hllj/quesmed huggingface dataset:
A 61-year-old man presents to General Practice with gastric cancer.

What signs and symptoms would you expect to find in this patient?

Options:
explanation: These are symptoms of lower gastrointestinal cancers, such as colorectal cancer. A gastric cancer - stomach cancer - would not produce lower gastrointestinal symptoms, as it is further away from the colon and rectum.
name: Change in bowel habits, fresh blood in the stool
label: b
answer: no
explanation: This would indicate a more acute upper gastrointestinal lesion, such as a tear in the oesophagus, or a ruptured vein.

A gastric cancer is unlikely to cause large volumes of acute blood loss. It may cause chronic blood loss, which can cause anaemia or melaena (tarry, black stool due to digested blood, which has been lost from the stomach and digested in the small bowel).
name: Haematemesis (vomiting blood)
label: d
answer: no
explanation: Unintentional, rapid weight loss is always a hallmark sign of cancer.

Gastric cancers tend to present with epigastric pain - pain in the centre of the abdomen, just under the diaphragm - in their early stages.
name: Weight loss, abdominal pain
label: a
answer: yes
explanation: These symptoms are indicative of renal colic, which is pain associated with kidney pathologies, such as a kidney stone.

Gastric cancers would not present with any renal symptoms. They classically present with weight loss and abdominal pain.
name: Pain radiating from the loin to the groin
label: c
answer: no
explanation: Iron deficiency anaemia and fatigue are symptoms of gastrointestinal cancers, however, bloating would suggest a differential diagnosis such as coeliac disease or inflammatory bowel disease.
name: Bloating, iron deficiency anaemia, fatigue
label: e
answer: no

Correct answer: a
A 28-year-old man presents to the Emergency Department with severe epigastric abdominal pain, nausea and vomiting. His pain is lightly relieved if he leans forwards.

This patient has a history of gallstones and drinks 20 units of alcohol a week.

What is the name of the criteria used to assess the severity of the disease this patient is presenting with?

Options:
explanation: This is an acronym used to remember the red flag symptoms associated with dyspepsia (difficulty/discomfort swallowing).

**A**naemia (iron deficiency)
**L**oss of weight
**A**norexia
**R**ecent onset of progressive symptoms
**M**elaena / haematemesis
**S**wallowing difficulty
**>55**yrs?

This is not the correct criteria to use - in this patient we are assessing for acute pancreatitis, not dyspepsia.
name: ALARMS55
label: d
answer: no
explanation: The CAGE Questionnaire is used to assess for harmful alcohol use. It stands for the following questions:

Have you ever felt you needed to **Cut** down on your drinking?

Have people **Annoyed** you by criticizing your drinking?

Have you ever felt **Guilty** about drinking?

Have you ever felt you needed a drink first thing in the morning **(Eye-opener)** to steady your nerves or to get rid of a hangover?

This is not the correct questionnaire used to assess the severity of acute pancreatitis, which this patient is presenting with.
name: CAGE Questionnaire
label: b
answer: no
explanation: The Glasgow Coma scale is used to assess a patient's neurological function. It is measured out of a total score of 13, assessing eye movement, motor movement and speech.

It is not used to assess the severity of acute pancreatitis - the condition this patient is presenting with.
name: Glasgow Coma Scale
label: e
answer: no
explanation: The Child-Pugh score is used to assess disease severity for end-stage Liver Failure. It takes into account total bilirubin, serum albumin, International Normalised Ratio (INR), ascites and hepatic encephalopathy.

It is not used to assess the severity of acute pancreatitis, which this patient is presenting with.
name: Child-Pugh Score
label: c
answer: no
explanation: Nausea, vomiting, and epigastric abdominal pain are symptoms associated with acute pancreatitis. Epigastric pain is usually alleviated when leaning forward in this condition, which can be caused by gallstones and excessive alcohol consumption.

The Glasgow-Imrie Criteria are the correct criteria to assess the severity of acute pancreatitis.

