hllj/quesmed huggingface dataset:
A 20-year-old male comes into the GP for a routine blood test. He is found to have low calcium, low phosphate, low viatmin D levels, and high levels of parathyroid hormone (PTH).

Which of the following is the most likely diagnosis?

Options:
explanation: If this patient was presenting with bony metastases, the bone profile would look slightly different. Bony metastases would cause high levels of calcium and ALP, and low levels of PTH. The phosphate levels would remain in range. The biochemical results in this question suggest a diagnosis of osteomalacia.
name: Bony metastases
label: c
answer: no
explanation: Osteoporosis would produce normal bone profile results. It would not explain the low calcium or phosphate levels or the rise in PTH.
name: Osteoporosis
label: d
answer: no
explanation: Osteomalacia is caused by low vitamin D levels and results in bone softening. Osteomalacia can cause normal or low levels of calcium or phosphate. It will cause a rise in the levels of alkaline phosphatase (ALP). It can cause normal or high levels of PTH.
name: Osteomalacia
label: a
answer: yes
explanation: Paget's disease of the bone would present as an isolated rise in ALP levels. It would not explain the low calcium or phosphate, or the rise in PTH levels. Therefore, it is not the most likely diagnosis in this case.
name: Paget's disease of the bone
label: b
answer: no
explanation: Primary hyperparathyroidism will cause high levels of calcium, ALP and PTH. It will cause low phosphate levels. The biochemical results in this question suggest a diagnosis of osteomalacia.
name: Primary hyperparathyroidism
label: e
answer: no

Correct answer: a
A 30-year-old female attends the GP with a 11-day history of dysphagia. On further questioning, she also describes having a burning sensation in her chest.

Which of the following medications is the most likely cause of her symptoms?

Options:
explanation: The symptoms this patient is describing is not likely to be a result of hydroxychloroquine. The dyspepsia and dysphagia described is more likely to be down to alendronic acid. Hydroxychloroquine can cause retinopathy or rashes, but dysphagia is not a known side effect of this medication.
name: Hydroxychloroquine
label: e
answer: no
explanation: Phenytoin would not cause the symptoms this patient is experiencing. The dyspepsia and dysphagia described is more likely to be a consequence of alendronic acid, a bisphosphonate.
name: Phenytoin
label: c
answer: no
explanation: Amiodarone is a medication that can be used to treat atrial fibrillation. It would not cause the symptoms this patient is experiencing. However, amiodarone can cause hypothyroidism or hyperthyroidism, as well as corneal deposits and liver failure.
name: Amiodarone
label: b
answer: no
explanation: The symptoms this patient is describing is not likely to be a result of ramipril. The dyspepsia and dysphagia described is more likely to be a consequence of alendronic acid, a bisphosphonate.
name: Ramipril
label: d
answer: no
explanation: Alendronic acid is an example of a bisphosphonate. Bisphosphonates can cause oesophagitis, oesophageal ulcers, dysphagia and dyspepsia. To reduce the risk of these side effects, there are guidelines surrounding these medications, including taking the tablets on an empty stomach and sitting upright for 30 minutes after taking these medications.
name: Alendronic acid
label: a
answer: yes

Correct answer: a
A 17-year-old university student presents to the GP as he has noticed yellowing of the skin. On further questioning, he tells you this skin yellowing comes and goes. He undergoes blood tests which show a raised bilirubin. Alkaline phosphatase (ALP), alanine transaminase (ALT) and albumin are all within the normal range. He drinks two to three units of alcohol per week and his BMI is 21.

Which of the following is the most likely diagnosis?

Options:
explanation: Haemochromatosis is a disorder of iron metabolism where excessive iron builds up in the body and accumulates in the body. It is deposited in a number of sites including the liver, heart, joints, pancreas and skin. You would expect haemochromatosis to show deranged LFTs as well as a raised serum ferritin and raised transferrin saturation.
name: Haemochromatosis
label: b
answer: no
explanation: Alpha-1 antitrypsin deficiency is an inherited condition that causes lung emphysema and liver cirrhosis. You would expect patients to present with shortness of breath and a raised ALP on blood results.
name: Alpha-1 antitrypsin deficiency
label: d
answer: no
explanation: This patient is presenting with intermittent jaundice and a high bilirubin which makes a diagnosis of Gilbert's syndrome the most likely diagnosis.
name: Hepatitis E
label: e
answer: no
explanation: Wilson's disease would show a low serum ceruloplasmin and copper levels. Wilsons disease would not account for the high ALT.
name: Wilson’s disease
label: c
answer: no
explanation: This patient is presenting with the signs and symptoms of Gilbert's syndrome. This condition causes intermitted episodes of jaundice which often occur due to stress, infection, fasting or exercise. Gilbert's syndrome will cause a raised bilirubin level in an otherwise normal set of bloods.
name: Gilbert's syndrome
label: a
answer: yes

