hllj/quesmed huggingface dataset:
A 24-year-old pregnant female presents to A&E with sudden dyspnoea and pleuritic chest pain. She has very swollen ankles due to her pregnancy but her left ankle and lower leg, in particular, are very tender and red.

Which of the following investigations would be useful to confirm the diagnosis?

Options:
explanation: This is a non-specific test, however, if negative it can be useful to rule out a pulmonary embolism. It is not completely diagnostic and a CTPA or a lower limb duplex in the case of pregnant patients are needed. There are many causes of a raised D Dimer, including pregnancy.
name: D-dimer
label: d
answer: no
explanation: A lower limb duplex is the diagnostic test for a pulmonary embolism in a pregnant patient. This patient likely developed deep vein thrombosis due to her hypercoagulable state with pregnancy and the clot embolised and travelled to her lung.
name: Lower limb duplex
label: a
answer: yes
explanation: This is often normal in a pulmonary embolism although may be useful at a later stage to rule out other differentials like an infection.
name: Chest x-ray
label: c
answer: no
explanation: ECG can be useful to check for right heart strain as a complication of pulmonary embolism, however, it is not diagnostic of a pulmonary embolism.
name: ECG
label: e
answer: no
explanation: CT pulmonary angiogram is usually the first line investigation to determine the diagnosis of a pulmonary embolism, however, this patient is pregnant and so a lower limb duplex is the first line investigation, especially if a DVT is thought to be the cause.
name: CT pulmonary angiogram
label: b
answer: no

Correct answer: a
A 79-year-old female is recovering from a cardiac bypass operation in the hospital and has not been mobile for 3 days. She develops a fever of 39 degrees, is tachypnoeic and is coughing up purulent sputum.

Which of the following pathogens is most likely to be causing this diagnosis?

Options:
explanation: This bacterium is a common organism causing hospital-acquired pneumonia. Other common organisms to consider include Enterobacteria.
name: *Pseudomonas aeruginosa*
label: a
answer: yes
explanation: This is a commensal fungus which more often causes vaginal candidiasis or oral thrush.
name: *Candida albicans*
label: d
answer: no
explanation: This pathogen most commonly causes pneumonia in patients who are alcoholics, diabetics or elderly patients.
name: *Klebsiella pneumoniae*
label: b
answer: no
explanation: This pathogen often causes infection in patients who are severely immunocompromised such as HIV-positive patients.
name: *Pneumocystis jirovecii*
label: c
answer: no
explanation: This is a bacterium that often causes psittacosis. It is acquired from contact with birds and cattle.
name: *Chlamydophila psittaci*
label: e
answer: no

Correct answer: a
A 22-year-old female with a known history of asthma and eczema presents to her GP as she feels that her 'blue' inhaler is not working as it used to.

Which of the following would be the next best management step for this patient's asthma?

Options:
explanation: This is step 4 of the BTS guidelines for managing chronic asthma and would not be appropriate yet. An inhaled corticosteroid would be the next appropriate step.
name: Add oral leukotriene receptor antagonist
label: c
answer: no
explanation: This is step 3 of the BTS guidelines for managing chronic asthma. It is more appropriate in the first instance to trial an inhaled corticosteroid.
name: Add long-acting beta-2 agonist
label: b
answer: no
explanation: This is step 2 of the BTS guidelines for the pharmacological management of chronic asthma. The first step, a short-acting beta-2 agonist e.g. salbutamol, is not working for this patient and so the next best step is to add an inhaled corticosteroid.
name: Add low-dose inhaled corticosteroid
label: a
answer: yes
explanation: This is useful in managing acute and severe asthma attacks. This patient is not experiencing an acute asthma attack and requires management of her chronic symptoms. An inhaled corticosteroid is more appropriate.
name: Give IV magnesium sulphate
label: d
answer: no
explanation: This is the first step in managing an acute asthma attack. The patient has come to her GP to discuss management options and does not show symptoms or signs of an acute asthma attack.
name: Ensure a patent airway
label: e
answer: no

Correct answer: a
A 57-year-old female returns from India after visiting family. She presents to her GP with night sweats, fever and a cough with haemoptysis.

Which of the following is the best management option for the most likely diagnosis?