It takes into account the following, which can be easily remembered with the acronym PANCREAS:

P- PaO2 (<8 kPa)
A- Age (>55 yrs)
N- Neutrophils (Wbc > 15x10^9^/L)
C- Calcium (<2 mmol/L)
R- Renal (Urea >16 mmol/L)
E- Enzymes (Liver enzymes AST (>200 iU/L)/ LDH >600 iU/L)
A- Albumin (<32 g)
S- Sugar (Blood Sugar >10 mmol/l)
name: Glasgow-Imrie Criteria
label: a
answer: yes

Correct answer: a
Which of the following describes the function of cholangiocyte cells?

Options:
explanation: The synthesis of clotting factors is the hepatocytes' job.

Hepatocytes make up 80% of the liver mass, synthesising albumin, clotting factors and bile salts. The bile salts are then mixed with bicarbonate and water produced by the cholangiocytes, to form bile.
name: Synthesis of clotting factors
label: b
answer: no
explanation: Cholangiocytes are epithelial cells found in the hepatobiliary system.

They are responsible for modifying the bile produced by the hepatocytes in the liver, making it more alkaline, through the addition of HCO^3- (bicarbonate).
name: Secrete bicarbonate into bile
label: a
answer: yes
explanation: Eliminating toxins is the Kuppfer cells' job. Kuppfer cells are sinusoidal macrophage cells, attached to endothelial cells.

Cholangiocytes are epithelial cells responsible for modifying bile produced by the hepatocytes, adding bicarbonate to it.
name: Detoxifies substances arriving in the liver from the portal circulation
label: d
answer: no
explanation: Vitamin A is stored in liver cytosolic droplets in hepatic stellate cells.

Cholangiocytes are responsible for finalising the production of bile - they secrete bicarbonate into the bile coming from the hepatocytes.
name: Storage of Vitamin A
label: c
answer: no
explanation: This is the job of Sinusoidal endothelial cells. The liver does not have a basement membrane - these are the cells that act as a barrier.

The cholangiocytes are not responsible for forming this barrier - instead, they add bicarbonate to the bile produced by the hepatocytes, making bile more alkaline.
name: Allows lipid movement to and from hepatocytes
label: e
answer: no

Correct answer: a
A 72-year-old man presents to General Practice complaining that his food feels 'stuck' when he swallows. This has been gradually worsening for the past 3 months. He has also noticed his trousers getting looser, despite not trying to lose weight.

What would be your first-line investigation for this patient?

Options:
explanation: We are most concerned about oesophageal cancer in this patient - dysphagia (difficulty swallowing) and weight loss, are both red flag symptoms for this condition.

A CT of the chest and abdomen would not be used as a diagnostic tool - it would be used to stage the cancer if one was confirmed. This would be done through an oesophagogastroduodenoscopy (OGD).
name: CT of chest & abdomen
label: b
answer: no
explanation: A staging laparoscopy is used to identify liver and peritoneal metastases. This would not be a first-line investigation.

The first-line investigation for an oesophageal cancer would be an oesophagogastroduodenoscopy (OGD). We are worried about this as this patient has dysphagia, and difficulty swallowing, accompanied by unintentional weight loss.
name: Staging Laparoscopy
label: d
answer: no
explanation: This procedure is used to clarify the depth of cancer invasion and the involvement of local lymph nodes. It would not be a first-line investigation.

To investigate this patient for the presence of oesophageal cancer, due to his dysphagia (difficulty swallowing) and weight loss, an oesophagogastroduodenoscopy (OGD) would be carried out.
name: Endoscopic ultrasound
label: e
answer: no
explanation: A PET-CT Scan is carried out to exclude metastases of malignant primary cancers. This would not be a first-line investigation.

We are worried about this patient having an oesophageal cancer - an oesophagogastroduodenoscopy (OGD) is the first-line investigation we would carry out.
name: PET-CT scan
label: c
answer: no
explanation: Dysphagia, difficulty swallowing, is the commonest symptom of oesophageal cancer.

This is a very worrying sign as significant cancer growth usually occurs before dysphagia develops.