Correct answer: a
A 65-year-old female presents to the GP with bone pain that began eight months ago. A blood test reveals no abnormalities except for a raised alkaline phosphatase (ALP) level.

Which of the following is the most likely diagnosis?

Options:
explanation: This patient is presenting with bone pain and an isolated rise in their ALP levels which is typical of a diagnosis of Paget's disease. Paget’s disease may also be diagnosed on X-ray where you may find osteolysis or an increase in bone size.
name: Paget’s disease of the bone
label: a
answer: yes
explanation: Gout would normally present with a single red, hot and swollen joint. Gout would not account for a raise in ALP, so is not the most likely diagnosis in this case.
name: Gout
label: c
answer: no
explanation: If the patient had osteoporosis, this would produce a normal bone profile and would not account for the raised ALP. Paget's disease is more likely to account for the biochemical findings in this patient.
name: Osteoporosis
label: e
answer: no
explanation: A presentation of ankylosing spondylitis would normally describe back pain that gets better with exercise. It would not account for the rise in ALP levels, and therefore Paget's disease is a more likely diagnosis in this case.
name: Ankylosing spondylitis
label: d
answer: no
explanation: Pseudogout would present as a single inflamed joint, and it usually affects the wrist or shoulder joints. It would not account for this patient’s high ALP, so is not the most likely diagnosis in this case.
name: Pseudogout
label: b
answer: no

Correct answer: a
A 20-year-old male presents to the GP with worsening back pain for the past ten months. He tells you the pain is worse in the morning, but gets better on exercise. You note he had an episode of anterior uveitis a month ago.

Which of the following is the most likely diagnosis?

Options:
explanation: This patient is presenting with the typical symptoms of ankylosing spondylitis: back pain and stiffness worse in the morning that gets better with movement. This condition is also associated with anterior uveitis, which this patient experienced one month ago.
name: Ankylosing Spondylitis
label: a
answer: yes
explanation: This patient's presentation is more typical of ankylosing spondylitis. The age and gender of this patient (a young man) also points towards this diagnosis.
name: Mechanical back pain
label: e
answer: no
explanation: Polymyalgia rheumatica would typically cause shoulder and hip girdle stiffness alongside some systemic symptoms such as fever, anorexia, weight loss and malaise. Normally, there would be raised inflammatory markers.
name: Polymyalgia Rheumatica
label: c
answer: no
explanation: Paget's disease would present with bone pain and an isolated rise in alkaline phosphatase (ALP). It could also be picked up on X-ray where you may find osteolysis, increased bone size and sclerosis or pathological fractures.
name: Paget’s disease of the bone
label: d
answer: no
explanation: Cauda equina syndrome would present with symptoms such as saddle anaesthesia, serve sudden onset back pain and urinary incontinence. This patient is more likely to have ankylosing spondylitis.
name: Cauda equina syndrome
label: b
answer: no

Correct answer: a
A 37-year-old female attends the GP practice complaining of episodes of throbbing pain on the left side of her head. Before these episodes, her vision can go funny. The episodes can last from 10- 24 hours at a time.  She has a past medical history of osteoarthritis and is currently taking naproxen.

Which of the following is the most likely diagnosis?