Options:
explanation: The total duration for tuberculosis antibiotic therapy is 6 months.
name: Isoniazid, rifampicin, ethambutol and pyrazinamide for 2 months then isoniazid and rifampicin for 2 further months
label: b
answer: no
explanation: This is the correct form of antibiotic therapy for tuberculosis. The total regimen is 6 months of antibiotics but this may be extended if there are complications of meningitis or pericarditis or spinal TB.
name: Isoniazid, rifampicin, ethambutol and pyrazinamide for 2 months then isoniazid and rifampicin for 4 further months
label: a
answer: yes
explanation: The total course of antibiotic therapy is 6 months, 2 months with isoniazid, rifampicin, ethambutol and pyrazinamide and a further 4 months with isoniazid and rifampicin.
name: Isoniazid, rifampicin, ethambutol and pyrazinamide for 2 months then pyrazinamide and ethambutol for 2 further months
label: e
answer: no
explanation: The total course of antibiotic therapy is 6 months, 2 months with isoniazid, rifampicin, ethambutol and pyrazinamide and a further 4 months with isoniazid and rifampicin.
name: Isoniazid, rifampicin, ethambutol and pyrazinamide for 2 months then isoniazid and ethambutol for 4 further months
label: c
answer: no
explanation: The total course of antibiotic therapy is 6 months, 2 months with isoniazid, rifampicin, ethambutol and pyrazinamide and a further 4 months with isoniazid and rifampicin.
name: Isoniazid, rifampicin, ethambutol and pyrazinamide for 2 months then pyrazinamide and ethambutol for 4 further months
label: d
answer: no

Correct answer: a
A 55-year-old male struggles with chest pain when walking with his dog. This is relieved by sitting on the park bench. The patient recalls his father had a similar problem and used 'some sort of spray in the mouth' to help.

What is the most appropriate initial investigation to do?

Options:
explanation: This can be used as a 3rd line investigation if there are inconclusive results from non-invasive tests like ECG.
name: Coronary angiogram
label: c
answer: no
explanation: This would not be useful unless there are other indicators which may suggest a different diagnosis rather than angina.
name: Chest x-ray
label: d
answer: no
explanation: This is a 2nd line investigation for angina and would only be used after the less invasive 1st line investigations are done first.
name: Stress ECHO
label: b
answer: no
explanation: This is a useful investigation, however, it is very invasive and therefore would be after initial investigations such as an ECG and stress echo.
name: CT coronary angiography
label: e
answer: no
explanation: Anginal pain is suspected in this patient and so it is useful to do an ECG to check if there are any other abnormalities.
name: ECG
label: a
answer: yes

Correct answer: a
A patient presents to A&E with severe shortness of breath, confusion and tachycardia. On examination, the patient is hypotensive, and has a raised jugular venous pressure (JVP) and muffled heart sounds.

Given the likely diagnosis, which of the following describes this triad of signs?

Options:
explanation: This is a triad which can indicate increased intracranial pressure. It consists of bradycardia, irregular respirations and a wide pulse pressure.
name: Cushing's triad
label: b
answer: no
explanation: This is a triad to determine venous thrombosis risk, consisting of stasis, hypercoagulability and vessel injury.
name: Virchow's triad
label: e
answer: no
explanation: The patient is experiencing a cardiac tamponade which is a medical emergency. Beck's triad is classic of cardiac tamponade with hypotension, raised JVP and muffled, quiet heart sounds.
name: Beck's triad
label: a
answer: yes
explanation: This consists of bronchial asthma, nasal polyps and aspirin sensitivity and is also known as aspirin exacerbated respiratory disease (AERD).
name: Samter's triad
label: d
answer: no
explanation: This is a triad consisting of interstitial keratitis, malformed teeth and deafness which is a common pattern of presentations for congenital syphilis.
name: Hutchinson's triad
label: c
answer: no

Correct answer: a
A 56-year-old female of Caribbean ethnicity goes to her GP for a routine blood pressure check. Her blood pressure was measured and found to be 155/95 mmHg.

Which of the following is the first-line treatment for hypertension in this patient?