The first-line investigation used to diagnose an oesophageal cancer is an upper gastrointestinal tract endoscopy, also known as an oesophagogastroduodenoscopy (OGD). If a lesion is found, it would be biopsied to confirm the diagnosis.
name: Oesophagogastroduodenoscopy (OGD)
label: a
answer: yes

Correct answer: a
A 35-year-old female presents to the Emergency Department with right upper quadrant abdominal pain, nausea, vomiting, and is jaundiced. She is diagnosed with acute liver failure.

Which of the following can be a cause of acute liver failure?

Options:
explanation: Right-sided heart failure can cause venous insufficiency through the portal hepatic system, decreasing blood flow to the liver.

This causes chronic liver failure instead of acute liver failure.
name: Right-sided heart failure
label: c
answer: no
explanation: Autoimmune hepatitis is a condition where the body's immune system attacks its own liver.

This is a cause of chronic liver failure, instead of acute liver failure.

Acute liver failure is most likely to be caused by toxins, or viral hepatitis.
name: Autoimmune hepatitis
label: b
answer: no
explanation: Non-alcoholic fatty liver disease is a gradual buildup of fat around the liver, not due to alcohol.

This is a gradual process and is therefore a cause for chronic liver failure, not acute liver failure.
name: Non-alcoholic fatty liver disease
label: d
answer: no
explanation: Alpha-1-antitrypsin (A1aT) deficiency is a condition where the liver is unable to make normal A1aT, a protein that helps protect your lungs. Instead, it produces a faulty A1aT, which builds up in the liver and causes damage. This is a gradual process and would result in chronic liver failure.
name: Alpha-1-antitrypsin deficiency
label: e
answer: no
explanation: Paracetamol overdose is responsible for almost 66% of acute liver failure cases in the United Kingdom. These can be both intentional, or unintentional overdoses.

Paracetamol is hepatotoxic, disrupting the liver cells' ability to function. An overdose can therefore push someone into liver failure, where the liver is unable to function normally.
name: Paracetamol Overdose
label: a
answer: yes

Correct answer: a
Which of the following statements is correct about the gastric phase of gastric secretion?

Options:
explanation: Smell, thought, sight and taste of food stimulate the brainstem and begin the cephalic phase of gastric secretion.

This triggers the secretion of Gastrin into the bloodstream and induces secretion by parietal and chief cells.

The gastric phase of gastric secretion occurs after this phase - where stomach distension due to the arrival of food triggers increased gastric secretions.
name: Smell, thought, sight and taste stimulate this phase
label: b
answer: no
explanation: The gastric phase is the second phase of gastric secretion.

The cephalic phase is first, followed by the gastric and the intestinal phase.
name: It is the last phase of gastric secretion
label: e
answer: no
explanation: The gastric phase of gastric secretion does last 3 - 4 hours.

It occurs after food arrives in the stomach, causing distention. This sends signals via the vagus nerve to the brainstem, which in turn stimulates stomach secretions.
name: This phase lasts 3 - 4 hours
label: a
answer: yes
explanation: Gastrin is released into the bloodstream during the cephalic phase of gastric secretion.

The cephalic phase is the first phase of gastric secretion. It is triggered by sensory inputs such as smell, thought, sight and taste of food.
name: Gastrin is released into the bloodstream during this phase
label: c
answer: no
explanation: Secretin is released by the duodenum in the final phase of gastric secretion, the intestinal phase.

It is secreted to inhibit gastric secretion as food has arrived in the small bowels - there is no need for gastric (stomach) secretions anymore.
name: Secretin is released
label: d
answer: no

Correct answer: a
Which of the following statements about asthma is correct?

Options:
explanation: Asthma does **not** consist of three pathological features. Chronic Obstructive Pulmonary Disease (COPD) is a disease that has three pathological features - chronic bronchitis, small airway disease and emphysema.
name: Asthma consists of three pathological features: chronic bronchitis, small airway disease and emphysema
label: c
answer: no
explanation: Glucocorticosteroids are generally effective in the treatment of asthma. When diagnosed, patients are prescribed inhaled corticosteroids (ICS), such as beclomethasone to use every day.
They are also given a bronchodilator such as salbutamol to use when their symptoms flare up.

