hllj/quesmed huggingface dataset:
A 30-year-old woman has presented with a productive cough, dyspnoea and a wheeze. She is a non-smoker. Her lung function tests have revealed an obstructive picture, most likely due to COPD.

Which of the following may be the cause of her COPD?

Options:
explanation: Sarcoidosis is a multisystem inflammatory disease that can affect the lungs but is distinct from COPD. It is characterised by the formation of granulomas in various organs, including the lungs.
name: Sarcoidosis
label: e
answer: no
explanation: Alpha-1-antitrypsin deficiency is a known genetic cause of COPD. It is key to consider this as a cause, especially in a non-smoker and if a young patient presents with this history and results.
name: Alpha-1-antitrypsin deficiency
label: a
answer: yes
explanation: GORD can lead to a variety of respiratory symptoms, including cough and asthma-like symptoms, but it is not a direct cause of COPD.
name: Gastroesophageal reflux disease (GORD)
label: c
answer: no
explanation: Smoking is the most common cause of COPD. This patient is young and a non-smoker making this option incorrect.
name: History of smoking
label: d
answer: no
explanation: Occupational asbestos exposure is associated with a different lung condition known as asbestosis, which is characterised by the scarring of lung tissue. Whilst asbestosis can lead to respiratory symptoms, it is not typically classified as COPD.
name: Occupational exposure to asbestos
label: b
answer: no

Correct answer: a
When a patient is admitted to the hospital for the treatment of pneumonia, which of the following drug combinations are typically used first-line?

Options:
explanation: Ampicillin and gentamicin may be used in hospital-acquired pneumonia and more severe cases of community-acquired pneumonia but are not typically the first-line treatment for uncomplicated community-acquired pneumonia.
name: Ampicillin and gentamicin
label: e
answer: no
explanation: Azithromycin and levofloxacin are effective antibiotics for certain respiratory infections, but they are not the first-line choice for all cases of community-acquired pneumonia.
name: Azithromycin and levofloxacin
label: d
answer: no
explanation: Ciprofloxacin and metronidazole are antibiotics that may be used for specific types of infections, but they are not typically the first-line choice for uncomplicated community-acquired pneumonia. The amoxicillin and clarithromycin combination is often preferred.
name: Ciprofloxacin and metronidazole
label: b
answer: no
explanation: Amoxicillin and clarithromycin are often chosen for the initial treatment of community-acquired pneumonia due to their efficacy against common respiratory pathogens.

However, the specific choice of antibiotics may vary based on factors such as the patient's clinical condition, local resistance patterns, and other individual considerations. It is important for the prescribing physician to consider the most appropriate antibiotics for each patient, especially if the 1st line treatment may be ineffective.
name: Amoxicillin and clarithromycin
label: a
answer: yes
explanation: Whilst penicillin and doxycycline may be used in some cases of pneumonia, they are not the first-line choice for many cases of community-acquired pneumonia.
name: Penicillin and doxycycline
label: c
answer: no

Correct answer: a
58-year-old Mike has been recently diagnosed with community-acquired pneumonia. He is known to have a longstanding history of excessive alcohol consumption.

Which of the following organisms is the most likely cause of his pneumonia?

Options:
explanation: Whilst *Streptococcus pneumoniae* is a common cause of community-acquired pneumonia - especially in healthy individuals-,  in patients with a history of alcoholism and aspiration risk, *Klebsiella pneumoniae* is the more likely cause.
name: *Streptococcus pneumoniae*
label: b
answer: no
explanation: The presence of ongoing alcoholism, particularly in patients with a history of heavy drinking, can increase the risk of aspiration pneumonia caused by *Klebsiella pneumoniae* due to compromised airway defences increasing the risk of inhaling contaminated oropharyngeal contents. Klebsiella pneumonia is often associated with more severe and necrotising lung infections.
name: *Klebsiella pneumoniae*
label: a
answer: yes
explanation: *Mycoplasma pneumoniae* is known for causing atypical pneumonia, which typically presents with milder symptoms. In a patient with a history of alcoholism and potentially severe pneumonia, Klebsiella is a more likely aetiology.
name: *Mycoplasma pneumoniae*
label: d
answer: no
explanation: *Haemophilus influenzae* can cause pneumonia, but it is more common in patients with compromised immune systems or chronic lung conditions. In a patient with a history of alcoholism, Klebsiella is a more likely cause of pneumonia.
name: *Haemophilus influenzae*
label: c
answer: no
explanation: *Legionella pneumophila* can cause a severe form of pneumonia known as Legionnaires' disease. Whilst it can be a cause of pneumonia, especially in certain environmental or occupational exposures, Klebsiella is a more common organism associated with alcohol-related aspiration pneumonia.
name: *Legionella pneumophila*
label: e
answer: no

