteroids.
name: Weight gain
label: c
answer: no
explanation: Dry cough is a side effect commonly associated with medications like angiotensin-converting enzyme (ACE) inhibitors, e.g. ramipril, which are used to treat hypertension.
name: Dry cough
label: b
answer: no
explanation: Hyperkalaemia can result from certain medications, such as potassium-sparing diuretics or angiotensin receptor blockers (ARBs).
name: Hyperkalaemia
label: e
answer: no

Correct answer: a
A 78-year-old man presents with recurrent episodes of palpitations and dizziness.

ECG reveals an irregular rhythm with no P waves. Holter monitor confirms atrial fibrillation (AF).

He is prescribed an antiarrhythmic medication which targets the ion channel involved in the repolarisation phase of the cardiac action potential.

What ion channel plays a crucial role in the repolarisation phase of the cardiac action potential in atrial myocytes?

Options:
explanation: Voltage-gated K+ channels are important in the repolarisation phase (Phase 3) of the cardiac action potential in atrial myocytes. During this phase, K+ channels open, allowing the efflux of potassium ions, which leads to the restoration of the resting membrane potential. In AF, where normal electrical signalling in the atria is disrupted, medications can be used to target voltage-gated K+ channels to help restore a more regular rhythm by influencing the repolarisation of atrial cells.
name: Voltage-gated K+ channels
label: a
answer: yes
explanation: HCN channels are involved in generating the pacemaker potential in the cells of the sinoatrial node, regulating heart rate.
name: Hyperpolarization-activated cyclic nucleotide-gated (HCN) channels
label: e
answer: no
explanation: Chloride channels play a role in cardiac action potentials but are not primary targets for antiarrhythmic medications.
name: Voltage-gated Cl- channels
label: d
answer: no
explanation: These channels are important in the cardiac action potential's plateau phase (Phase 2). They allow calcium ions to enter the cells, contributing to the sustained depolarization of the myocardium.
name: Voltage-gated Ca2+ channels
label: c
answer: no
explanation: These channels are important in the cardiac action potential depolarisation phase (Phase 0) by allowing the influx of sodium ions.
name: Voltage-gated Na+ channels
label: b
answer: no

Correct answer: a
A 32-year-old female presents to an outpatient clinic. She has developed petechiae and bruising over the last 3 weeks. She has recently had a cold but has recovered and has no other symptoms, such as hepatosplenomegaly or lymphadenopathy.

She is not on any regular medications.

Which of the following is the most likely diagnosis?

Options:
explanation: Patients with thrombotic thrombocytopenic purpura characteristically present with a fever, acute kidney injury and neurological changes.
name: Thrombotic thrombocytopenic purpura
label: e
answer: no
explanation: Patients with HSP present with a characteristic tetrad of symptoms - abdominal pain, joint pain, renal disease and a rash.
name: Henoch-Schonlein purpura (HSP)
label: c
answer: no
explanation: Certain medications can cause a drop in platelet count, leading to petechiae and bruising. These include carbamazepine, vancomycin and heparin.
name: Drug-induced thrombocytopenia
label: b
answer: no
explanation: ITP is a condition characterised by a low platelet count (thrombocytopenia) due to the destruction of platelets by the body's immune system. This destruction results in bleeding manifestations such as petechiae and easy bruising, both of which are characteristic symptoms of ITP. ITP also often presents without hepatosplenomegaly or lymphadenopathy, making it a likely diagnosis in this case.
name: Immune thrombocytopenic purpura (ITP)
label: a
answer: yes
explanation: This is an inherited bleeding disorder caused by a reduction in von Willebrand Factor. It typically presents earlier in life. Patients may have a history of excess or prolonged bleeding from minor wounds, nosebleeds and periods.
name: Von Willebrand Disease
label: d
answer: no

Correct answer: a
A 15-year-old girl presents to the emergency department with abdominal pain. The A&E doctors suspect appendicitis and would like to admit her for surgery; however, the girl is refusing to have the surgery. She is deemed to be Gillick competent.