Steroids can also be used in COPD with asthma-like symptoms.
name: Steroids are ineffective in the management of asthma
label: d
answer: no
explanation: A high fever is not a feature of asthma. If a child presents with a high fever along with respiratory symptoms, this would point towards an upper or lower respiratory infection.
name: High fever at initial presentation
label: b
answer: no
explanation: Asthma is a disease characterised by chronic airway inflammation, leading to constriction. What differentiates asthma from Chronic Obstructive Pulmonary Disease (COPD) is the airway reversibility.

In asthma, although the airways constrict, bronchodilators are still able to reverse this constriction. This phenomenon is known as bronchodilator reversibility. In COPD, the damage to the lungs is permanent. Bronchodilators are still used in COPD to ease symptoms but they do not reverse the damage.
name: Airway constriction caused by inflammation is reversible with bronchodilators
label: a
answer: yes
explanation: Chronic Obstructive Pulmonary Disease (COPD) is a disorder associated with prolonged cigarette smoking, not asthma.

Asthma is considered a hypersensitive allergic-type condition, causing inflammation of the airways. Smoking can worsen asthma, but does not cause it.
name: Asthma is caused by cigarette smoking
label: e
answer: no

Correct answer: a
A 67-year-old man presents to the Emergency Department with shortness of breath.

Upon questioning, he reveals that this has been gradually getting worse over the past year. He is also coughing up some grey sputum. He has been smoking 20 cigarettes daily for 40 years, drinks one pint of beer a day and has never used recreational drugs.

Which of the following is this patient's most likely diagnosis?

Options:
explanation: Chronic Obstructive Pulmonary Disease (COPD) is a chronic lung condition that develops gradually over the years.

The classic symptoms of COPD include increasing breathlessness, a cough with white or grey sputum that does not get better, frequent chest infections and wheezing.

The biggest risk factor for this is smoking - our patient has been a heavy smoker for 40 years, making it very likely that they have COPD when presenting with shortness of breath.
name: Chronic Obstructive Pulmonary Disease (COPD)
label: a
answer: yes
explanation: Heart failure can cause shortness of breath.

For example, in left-sided heart failure, the heart is unable to pump properly to the rest of the body, leading to a backlog of blood in the pulmonary system. This can cause pulmonary oedema, fluid in the lungs, which would cause shortness of breath.

However, this is associated with sputum that is pink and frothy, and swelling in the ankles, which this patient does not have.
name: Heart Failure
label: b
answer: no
explanation: An anaphylactic shock occurs when the body has a severe allergic reaction. The patient deteriorates rapidly as their airways constrict - in some patients their airway completely closes, making them unable to breathe.

The patient is much more likely to have chronic obstructive pulmonary disease (COPD), in which we see a gradual onset of shortness of breath.
name: Anaphylactic Shock
label: e
answer: no
explanation: Pneumonia is an acute, lower respiratory tract infection. Shortness of breath in pneumonia would worsen much more quickly, and you would find associated symptoms indicating infection. These symptoms include fever, fatigue, and coughing up yellow or green sputum, which this patient does not have.

Grey sputum and a gradual onset of shortness of breath are suggestive of chronic obstructive pulmonary disease (COPD).
name: Pneumonia
label: d
answer: no
explanation: The patient is complaining of a gradual worsening in shortness of breath - this is more indicative of chronic obstructive pulmonary disease (COPD) than asthma.

COPD is a chronic condition that usually develops in smokers - another red flag that our patient has - and in older patients. Asthma is usually found in younger patients, usually in children.
name: Asthma
label: c
answer: no

Correct answer: a
Which of the following would you expect to see on the flow-volume loop of a patient with an obstructive respiratory disease?

Options:
explanation: There would be a reduced forced vital capacity (FVC) in patients with an obstructive lung disorder. The obstruction leads to a decrease in lung airway space, reducing the volume of air that is both inhaled and exhaled.

You would also find an indented exhalation curve on the flow volume loops of patients with an obstructive pulmonary disorder - a narrowed exhalation curve is a classic finding of patients with a restrictive lung disorder.
name: Normal forced vital capacity (FVC) with a narrowed exhalation curve
label: d
answer: no
explanation: The forced vital capacity, FVC, is the maximum volume of air that can be exhaled from the lungs.