Correct answer: a
A 65-year-old patient with atrial fibrillation is at risk of having a stroke.

Which of the following medications is the most appropriate choice for stroke prevention in this patient?

Options:
explanation: Amiodarone is an antiarrhythmic medication used to control atrial fibrillation rhythm, but it is not an anticoagulant. Stroke prevention in atrial fibrillation usually requires anticoagulation therapy to reduce the risk of thrombus formation.
name: Amiodarone
label: e
answer: no
explanation: Diltiazem is a calcium channel blocker often used for rate control in atrial fibrillation, but it is not primarily used for stroke prevention. Stroke prevention in atrial fibrillation is achieved through anticoagulant therapy.
name: Diltiazem
label: c
answer: no
explanation: Metoprolol is a beta-blocker commonly used for rate control in atrial fibrillation but does not directly address stroke prevention. Stroke prevention is a separate aspect of atrial fibrillation management that typically involves anticoagulant therapy.
name: Metoprolol
label: d
answer: no
explanation: Aspirin is an antiplatelet medication and, whilst it can reduce the risk of stroke to some extent, it is generally considered less effective than anticoagulants like warfarin or direct oral anticoagulants for stroke prevention in atrial fibrillation. Anticoagulants target the formation of blood clots (thrombi) in the atria, which is a significant concern in atrial fibrillation.
name: Aspirin
label: b
answer: no
explanation: Atrial fibrillation is a significant risk factor for stroke due to the potential for blood stasis and the formation of atrial thrombi. Anticoagulation therapy is crucial for stroke prevention in patients with atrial fibrillation. Warfarin is a well-established oral anticoagulant that reduces the risk of stroke by inhibiting the formation of blood clots. Other options do not provide the same level of stroke prevention in atrial fibrillation. Aspirin may be considered in some low-risk patients, but warfarin or newer oral anticoagulants (e.g. direct oral anticoagulants like rivaroxaban) are more effective choices for patients at moderate to high risk of stroke.
name: Warfarin
label: a
answer: yes

Correct answer: a
With regards to a standard 12-lead ECG, which of the following changes is most likely to indicate an inferior ST-elevation myocardial infarction (STEMI)?

Options:
explanation: These leads are specifically oriented to detect changes in the inferior part of the heart, making them critical for the diagnosis of an inferior STEMI.
name: ST-segment elevation in leads II, III, and aVF
label: a
answer: yes
explanation: ST-segment elevation in leads I, aVL, and aVR can indicate high lateral involvement or possible left main coronary artery disease.
name: ST-segment elevation in leads I, aVL, and aVR
label: d
answer: no
explanation: ST-segment elevation in leads I and aVL usually suggests high lateral wall involvement, while V1-V6 is associated with anterior wall involvement.
name: ST-segment elevation in leads I, aVL, and V1-V6
label: c
answer: no
explanation: ST-segment elevation in the precordial (chest) leads (V1-V6) typically indicates anterior myocardial infarction, not an inferior STEMI.
name: ST-segment elevation in leads V1-V6
label: b
answer: no
explanation: T-wave inversion in the precordial leads may be seen in various conditions and could be a precursor sign for a STEMI, but is not the classic ECG change associated with an acute STEMI, especially an inferior one.
name: T-wave inversion in leads V1-V6
label: e
answer: no

Correct answer: a
In the management of heart failure, which class of medications is commonly used to reduce fluid overload and relieve symptoms of congestion?