Out of the following options, who can consent on her behalf and override her refusal?

Options:
explanation: In some instances, a court-appointed advocate may be involved to represent the minor's best interests in court proceedings. However, they cannot override the child's decision without court approval.
name: A court-appointed advocate
label: c
answer: no
explanation: A person with parental responsibility, such as a parent or legal guardian, has the authority to make medical decisions on behalf of a minor child, even if the child is Gillick competent. Whilst a Gillick competent child can refuse medical treatment, if they refuse medical treatment, which may lead to their death or severe permanent harm, this decision can be overridden by a person with parental responsibility.
name: A person with parental responsibility
label: a
answer: yes
explanation: A patient must be at least 18 to appoint a lasting power of attorney.
name: Lasting power of attorney
label: e
answer: no
explanation: A teacher does not typically have legal authority to make medical decisions on behalf of a student.
name: The patient's teacher
label: d
answer: no
explanation: Friends do not generally have the legal authority to make medical decisions on behalf of minors or override their refusal.
name: A close friend of the patient
label: b
answer: no

Correct answer: a
A 28-year-old male presents to the gastroenterology clinic experiencing chronic diarrhoea, abdominal cramping and weight loss of 15 pounds over the past 3 months. He reports no blood in his stool, but the diarrhoea occurs multiple times daily and wakes him up at night.

On examination, he has mild tenderness in the lower abdomen.

Blood results reveal anaemia and raised inflammatory markers. Faecal calprotectin is significantly raised.

What is the most appropriate next step in investigating this patient's symptoms?

Options:
explanation: An OGD examines the upper GI tract, including the oesophagus, stomach and duodenum. It is more appropriate for assessing symptoms related to acid reflux, gastritis, upper GI bleeding and peptic ulcers.
name: Oesophago-gastro-duodenoscopy (OGD)
label: b
answer: no
explanation: Helicobacter pylori testing is appropriate for assessing upper GI symptoms, particularly in suspected peptic ulcers or gastritis. It would not directly assess this patient's lower GI symptoms of chronic diarrhoea and weight loss.
name: Helicobacter pylori testing
label: c
answer: no
explanation: IBS is a diagnosis of exclusion, and it is important to rule out other potential causes before considering IBS.
name: Diagnosis of irritable bowel syndrome (IBS) and reassurance
label: e
answer: no
explanation: A trial of a gluten-free diet is appropriate when coeliac disease is suspected.
name: Trial of a gluten-free diet
label: d
answer: no
explanation: The patient's symptoms suggest they possibly have inflammatory bowel disease (IBD). Colonoscopy with biopsy would allow direct visualisation of the colon to evaluate the extent of the inflammation, and the biopsy sample can help to confirm or rule out IBD.
name: Colonoscopy with biopsy
label: a
answer: yes

Correct answer: a
A 60-year-old man presents to A&E experiencing weakness, confusion and generalised swelling for the past week. He is a smoker and drinks 20 units of alcohol a week.

Physical examination shows he has pitting oedema in his legs.

Blood results show hyponatraemia and a low serum osmolality.

A chest x-ray shows he has a small mass in his lungs.

What is the most likely cause of this patient's hyponatraemia?

Options:
explanation: Cushing's syndrome is characterised by excessive cortisol and typically leads to hypernatraemia rather than hyponatraemia due to sodium retention.
name: Cushing's syndrome
label: c
answer: no
explanation: Addison's disease can lead to hyponatraemia by reducing sodium re-absorption in the kidneys. However, the history of smoking and small cell lung cancer makes SIADH a more likely diagnosis.
name: Addison's Disease
label: e
answer: no
explanation: SIADH is caused by the excess secretion of antidiuretic hormone (ADH), leading to water retention and dilutional hyponatraemia. In this case, the source is from the paraneoplastic secretion of ADH from a likely underlying small cell lung cancer (SCLC).
name: Syndrome of Inappropriate ADH (SIADH)
label: a
answer: yes
explanation: Primary hyperaldosteronism is characterised by increased aldosterone production and typically leads to hypernatraemia rather than hyponatraemia due to increased sodium retention by the kidneys.
name: Primary hyperaldosteronism
label: b
answer: no
explanation: Diabetes insipidus is caused by inadequate secretion of ADH by the posterior pituitary. It typically causes hypernatraemia due to excessive excretion of dilute urine.
name: Diabetes insipidus
label: d
answer: no