FVC is lower in patients with an obstructive lung disorder. Obstructive disorders, such as chronic obstructive pulmonary disease (COPD), narrow the patient's airways, decreasing how much air can both enter and leave the lungs.

There is also a classic indented exhalation curve that you would find in patients with obstructive disorders, which is not found in other types of lung pathology.
name: Reduced forced vital capacity (FVC) with an indented exhalation curve
label: a
answer: yes
explanation: There would be a reduced forced vital capacity (FVC) in patients with an obstructive pulmonary disorder. Obstructive disorders such as asthma and chronic obstructive pulmonary disease (COPD) narrow the airways and increases the air resistance inside them - less air can enter and leave the lungs.

An indented exhalation curve is a classic finding in the flow volume loop of patients with obstructive lung disorders.
name: Normal forced vital capacity with an indented exhalation curve
label: c
answer: no
explanation: There would be a reduced forced vital capacity (FVC) in patients with an obstructive disorder, as the narrowing of their airways increases resistance, decreasing the volume of air that can be expelled from the lungs.

However, a narrowed exhalation curve is found in restrictive respiratory diseases such as pulmonary lung fibrosis. In obstructive pulmonary disorders, an indented exhalation curve would be found instead.
name: Reduced forced vital capacity (FVC) with a narrowed exhalation curve
label: b
answer: no
explanation: A **decreased** forced vital capacity (FVC) would be found in patients with an obstructive lung disease. This is because airway obstruction increases the resistance to the air inside the lungs, decreasing the volume that can be both inhaled and exhaled.

An indented exhalation curve is a classic finding in a patient with an obstructive respiratory disorder.
name: Increased forced vital capacity (FVC) with an indented exhalation curve
label: e
answer: no

Correct answer: a
A 25-year-old woman presents to the Emergency Department with increased urinary frequency, pain upon urinating and a fever for the past 2 days.

On examination, there is no renal angle tenderness.

A urine dipstick is positive for blood.

Which of the following is the most likely diagnosis?

Options:
explanation: Bladder Cancer commonly presents as painless haematuria (blood in the urine). A cancer would develop gradually, therefore we would expect to see symptoms that come on over a longer period.

The acute nature of this patient's symptoms, her age, and her fever point towards an infectious cause - such as a urinary tract infection - rather than a cancer.
name: Bladder Cancer
label: b
answer: no
explanation: Renal stones are calcium and oxalate-based stones that form in the kidneys. If they are large enough, they can block the kidney tubules causing renal colic - a severe pain in the patient's back that comes in waves. Renal colic is sometimes described as 'loin to groin' pain.

This patient is not complaining of back, or 'loin to groin' pain - her symptoms point more towards a urinary tract infection than a renal stone.
name: Renal Stones
label: c
answer: no
explanation: Nephritic syndrome is an autoimmune disorder where IgA antibodies attack the kidneys. This causes haematuria (blood in the urine), increased blood pressure, oedema and decreased urinary output.

The patient is not reporting any of these symptoms - her fever and pain upon urinating suggest an infection such as a urinary tract infection (UTI).
name: Nephritic Syndrome
label: e
answer: no
explanation: A urinary tract infection (UTI) is the most likely cause of this patient's symptoms. UTIs can cause symptoms such as fever, abdominal pain, increased urinary frequency, pain upon urinating. Haematuria can be associated with UTI's however urine should be re-tested after completing treatment with an appropriate antibiotic and if there is persistent haematuria, other underlying causes should be considered.

They are more common in females, especially females of reproductive age as sexual intercourse is a common cause of UTIs.
name: Urinary Tract Infection
label: a
answer: yes
explanation: Nephrotic syndrome is a renal disorder characterised by three findings: increased protein loss from the kidneys (proteinuria), decreased serum albumin (hypoalbuminaemia) and peripheral oedema.

Symptoms of nephrotic syndrome also include frothy urine, weight gain, decreased appetite and increased fatigue.

This patient is not complaining of any of these symptoms - her symptoms suggest an infection, most likely a urinary tract infection (UTI).
name: Nephrotic Syndrome
label: d
answer: no

Correct answer: a