Options:
explanation: This classically presents as a temporal headache alongside  jaw claudication (pain on chewing food) and scalp tenderness. It can also lead to blindness if not treated promptly. The patient may also describe a thickened tender temporal artery on examination. You should also look out for a patient with symmetrical proximal muscle weakness and oligoarthritis as giant cell arteritis is often associated with polymyalgia rheumatica.
name: Giant cell arteritis
label: e
answer: no
explanation: Cluster headaches present as unilateral headaches that are worse around the eye. They occur in attacks, or clusters over time. Patients would typically describe associated symptoms such as a bloodshot eye, rhinorrhea, lid swelling and facial flushing. The length of attacks is a lot shorter than migraines, typically lasting between 15 minutes and three hours.
name: Cluster headache
label: c
answer: no
explanation: This presents as short episodes of stabbing pain, affecting one side of the face, in the trigeminal nerve distribution. They are triggered by talking, eating or touching the face. The headache in this patient is not described as following the trigeminal nerve distribution, and no triggers are given that would indicate trigeminal neuralgia being the most likely diagnosis.
name: Trigeminal Neuralgia
label: d
answer: no
explanation: You would expect a tension headache to present as a bilateral, non-pulsatile headache. They can feel tight, like around the head. They are not associated with aura’s or photophobia, and therefore do not fit this woman’s symptoms.
name: Tension headache
label: b
answer: no
explanation: This is a typical presentation of a migraine. The question describes a unilateral headache associated with photophobia and phonophobia. Migraines can last anything from four to 72 hours at a time. Episodes of migraine can be preceded by an aura, such as a visual aura, like in this patient, or can present with sensory symptoms like paraesthesia. Migraines can have various triggers, which include medications such as aspirin and naproxen and certain foods like cheese or chocolate.
name: Migraine
label: a
answer: yes

Correct answer: a
A 25-year-old female presents to the GP with palpations and shortness of breath for the last two weeks. She describes several episodes of feeling hot and breathless before seeing vivid images. She says these episodes began after she was involved in a car crash two weeks ago.

Which of the following is the most likely diagnosis?

Options:
explanation: This patient is experiencing symptoms of acute stress reaction, which is a mental health condition that can occur up to a month after someone goes through a traumatic event.
name: Acute stress reaction
label: a
answer: yes
explanation: Schizotypal personality disorder is a personality disorder is characterized by bizarre or magical thinking. It causes individuals to have difficulty with social interactions.
name: Schizotypal personality disorder
label: e
answer: no
explanation: EUPD is characterized by individuals having sudden mood swings, unstable relationships, and an unstable sense of self and self-image. The patient in this question is experiencing symptoms of acute stress reaction after experiencing a traumatic event.
name: Emotionally unstable personality disorder (EUPD)
label: d
answer: no
explanation: Bipolar disorder is diagnosed when someone has both a major depressive episode and an episode of mania or hypomania. Manic episodes involve elated mood or irritability, often involving people making dangerous decisions with little thought for consequences. The patient in this question is experiencing symptoms of acute stress reaction after experiencing a traumatic event.
name: Bipolar Disorder
label: c
answer: no
explanation: Post traumatic stress disorder can only be diagnosed when a person has symptoms for more than one month. Therefore, the correct answer to this question is acute stress reaction.
name: Post-traumatic stress disorder
label: b
answer: no

Correct answer: a
A 50-year-old female is found collapsed in her home. She is found to have thin hair, and is hot and clammy to touch. Her wife tells you that she has lost some weight in the last month. On examination, you notice brisk reflexes and a heartrate of 144. A thyroid function test shows a low thyroid-stimulating hormone (TSH) and high T4.

Which of the following is the most likely diagnosis?

Options:
explanation: Thyrotoxicosis occurs when there is excess thyroid hormone action at the level of the tissues. The most common cause of this is Grave's disease. This patient is presenting with lots of the typical symptoms of thyrotoxicosis: weight loss, heat intolerance, tremor, palpitations, irritability and muscle weakness.
name: Thyrotoxicosis
label: a
answer: yes
explanation: An Addisonian crisis is a severe presentation of Addison's disease when it is left untreated. It can present with symptoms such as dizziness, fainting, abdominal pain, depression and muscle weakness. Patients will often describe a bronze hyperpigmentation to the skin. The key biochemical finding of hyponatremia.
name: Addisonian crisis
label: c
answer: no
explanation: Diabetic ketoacidosis will often present with polyuria and polydipsia preceding unconsciousness. This patient is presenting with lots of the typical symptoms of thyrotoxicosis.
name: Diabetic ketoacidosis (DKA)
label: d
answer: no
explanation: Hypothyroidism would present with weight gain, rather than weight loss. It would also cause symptoms like lethargy, anhydrosis, constipation and in some patients menorrhagia.
name: Hypothyroidism
label: b
answer: no
explanation: Hyperosmolar hyperglycaemic state is a complication of untreated type 2 diabetes. Like DKA, it often presents with polyuria and polydipsia. It does not produce ketones, making it different to diabetic ketoacidosis.
name: Hyperosmolar hyperglycaemic state (HHS)
label: e
answer: no

Correct answer: a
A 19-year-old male is brought into the emergency department by his flatmates after taking an overdose of paracetamol. He states that he took a total of 8g of paracetamol at around 6pm and another 6g of paracetamol an hour and a half later. It is now 9pm.