Correct answer: a
A 25-year-old female attends a psychiatry appointment. During the appointment, she says that she can hear three voices threatening her and telling her to harm her family.

What type of hallucination is being described?

Options:
explanation: In this type of hallucination, individuals hear voices that speak about them or discuss their actions in the third person.
name: Third-person auditory hallucination
label: c
answer: no
explanation: Tactile hallucinations involve a false perception of physical sensations — for example, insects crawling on the skin.
name: Tactile hallucination
label: e
answer: no
explanation: This type of hallucination is when individuals can hear a voice or voices that talk directly to them or command them. In this case, the patient hears voices threatening her and instructing her to perform harmful actions.
name: Second-person auditory hallucination
label: a
answer: yes
explanation: This involves perceiving things, people or objects that are not present.
name: Visual hallucination
label: d
answer: no
explanation: In this type of hallucination, individuals hear themselves and their own thoughts spoken aloud.
name: First-person auditory hallucination
label: b
answer: no

Correct answer: a
A 28-year-old woman presents to the gynaecology clinic with vaginal itching, foul-smelling vaginal discharge and occasional discomfort when urinating.

On examination, a frothy, greenish-yellow discharge and vulvar erythema and oedema are visible.

Wet mount microscopy of the discharge reveals motile, flagellated protozoa.

Considering the most likely diagnosis, which of the following is the most appropriate management?

Options:
explanation: Based on the clinical presentation and microscopy findings, the most likely diagnosis is trichomoniasis. Metronidazole is the treatment for trichomoniasis. It is a sexually transmitted infection caused by the protozoan parasite *Trichomonas vaginalis*.
name: Metronidazole
label: a
answer: yes
explanation: Topical steroids are used to treat various inflammatory conditions but are inappropriate for treating trichomoniasis.
name: Topical steroids
label: e
answer: no
explanation: Fluconazole is an antifungal medication used to treat candidiasis.
name: Fluconazole
label: b
answer: no
explanation: Ceftriaxone is an antibiotic commonly used to treat gonorrhoea.
name: Ceftriaxone
label: d
answer: no
explanation: Clindamycin is an antibiotic used to treat infections, including bacterial vaginosis.
name: Clindamycin
label: c
answer: no

Correct answer: a
A 52-year-old postmenopausal woman presents to her GP with concerns about abdominal discomfort and bloating that have persisted for several months. She reports feeling full quickly when eating and has noticed a gradual increase in abdominal girth.

She has no significant medical history.

On examination, there is abdominal distension and a palpable mass in her lower abdomen.

Which of the following signs or symptoms would raise suspicion for ovarian cancer in this patient?

Options:
explanation: Urinary tract infections are not typically considered a direct sign of ovarian cancer. However, urinary symptoms can occur if the tumour compresses nearby structures.
name: Frequent urinary tract infections
label: e
answer: no
explanation: Hot flushes are a common symptom in postmenopausal women due to hormonal changes but are not specific to ovarian cancer.
name: Hot flushes
label: b
answer: no
explanation: Unintentional weight loss in the context of persistent abdominal discomfort and bloating can raise suspicion of ovarian cancer.
name: Weight loss over the past year
label: a
answer: yes
explanation: Ovarian cancer is more likely to cause fatigue and general feelings of unwellness as it progresses.
name: Increased energy levels
label: d
answer: no
explanation: Irregular menstrual cycles are a common symptom during menopause and are not typically associated with ovarian cancer.
name: Irregular menstrual cycles
label: c
answer: no

Correct answer: a
A 59-year-old man presents with a 2-day history of abdominal pain and dark, tarry stools.