Options:
explanation: This is a thiazide-like diuretic which is typically used as the next step after CCBs for a patient >55 and/or of African or Caribbean ethnicity.
name: Indapamide
label: d
answer: no
explanation: This is an ACE-inhibitor the 1st line treatment for patients who are <55 years old and not of Afro-Caribbean ethnicity.
name: Ramipril
label: b
answer: no
explanation: This is an aldosterone receptor antagonist and would be used as step 4 of pharmacological management for hypertension.
name: Spironolactone
label: c
answer: no
explanation: This is an angiotensin receptor blocker, often used for patients who are unable to tolerate ACE-I due to the side effects such as dry cough.
name: Candesartan
label: e
answer: no
explanation: This patient is >55 years old and of Caribbean ethnicity, therefore she requires a calcium channel blocker as 1st line pharmacological management for her hypertension.
name: Nifedipine
label: a
answer: yes

Correct answer: a
A 17-year-old male notices he gets short of breath more quickly than normal when playing football. He also has to take more breaks compared to his peers. He goes to his GP who performs spirometry tests.

Given the likely diagnosis, which of the following is the most likely FEV1/FVC ratio?

Options:
explanation: This is an elevated FEV1/FVC ratio which can occur in restrictive lung conditions like pulmonary fibrosis.
name: 0.85
label: c
answer: no
explanation: This is an elevated FEV1/FVC ratio which can occur in restrictive lung conditions whereas a ratio <0.7 indicates an obstructive condition.
name: 0.90
label: e
answer: no
explanation: This is a normal FEV1/FVC ratio.
name: 0.70
label: b
answer: no
explanation: This is likely to be an obstructive illness like asthma due to the age of the patient and its symptoms. An FEV1/FVC <0.7 is seen in obstructive conditions where the airways are narrowed or obstructed.
name: 0.65
label: a
answer: yes
explanation: This is an elevated FEV1/FVC ratio which can occur in restrictive lung conditions and neuromuscular conditions.
name: 0.75
label: d
answer: no

Correct answer: a
Which of the following is a common side effect of ACE-inhibitors?

Options:
explanation: This is a common side effect of the antibiotic rifampicin, used for tuberculosis.
name: Red/orange urine
label: d
answer: no
explanation: This is a common side effect of calcium channel blockers.
name: Ankle oedema
label: e
answer: no
explanation: This is a common side effect of ACE-I and patients who cannot tolerate these side effects often switch to an angiotensin receptor blocker like candesartan.
name: Dry cough
label: a
answer: yes
explanation: This is can be a common side effect of sulphonylureas which are an anti-diabetic drug class.
name: Weight gain
label: c
answer: no
explanation: This is a common side effect of amiodarone which is used for rhythm control in atrial fibrillation.
name: Hypothyroidism
label: b
answer: no

Correct answer: a
A 78-year-old male presented to his GP with a chronic productive cough and difficulty breathing. He has been a smoker for 50 years. Spirometry shows an FEV1/FVC ratio of 0.5.

Which of the following is the most likely diagnosis?

Options:
explanation: This is an obstructive lung condition with reversible bronchoconstriction. It would be less common to see a presentation of asthma for the first time in a 78-year-old. The spirometry would show an obstructive pattern with an FEV1/FVC ratio of <0.7.
name: Asthma
label: c
answer: no
explanation: COPD is a chronic irreversible obstruction to the airways. This patient fits the typical presentation for COPD. He is a smoker and has a chronic cough productive of phlegm and dyspnoea. A common aetiology of COPD is smoking alongside air pollutants. The spirometry would show an obstructive pattern with an FEV1/FVC ratio of <0.7.
name: Chronic obstructive pulmonary disease (COPD)
label: a
answer: yes
explanation: This is a restrictive lung condition and so the FEV1/FVC ratio would appear normal (0.7) despite the individual values being lower. Patients also exhibit a dry cough rather than productive, dyspnoea and fatigue.
name: Pulmonary fibrosis
label: e
answer: no
explanation: This is a permanent dilatation of the bronchi due to chronic infection. A productive cough, purulent sputum and haemoptysis would be symptoms of bronchiectasis. Bronchiectasis would show an obstructive type spirometry of <0.7.
name: Bronchiectasis
label: d
answer: no
explanation: This is an inflammatory condition caused by infection and often caused by streptococcus pneumonia in the community. It can also be hospital-acquired or due to aspiration. Pneumonia can show a restrictive type pattern in spirometry with a normal FEV1/FVC ratio.
name: Pneumonia
label: b
answer: no

Correct answer: a
A 35-year-old male was playing tennis with his friend when he suddenly he developed severe chest pain and breathlessness.