Which of the following is the most appropriate management of this patient?

Options:
explanation: IV fluids are not the most appropriate treatment for this patient. This patient has taken a staggered overdose, and therefore they require management with N-acetylcysteine.
name: Give IV fluids
label: e
answer: no
explanation: This patient has taken a staggered overdose, taking two doses over an hour apart. This means the patient should be treated with N-acetylcysteine. Other indications for N-acetylcysteine treatment include uncertainty over the timing of the overdose and the patient being unconscious.
name: Give N-acetylcysteine
label: a
answer: yes
explanation: Activated charcoal should only be given to patients who are less than an hour post-overdose and have taken more than 75mg/kg. This patient has taken a staggered overdose, and therefore requires treatment with N-acetylcysteine.
name: Give activated charcoal
label: b
answer: no
explanation: This patient has taken a staggered overdose, and therefore requires treatment with N-acetylcysteine.
name: Take paracetamol levels at four hours after the second dose
label: c
answer: no
explanation: This patient has taken a staggered overdose, and therefore requires treatment with N-acetylcysteine.
name: Take paracetamol levels at one hour after the second dose
label: d
answer: no

Correct answer: a
A 17-year-old female patient is currently detained under the Mental Health Act with anorexia nervosa.

Which of the following is a consequence of anorexia nervosa?

Options:
explanation: A consequence of anorexia nervosa is hypercholesterolaemia, which is thought to be due to changes to  metabolic pathways as a consequence of the conditon.
name: Low cholesterol levels
label: c
answer: no
explanation: Anorexia nervosa causes the levels of growth hormone to increase, rather than decrease.
name: Low growth hormone (GH) levels
label: d
answer: no
explanation: Anorexia nervosa causes low potassium levels, not high.
name: Hyperkalaemia
label: b
answer: no
explanation: Anorexia nervosa causes the levels of sex hormones to decrease, so it would be typical to find low levels of testosterone, rather than high.
name: High testosterone levels
label: e
answer: no
explanation: A consequence of anorexia nervosa is low levels of lutenising hormone (LH) and FSH. It also causes lower levels of other sex hormones, including low oestrogen and testosterone levels.
name: Low follicle stimulating hormone (FSH)
label: a
answer: yes

Correct answer: a
An 18-year-old female student presents to the GP with a fever. She also reports a headache and neck stiffness. On examination, she has a temperature of 39 degree Celsius and you notice a purpuric rash on her abdomen. Cerebral spinal fluid analysis shows low glucose levels, high protein levels and an increased white cell count.

Which of the following is the most likely causative organism?

Options:
explanation: This is the most common cause of meningococcal sepsis in neonates, so is unlikely to be the cause of this patient's meningitis. The rash described in the question is more typical of *Neisseria meningitidis*, rather than Group B Streptococcus.
name: Group B Streptococcus
label: b
answer: no
explanation: Herpes simplex virus 2 would cause a viral meningitis, meaning the cerebral spinal fluid would show a high glucose and low protein. This patient has a bacterial meningitis, and the most likely causative organism is *Neisseria meningitidis*.
name: Herpes simplex virus 2
label: d
answer: no
explanation: This patient is presenting with meningococcal disease. *Neisseria meningitidis* is the most likely causative organism. Typical features include fever, headache, neck stiffness and photophobia. The presence of a non-blanching rash indicates the infection has spread into the bloodstream.
name: *Neisseria meningitidis*
label: a
answer: yes
explanation: *Listeria monocytogenes* causes infections in immunosuppressed patients and can be found in patients at the extremes of age. The patient in question is more likely to be caused by *Neisseria meningitidis*.
name: *Listeria monocytogenes*
label: c
answer: no
explanation: This would cause a viral meningitis, meaning the cerebral fluid analysis would show a high glucose and low protein content. This patient has a bacterial meningitis, and the most likely causative organism is *Neisseria meningitidis*.
name: Coxsackie Virus A
label: e
answer: no

Correct answer: a
A 55-year-old male presents to the emergency department with a three-week history of fevers, weight loss and chest pain. On examination, there are splinter haemorrhages on his nails and macules on his palms consistent with janeway lesions. He had a prosthetic valve replacement one month ago.