He has a history of liver disease.

**Blood results reveal the following:**

* Haemoglobin: 7.8 g/dL *(normal range: >12 g/dL)*
* Platelet count: 190,000/uL *(normal range: 150,000 - 45000/uL)*
* Prothrombin Time (PT): *26 seconds (normal range: 11 - 13.5 seconds)*
* Activated Partial Thromboplastin Time (APTT): 53 seconds *(normal range: 27 - 41 seconds)*

Which of the following factors is most likely contributing to the abnormal blood results in this patient?

Options:
explanation: Liver disease can impair the production of clotting factors, including those dependent on vitamin K. These factors are essential for both the intrinsic (APTT) and extrinsic (PT) coagulation pathways. Vitamin K is necessary for synthesising factors II, VII, IX and X. The impaired synthesis and decreased availability of vitamin K in liver disease can lead to prolonged PT and APTT.
name: Vitamin K deficiency
label: a
answer: yes
explanation: Thrombocytosis refers to an elevated platelet count and is not a common cause of prolonged PT and APTT.
name: Thrombocytosis
label: e
answer: no
explanation: Factor IX deficiency is associated with haemophilia B and typically results in prolonged APTT; however, it does not significantly affect PT.
name: Factor IX deficiency
label: d
answer: no
explanation: Factor VIII deficiency is associated with haemophilia A. It typically results in prolonged APTT but does not significantly affect PT.
name: Factor VIII deficiency
label: c
answer: no
explanation: Platelet dysfunction is not typically associated with prolonged PT and APTT. It is more relevant to bleeding disorders related to platelet function, such as von Willebrand disease.
name: Platelet dysfunction
label: b
answer: no

Correct answer: a
A 68-year-old female presents with symptoms of headache, confusion and nausea. She has a past medical history of heart failure.


On examination, she appears lethargic and has signs of peripheral oedema.


Blood results show she has a serum sodium level of 120 mmol/L *(normal range: 135-145 mmol/L)*.


What is the most appropriate initial investigation to investigate the underlying cause of this patient's symptoms?

Options:
explanation: Thyroid disorders are not typically the primary cause of acute hyponatraemia symptoms such as confusion.
name: Thyroid function tests
label: c
answer: no
explanation: A serum osmolality test would tell you the overall concentration of solutes in the blood and help you to differentiate between true hyponatraemia and pseudohyponatraemia and also rule out hyperglycaemia, which can also cause low serum sodium.
name: Serum osmolality
label: a
answer: yes
explanation: This test helps differentiate between different causes of hyponatraemia once you have ruled out pseudohyponatraemia and hyperglycaemia. In conditions like SIADH, urine osmolality is high.
name: Urine osmolality
label: b
answer: no
explanation: Blood cultures are important for identifying potential sources of infection, especially in a patient with confusion, but they do not directly investigate the hyponatraemia.
name: Blood Cultures
label: e
answer: no
explanation: A urine dipstick can provide information about urinary sodium and specific gravity, which may help assess the cause of the hyponatraemia but is not the most appropriate initial investigation.
name: Urine dipstick
label: d
answer: no

Correct answer: a
A 25-year-old female presents to her GP with a history of back pain persisting for 4 months. She reports that her back feels stiff in the morning, and the pain gradually improves as she cycles to work. She denies any trauma.

She has no significant past medical history.

An X-ray of her spine shows no abnormalities.

Which of the following is the most likely diagnosis for this patient?