Unfortunately the man died before the ambulance arrived. He was generally fit and well and did not have any health issues before this incident.

Given the above information, which of the following is the most likely underlying health condition?

Options:
explanation: This is an accumulation of fluid, blood, pus or air in the pericardial space. It is a medical emergency and patients will present with tachycardia, confusion, chest pain and shortness of breath. In this case, given the absence of trauma and acute presentation, hypertrophic obstructive cardiomyopathy is more likely.
name: Cardiac tamponade
label: d
answer: no
explanation: The heart is non-dilated and non-hypertrophied however has impaired ventricular filling. Patients may experience heart failure and many have atrial fibrillation.
name: Restrictive cardiomyopathy
label: c
answer: no
explanation: Mitral regurgitation is the backflow of blood across the mitral valve during systole due to an incompetent valve. It can be acute or chronic and presents with dyspnoea, exertional dyspnoea, fatigue and weakness.
name: Mitral regurgitation
label: e
answer: no
explanation: This is an autosomal dominant inherited condition and can often result in sudden death in young people and athletes. It is the commonest genetic heart condition whereby there is septal hypertrophy obstructing the left ventricular outflow tract and anterior movement of the mitral valve in systole. Many patients will be asymptomatic throughout their life.
name: Hypertrophic obstructive cardiomyopathy (HOCM)
label: a
answer: yes
explanation: This is the most common type of cardiomyopathy and is defined by dilatation and poor contraction of the ventricles. It often presents first in those between 30-60 years of age with exertional dyspnoea, orthopnoea and paroxysmal nocturnal dyspnoea.
name: Dilated cardiomyopathy
label: b
answer: no

Correct answer: a
A 45-year-old female presents to her GP with a fever, productive cough with green sputum and dyspnoea. She is a long-term smoker of 30 years and often gets chest infections. On examination she has finger clubbing and dull notes on percussion. Bronchial breathing is heard on auscultation. The GP suggests blood tests should be taken.

Which of the following blood results would be the most pertinent to this case?

Options:
explanation: This presentation is likely to be that of a lung abscess due to the presence of fever, dyspnoea and green sputum. As this is infective, inflammatory markers like CRP and ESR will likely be raised.
name: Raised CRP and ESR
label: a
answer: yes
explanation: This is likely to be a lung abscess based on the presentation and history of recurrent pneumonia. The bloods would likely show raised CRP and ESR.
name: Normal bloods
label: b
answer: no
explanation: Thyroid function tests would not be necessary to take here as the patient is not displaying symptoms of an abnormal thyroid condition such as Hashimoto's or Grave's disease. A full blood work up is useful if the differential diagnoses are unclear.
name: Raised TFTs
label: d
answer: no
explanation: Glucose is unlikely to be measured here as the patient is not displaying features of a condition that may show raised glucose. However, a full blood workup is useful if the differential diagnoses are unclear.
name: Raised glucose
label: e
answer: no
explanation: Leukocytes are likely to be raised in this presentation of a lung abscess due to the infective nature of the disease.
name: Low leukocytes
label: c
answer: no

Correct answer: a
A 61-year-old male presents to the emergency department with a 4-hour history of diffuse central abdominal pain and bilious vomiting. He has not passed stool or flatus in 3 days.

Which of the following is the best diagnostic investigation?

Options:
explanation: A barium enema may be used in large bowel obstruction but is unlikely to be used in the investigation of small bowel obstruction, as barium is unlikely to reach the small bowel. Furthermore, barium studies are contraindicated in perforation so it is important to rule this out first.
name: Barium enema
label: e
answer: no
explanation: This is a case of small bowel obstruction as indicated by the bilious vomiting, total constipation and abdominal pain. The BMJ and American College of Radiology both state that abdominal CT scans are the investigation of choice for a definitive diagnosis of small bowel obstruction. This is due to superior sensitivity as well as the ability to detect aetiology.
name: Abdominal CT scan
label: a
answer: yes
explanation: Although an abdominal X-Ray is a good initial investigation, plain radiographs lack sensitivity, especially in the early stages of bowel obstruction.
name: Abdominal X-Ray
label: b
answer: no
explanation: A colonoscopy may be used as part of therapeutic management but is unlikely to feature in the acute phase of investigation.
name: Colonoscopy
label: d
answer: no
explanation: Although MRI scans can provide strong soft tissue contrast and do not expose the patient to radiation, in the acute setting these investigations are too time-consuming to be appropriate.
name: Abdominal MRI
label: c
answer: no

Correct answer: a
A 54-year-old female on the general surgery ward is assessed for severe epigastric abdominal pain that radiates to the back and vomiting. An abdominal exam reveals epigastric tenderness and abdominal distension. She underwent an ERCP for gallstones 4 hours ago.