Options:
explanation: Whilst ARBs are used in heart failure management to reduce the effects of angiotensin II and improve cardiac function, they are not primarily used for reducing fluid overload and relieving congestion.
name: Angiotensin receptor blockers (ARBs)
label: e
answer: no
explanation: Beta-blockers are used in heart failure management to improve heart function and reduce the heart's workload, primarily by slowing the heart rate and decreasing myocardial oxygen demand. Whilst they have many benefits in heart failure, they do not directly target fluid overload and congestion.
name: Beta-blockers
label: b
answer: no
explanation: Diuretics are medications that help reduce fluid overload in heart failure patients by increasing the excretion of excess sodium and water through the kidneys. This helps relieve symptoms of congestion, such as fluid retention and oedema, commonly seen in heart failure.
name: Diuretics
label: a
answer: yes
explanation: ACE inhibitors are important medications in heart failure management as they help improve cardiac function and reduce afterload, but their primary role is not to reduce fluid overload and congestion. They work by inhibiting the renin-angiotensin-aldosterone system to improve cardiac remodelling.
name: Angiotensin-converting enzyme (ACE) inhibitors
label: d
answer: no
explanation: Calcium channel blockers are not typically used in heart failure management as they may have negative inotropic effects. They are not the primary medications for reducing fluid overload and congestion in heart failure.
name: Calcium channel blockers
label: c
answer: no

Correct answer: a
Pernicious anaemia is characterised by a deficiency of which essential nutrient due to impaired absorption?

Options:
explanation: Pernicious anaemia is primarily characterised by a deficiency of vitamin B12 (cobalamin) due to impaired absorption in the gastrointestinal tract. It is typically caused by the autoimmune destruction of parietal cells in the stomach, which results in a lack of intrinsic factor. Intrinsic factor is essential for the absorption of vitamin B12 in the ileum. The deficiency of vitamin B12 results in the characteristic features of pernicious anaemia: macrocytic megaloblastic anaemia, neurological symptoms, and other systemic manifestations.
name: Vitamin B12 (cobalamin)
label: a
answer: yes
explanation: Vitamin C deficiency leads to a condition called scurvy which is characterised by gum bleeding, skin changes, and muscle weakness. It is unrelated to the underlying mechanism of pernicious anaemia, which is specifically associated with vitamin B12 deficiency.
name: Vitamin C (ascorbic acid)
label: d
answer: no
explanation: Vitamin D deficiency results in various manifestations, such as rickets in children and osteomalacia in adults. These conditions are associated with calcium and phosphate metabolism, bone health, and the musculoskeletal system. Vitamin D deficiency is not the primary cause of pernicious anaemia, which primarily involves a vitamin B12 deficiency.
name: Vitamin D (cholecalciferol)
label: e
answer: no
explanation: Pernicious anaemia is not related to iron deficiency. Iron deficiency anaemia is a distinct condition caused by insufficient dietary iron intake or impaired iron absorption. In pernicious anaemia, the primary issue is the inability to absorb vitamin B12 due to a lack of intrinsic factor.
name: Iron
label: b
answer: no
explanation: Whilst a deficiency of folate can also lead to a macrocytic megaloblastic anaemia, it is not the primary nutrient deficiency associated with pernicious anaemia. Pernicious anaemia specifically involves vitamin B12 deficiency due to impaired absorption.
name: Folate (vitamin B9)
label: c
answer: no

Correct answer: a
A 32-year-old pregnant woman in her second trimester presents with hypertension. She is also asthmatic.

Which of the following drugs is considered safe for the management of hypertension during pregnancy?

Options:
explanation: Beta-blockers, such as labetalol, are considered safe and are often used for the management of hypertension during pregnancy. They can help reduce blood pressure without posing significant risks to the developing foetus. However, this woman is asthmatic, thus beta-blockers are contraindicated.
name: Labetalol
label: c
answer: no
explanation: The first line treatment for hypertension in pregnant women is labetalol. However, since this woman is asthmatic, beta-blockers are contraindicated. Calcium channel blockers, such as nifedipine, are generally considered safe and effective for managing hypertension during pregnancy. They relax blood vessels and lower blood pressure without significant adverse effects on the foetus.
name: Nifedipine
label: a
answer: yes
explanation: ACE inhibitors are contraindicated during pregnancy as they have been associated with foetal abnormalities; they particularly affect the development of the foetal kidneys and lungs. They can lead to a condition known as foetal ACE inhibitor syndrome.
name: Ramipril
label: b
answer: no
explanation: Drugs like losartan and valsartan, which are similar to ACE inhibitors in their mechanism of action, are contraindicated in pregnancy due to the risk of foetal harm.
name: Losartan
label: d
answer: no
explanation: Medications like spironolactone are typically not recommended during pregnancy because they can affect foetal development, particularly the development of male reproductive organs.
name: Spironolactone
label: e
answer: no

Correct answer: a
A 55-year-old patient with hypertension has been prescribed an ACE inhibitor for blood pressure management.