Options:
explanation: Osteoarthritis is typically seen in older adults and can cause back pain.
name: Osteoarthritis
label: c
answer: no
explanation: Lumbar disc herniation typically presents with back and radicular pain (leg pain and numbness). Improvement with exercise is less typical.
name: Lumbar disc herniation
label: b
answer: no
explanation: This condition typically presents with inflammatory back pain that is worst in the morning and improves with exercise. It often affects young patients and can be associated with a positive HLA-B27 antigen.
name: Ankylosing spondylitis
label: a
answer: yes
explanation: Scoliosis may cause back pain but is usually identified in childhood or adolescence. Its symptoms are not typically related to morning stiffness and exercise.
name: Scoliosis
label: e
answer: no
explanation: Mechanical lower back pain is a common cause of back pain and can be related to posture and physical activity. However, it does not typically involve morning stiffness.
name: Mechanical lower back pain
label: d
answer: no

Correct answer: a
A 61-year-old man presents with decreased urine output, haematuria, ankle swelling and fatigue. His past medical history includes hypertension and type 2 diabetes. He recently started a new medication for his hypertension one week ago.

What is the most likely cause of this patient's acute kidney injury (AKI)?

Options:
explanation: UTIs present with urinary symptoms such as frequent urination, pain or burning during urination and urgency. Whilst UTIs can progress to serious kidney infections such as pyelonephritis, which may cause an AKI, these infections are often accompanied by fever and flank pain.
name: Urinary tract infection (UTI)
label: e
answer: no
explanation: Although renal calculi can cause an AKI, renal calculi-associated AKIs are more commonly associated with severe, colicky flank pain, haematuria, nausea and vomiting.
name: Renal calculi
label: b
answer: no
explanation: ATN is a common cause of intrinsic renal AKI and typically presents with haematuria and oedema. Various factors, including medications, can trigger it. Given this patient's recent initiation of a new hypertension medication and his clinical presentation, ATN secondary to medication is the most likely cause of his AKI.
name: Acute tubular necrosis (ATN)
label: a
answer: yes
explanation: Renal artery stenosis may cause hypertension and fluid retention but does not typically present with fluid overload symptoms such as ankle swelling or oedema. AKIs from renal artery stenosis often develop gradually over time and do not typically have a rapid onset of symptoms.
name: Renal artery stenosis
label: c
answer: no
explanation: Sepsis typically presents with symptoms of infection, such as fever, tachycardia, chills, and evidence of systemic inflammation. Sepsis can lead to an AKI but usually develops due to the systemic inflammatory response to an infection. This patient developed an AKI one week after starting a new hypertension medication.
name: Sepsis
label: d
answer: no

Correct answer: a
A 45-year-old female presents to the gastroenterology clinic with a history of epigastric pain and occasional nausea, which has persisted for the past few months.

An upper gastrointestinal endoscopy reveals gastritis, and a biopsy confirms the presence of *Helicobacter pylori (H. pylori)* infection.

She has no known allergies or intolerances to medications.

Which of the following treatment regimens is the most appropriate first-line therapy for this patient?

Options:
explanation: Metronidazole and tetracycline can be used as part of a *H. pylori* eradication regimen but are not typically used together as first-line treatment. 
name: Metronidazole and tetracycline
label: d
answer: no
explanation: Doxycycline and bismuth subsalicylate are used in salvage therapy for resistant cases of *H. pylori* but are not included in the first-line treatment regimen.
name: Doxycycline and bismuth subsalicylate
label: e
answer: no
explanation: This combination of antibiotics may be used for *H. pylori* eradication, but should also be combined with a PPI and metronidazole.
name: Clarithromycin and amoxicillin
label: c
answer: no
explanation: The first-line therapy for *H.Pylori* infection typically includes a PPI to reduce stomach acid production in combination with amoxicillin, clarithromycin (or metronidazole). This is recommended to improve eradication rates and overcome antibiotic resistance.
name: Triple therapy with a PPI, amoxicillin, clarithromycin or metronidazole
label: a
answer: yes
explanation: Monotherapy with a PPI is not sufficient for eradicating *H. pylori* infection. PPIs can reduce acid production and improve symptoms but do not directly target the bacteria.
name: Monotherapy with a proton pump inhibitor (PPI)
label: b
answer: no

Correct answer: a