What is the most likely diagnosis?

Options:
explanation: Acute appendicitis is an important acute abdomen differential but classically presents with acute diffuse abdominal pain that localises to the right iliac fossa, not epigastric pain.
name: Acute appendicitis
label: c
answer: no
explanation: Acute pancreatitis classically presents with severe epigastric pain and vomiting. Pain in acute pancreatitis may also radiate to the back. The recent ERCP is a major risk factor for iatrogenic acute pancreatitis. Other causes of acute pancreatitis include gallstones, alcohol abuse, and autoimmune aetiologies amongst others.
name: Acute pancreatitis
label: a
answer: yes
explanation: Although a history of gallstones may indicate acute cholecystitis, this condition typically presents with right upper quadrant pain and fever. Furthermore, the recent ERCP is an important risk factor for iatrogenic acute pancreatitis.
name: Gallstones
label: b
answer: no
explanation: Biliary colic typically presents with intermittent right upper quadrant pain, and patients are typically systemically well. This makes biliary colic an unlikely diagnosis in this case.
name: Biliary colic
label: e
answer: no
explanation: Small bowel obstruction is another important differential, though a history may include total constipation and vomiting is often bilious.
name: Small bowel obstruction
label: d
answer: no

Correct answer: a
A 60-year-old man has recently been diagnosed with colorectal cancer. A CT scan indicates he has a tumour of the descending colon.

Which of the following lymph node groups drain this area of the colon?

Options:
explanation: The retrocaval lymph nodes receive lymph from the posterior abdominal wall.
name: Retrocaval lymph nodes
label: d
answer: no
explanation: The coeliac lymph nodes receive lymph from other nodes that drain the stomach.
name: Coeliac  group
label: c
answer: no
explanation: The inferior mesenteric nodes receive lymph from the descending and sigmoid colon.
name: Inferior mesenteric nodes
label: a
answer: yes
explanation: The superior mesenteric nodes receive lymph from the ascending and transverse colon.
name: Superior mesenteric group
label: b
answer: no
explanation: The internal iliac nodes receive lymph from the pelvic organs and perineum.
name: Internal iliac nodes
label: e
answer: no

Correct answer: a
A 24-year-old female presents to clinic and reports a 5-week history of bloody diarrhoea and weight loss. You suspect inflammatory bowel disease and request a colonoscopy and biopsy.

Which histopathological sign would be most indicative of ulcerative colitis?

Options:
explanation: Non-caseating granulomas are another hallmark of Crohn's disease. Ulcerative colitis does not feature granulomas, indeed the BMJ cite the absence of granulomas as an indication of ulcerative colitis over Crohn's disease.
name: Presence of granulomas
label: d
answer: no
explanation: Cobblestone inflammation is not a histopathological sign but an endoscopic sign found in Crohn's disease that occurs when fissures/ulceration leaves elevated patches of mucosa.
name: Cobblestone inflammation
label: e
answer: no
explanation: Skip lesions are a classic histopathological sign of Crohn's disease. Ulcerative colitis on the other hand manifests as continuous inflammation extending proximally from the rectum.
name: Skip lesions
label: c
answer: no
explanation: Diverticula are a hallmark of diverticulosis and occur when pouches of colonic mucosa herniate through the muscular layer of the colon wall. They are often asymptomatic but can become problematic in diverticular disease and diverticulitis.
name: Diverticula
label: b
answer: no
explanation: In ulcerative colitis, inflammation is typically limited to the mucosa and submucosa unless in fulminant disease. This is different from Crohn's disease which typically involves transmural inflammation. Other histopathological hallmarks of ulcerative colitis include continuous inflammation, goblet cell depletion,  and crypt abscesses.
name: Inflammation is limited to mucosa and submucosa
label: a
answer: yes

Correct answer: a