Which of the following side effects is commonly associated with ACE inhibitors?

Options:
explanation: Constipation is not a common side effect of ACE inhibitors.
name: Constipation
label: d
answer: no
explanation: ACE inhibitors are not typically associated with hypoglycemia. In fact, they may slightly increase blood glucose levels and are sometimes used to manage blood pressure in individuals with diabetes.
name: Hypoglycemia
label: b
answer: no
explanation: Weight gain is not a common side effect of ACE inhibitors. In fact, these medications are more likely to have a neutral or even a mild weight-reducing effect.
name: Weight gain
label: e
answer: no
explanation: ACE inhibitors are not known to cause bradycardia (slow heart rate). They can affect blood pressure but usually do not have a significant impact on heart rate.
name: Bradycardia
label: c
answer: no
explanation: ACE inhibitors can lead to hyperkalemia, an elevated level of potassium in the blood. They reduce aldosterone secretion, which normally helps regulate potassium levels, leading to an increased risk of hyperkalemia.
name: Hyperkalemia
label: a
answer: yes

Correct answer: a
Which of the following is the most common type of lung cancer among adults?

Options:
explanation: Squamous cell carcinoma is another type of lung cancer, but it is not the most common. It tends to arise in the central airways and is often associated with a history of smoking.
name: Squamous cell carcinoma
label: b
answer: no
explanation: Large cell carcinoma is a less common type of lung cancer. It is characterised by large, abnormal-looking cells and can occur in any part of the lung.
name: Large cell carcinoma
label: d
answer: no
explanation: Carcinoid tumours are relatively rare in the lung and are usually slow-growing. They are not the most common type of lung cancer.
name: Carcinoid tumours
label: e
answer: no
explanation: Small cell lung cancer is a type of lung cancer, but it is not the most common. It accounts for a smaller percentage of lung cancer cases and is often associated with a more aggressive clinical course.
name: Small cell lung cancer
label: c
answer: no
explanation: Adenocarcinoma is the most common type of lung cancer among adults. It typically originates in the peripheral (outer) areas of the lung and is often seen in non-smokers and ex-smokers.
name: Adenocarcinoma
label: a
answer: yes

Correct answer: a
When considering the borders of the anterior triangle of the neck, which of the following structures forms its superior border?

Options:
explanation: The inferior border of the mandible is the correct answer. It forms the superior border of the anterior triangle of the neck, which extends from the mandible down to the clavicle.
name: Inferior border of the mandible
label: a
answer: yes
explanation: The hyoid bone is located in the neck and serves as a reference point for various structures, but it is not part of the superior border of the anterior triangle.
name: Hyoid bone
label: d
answer: no
explanation: The thyroid cartilage is a structure in the neck but does not contribute to the formation of the superior border of the anterior triangle.
name: Thyroid cartilage
label: e
answer: no
explanation: The anterior belly of the digastric muscle is an important landmark, but it is not part of the superior border of the anterior triangle. It helps define the submandibular triangle.
name: Anterior belly of the digastric muscle
label: b
answer: no
explanation: The sternocleidomastoid muscle is a prominent muscle located in the neck, but it does not form the superior border of the anterior triangle of the neck. It actually divides the neck into anterior and posterior triangles.
name: Sternocleidomastoid muscle
label: c
answer: no

Correct answer: a
Which of the following genetic mutations is most strongly associated with an increased risk of hereditary breast cancer?