Given the most likely diagnosis, which of the following is the most likely causative organism?

Options:
explanation: This patient has the typical findings of infective endocarditis: fevers (most common), weight loss, and chest pain. You may also find night sweats, muscle pains and lethargy as well as typical nail signs like splinter haemorrhages. The first two months after prosthetic valve surgery would put a patient at risk of infective endocarditis with *staph. epidermis*. Therefore, the most likely causative organism in this case is *staph. epidermis*.
name: *Staphlococcus epidermis*
label: a
answer: yes
explanation: *Streptococcus viridans* is found in dental plaque and is a common cause of endocarditis in patients with poor dental hygiene. However, this patient is most likely to be colonised with *staph. epidermis* as he has had a prosthetic valve replacement a month ago.
name: *Streptococcus viridans*
label: d
answer: no
explanation: The most common causative organism of infective endocarditis overall is *Staph. aureus*. However, this patient has had a prosthetic valve replacement a month ago and therefore is at risk of colonisation with *staph. epidermis*.
name: *Staphylococcus aureus*
label: b
answer: no
explanation: This organism is associated with colorectal cancer. The question gives us no indications the patient has colorectal cancer. Therefore, *strep. bovis* is not a likely cause of this patient's infective endocarditis.
name: *Streptococcus bovis*
label: c
answer: no
explanation: This is an uncommon cause of infective endocarditis and therefore is not the most likely causative organism of this patient’s infective endocarditis.
name: *Coxiella burnetii*
label: e
answer: no

Correct answer: a
Which structure control paralysis during sleep?

Options:
explanation: The ventrolateral preorbital nucleus is the structure in the brain responsible for paralysis during sleep.
name: Ventrolateral preorbital nucleus
label: a
answer: yes
explanation: This structure stabilizes the sleep-wake switch. It does not control paralysis during sleep.
name: Hypothalamic orexin
label: e
answer: no
explanation: This is an excitatory neurotransmitter that interacts with nuclei in the midbrain during sleep. It does not control paralysis during sleep.
name: Hypocretin
label: d
answer: no
explanation: This structure is located in the brainstem and is silenced during REM (rapid eye movement) atonia. The ventrolateral preorbital nucleus controls paralysis during sleep.
name: Locus coeruleus
label: c
answer: no
explanation: The suprachiasmatic nucleus controls the circadian rhythm, meaning it controls the regulation of sleep across 24 hours. Circadian rhythm is affected by both light and melatonin. It does not control paralysis during sleep.
name: Suprachiasmatic nucleus
label: b
answer: no

Correct answer: a
A 50-year-old female attends the GP for a medication review. She has recently been started on haloperidol by her psychiatrist.

Which of the following side effects is most likely to occur with this medication?

Options:
explanation: Haloperidol is associated with a reduced seizure threshold, rather than an increased seizure threshold.
name: Increased seizure threshold
label: d
answer: no
explanation: Agranulocytosis is more likely to occur with second-generation antipsychotics like clozapine. Haloperidol is more likely to cause side effects like dystonia and akathisia.
name: Agranulocytosis
label: b
answer: no
explanation: Haloperidol is a first-generation antipsychotic. Dystonia is a type of extra-pyramidal side effect that can occur with use of these medications. Other extra-pyramidal side effects include akathisia, parkinsonism and tardive dyskinesia.
name: Dystonia
label: a
answer: yes
explanation: Dyslipidaemia is a side effect more likely to occur with the use of second-generation antipsychotics like clozapine and olanzapine, not first-generation antipsychotics like haloperidol.
name: Dyslipidaemia
label: e
answer: no
explanation: Weight gain is more likely to occur with second-generation antipsychotics like olanzapine, rather than first-generation antipsychotics like haloperidol.
name: Weight gain
label: c
answer: no

Correct answer: a