Options:
explanation: KRAS mutations are more commonly associated with colorectal cancer and certain other cancers. They are not a primary genetic factor in hereditary breast cancer.
name: KRAS
label: e
answer: no
explanation: Mutations in the BRCA1 gene are strongly associated with an increased risk of hereditary breast cancer. Individuals with BRCA1 mutations have a significantly higher lifetime risk of developing breast cancer, as well as ovarian cancer.
name: BRCA1
label: a
answer: yes
explanation: BCR-ABL gene fusions are characteristic of chronic myeloid leukaemia (CML) and are not directly related to breast cancer.
name: BCR-ABL
label: d
answer: no
explanation: The EGFR (Epidermal Growth Factor Receptor) gene is not typically associated with hereditary breast cancer. EGFR mutations are more commonly linked to certain types of lung cancer and other malignancies.
name: EGFR
label: c
answer: no
explanation: Mutations in the TP53 gene are associated with Li-Fraumeni syndrome, which increases the risk of various cancers, including breast cancer. However, BRCA1/BRCA2 mutations are more strongly associated with hereditary breast cancer.
name: TP53
label: b
answer: no

Correct answer: a
Which of the following is considered a major risk factor for the development of breast cancer?

Options:
explanation: The daily consumption of organic foods has not been established as a risk factor for breast cancer. The relationship between diet and breast cancer risk is complex and multifactorial.
name: Daily consumption of organic foods
label: b
answer: no
explanation: Living at higher altitudes is not a well-established risk factor for breast cancer. Breast cancer risk is influenced by a range of factors: altitude is not one of the major determinants.
name: Living at higher altitudes
label: e
answer: no
explanation: A family history of breast cancer, especially in first-degree relatives (e.g. mother, sister), is a well-established risk factor for the development of breast cancer. Individuals with affected family members may have an increased risk due to genetic and environmental factors.
name: Having a first-degree relative with breast cancer
label: a
answer: yes
explanation: High consumption of vitamin C is not a well-established risk factor for breast cancer. Whilst a healthy diet is important, the impact of specific nutrients like vitamin C on breast cancer risk is not fully understood.
name: High consumption of vitamin C
label: d
answer: no
explanation: There is no scientific evidence to support the claim that frequent use of underwire bras is a risk factor for breast cancer. This is a common misconception.
name: Frequent use of underwire bras
label: c
answer: no

Correct answer: a
What is the most common mechanism of injury for scaphoid fractures in the wrist?

Options:
explanation: Whilst this can result in wrist injuries, including scaphoid fractures, it is not the most common mechanism of injury for scaphoid fractures.
name: Direct blow to the dorsal surface of the wrist
label: b
answer: no
explanation: Compression injuries can affect the wrist, but they are not the most common cause of scaphoid fractures.
name: Compression of the wrist from a heavy load
label: e
answer: no
explanation: Repetitive stress on the wrist can lead to overuse injuries, but it is not the primary mechanism for acute scaphoid fractures.
name: Repetitive stress from gripping objects
label: d
answer: no
explanation: Hyperextension of the wrist can lead to various wrist injuries, but it is not the primary mechanism for scaphoid fractures.
name: Hyperextension of the wrist
label: c
answer: no
explanation: Falling on an outstretched hand with the wrist in dorsiflexion is the most common mechanism of injury for scaphoid fractures. This position places stress on the scaphoid bone and can lead to a fracture.
name: Falling on an outstretched hand with the wrist in dorsiflexion
label: a
answer: yes

Correct answer: a
With reference to the process of healing after a fracture, which of the following cells are responsible for the production of new bone?

Options:
explanation: Osteoblasts are responsible for the production of new bone. They lay down the matrix for bone formation and initiate the mineralisation process during bone healing.
name: Osteoblasts
label: a
answer: yes
explanation: Osteoclasts are responsible for the resorption of old or damaged bone tissue, not the production of new bone. They break down bone as part of the bone remodelling process.
name: Osteoclasts
label: b
answer: no
explanation: Chondrocytes are specialised cells responsible for cartilage formation and maintenance. They are not directly involved in the production of new bone.
name: Chondrocytes
label: d
answer: no
explanation: Macrophages play a role in the immune response and can be involved in clearing cellular debris at a fracture site, but they are not the primary cells responsible for new bone production.
name: Macrophages
label: e
answer: no
explanation: Fibroblasts are involved in the production of collagen and other connective tissue components, such as scar tissue, but they are not primarily responsible for the production of new bone.
name: Fibroblasts
label: c
answer: no

Correct answer: a