hllj/quesmed huggingface dataset:
A 38-year-old male presents to his GP complaining of worsening tingling and numbness in both hands, as well as new severe weakness in his feet and calves. These symptoms started about seven days ago. He reports that he had a bout of non-bloody diarrhoea approximately two weeks ago following a barbeque. Following examination and further investigations, a diagnosis of Guillain-Barre syndrome (GBS) is made.

Which of the following examination findings would most likely be found on examination of this patient?

Options:
explanation: Fasciculations are a sign of an upper motor neurone lesion, and are seen in amyotrophic lateral sclerosis (and to a lesser extent in some other more common conditions). It would not be present in a patient with Guillain-Barre syndrome.
name: Fasciculations in hands and arms
label: d
answer: no
explanation: Muscle wasting is not a typical sign of Guillain-Barre syndrome, and may be caused by inactivity, or conditions such as muscular dystrophy.
name: Lower limb muscle wasting
label: e
answer: no
explanation: This may be a sign of Lambert-Eaton myasthenic syndrome (LEMS), which is associated with lung cancer. It causes weakness in muscles around the body, with autonomic dysfunction. Weakness typically improves with exercise, and then begins to worsen again. Improvement with exercise would not be exhibited in patients with GBS.
name: Muscle weakness improving with use
label: b
answer: no
explanation: Patients with Guillain-Barre syndrome characteristically have reduced or absent deep tendon reflexes. GBS is a common cause of acute peripheral neuropathy, and typically occurs following a recent infection. It causes symmetrical ascending weakness which begins in the legs. Severe cases can result in severe respiratory muscle weakness necessitating ventilatory support.
name: Reduced knee-jerk reflex
label: a
answer: yes
explanation: Weakness on mastication (chewing) is seen in a majority of patients with myasthenia gravis (MG). However, it is very rarely seen in Guillain-Barre syndrome (GBS). Myasthenia gravis is an important differential diagnosis for GBS. However, MG typically affects the small and proximal muscles of the face and neck initially, while GBS is an ascending weakness beginning in the legs. MG is usually caused by circulating acetylcholine receptor antibodies.
name: Weakness of mastication
label: c
answer: no

Correct answer: a
A 68-year-old man presents with his daughter complaining of a three-month history of weakness. He first noticed that he was struggling to open jars, but is now unable to lift his arms and to get changed. His daughter has also noticed him tripping up and, on occasion, his speech has been slurred. A diagnosis of motor neurone disease is suspected, and he is examined and referred for further investigations.

Which of the following is a lower motor neurone sign which may be seen in a patient with motor neurone disease?

Options:
explanation: Fasciculations are caused by lower motor neurone lesions. Patients with amyotrophic lateral sclerosis (a subtype of MND) typically present with a mixture of upper and lower motor neurone signs, with wasting and fasciculations being the predominant lower motor neurone signs.
name: Fasciculations
label: a
answer: yes
explanation: Although patients with motor neurone disease may describe a tremor, this is often due to muscle weakness and an inability to move their muscles effectively. Tremor is an upper motor neurone sign.
name: Tremor
label: d
answer: no
explanation: Spasticity is often seen in motor neurone disease. However, this is an upper motor neurone sign and is therefore incorrect.
name: Spasticity
label: c
answer: no
explanation: Hyperreflexia is often seen in motor neurone disease. However, this is an upper motor neurone sign and is therefore incorrect.
name: Hyperreflexia
label: b
answer: no
explanation: Although motor neurone disease may cause rigidity/stiffness, this would be an upper motor neurone sign. Rigidity is commonly seen in patients with Parkinson's disease.
name: Rigidity
label: e
answer: no

Correct answer: a
A 64-year-old man is prescribed digoxin for his chronic atrial fibrillation. Digoxin has a half-life of 36 hours.

How long would it take for digoxin to be effectively eliminated from the body (reach a level less than 5% of peak concentration)?

Options:
explanation: At 108 hours, three half-lives have passed, meaning that the drug concentration will be at 12.5% of the maximum.
name: 108 hours
label: e
answer: no
explanation: 36 hours is the half-life for digoxin, meaning that the plasma concentration would in theory be exactly 50% of it's peak at this point.
name: 36 hours
label: b
answer: no
explanation: At 144 hours, four half-lives have passed, meaning that the drug concentration will have reached 6.125% of the maximum concentration. This is higher than 5%, and is therefore incorrect.
name: 144 hours
label: d
answer: no
explanation: At 72 hours, two half-lives have passed, meaning that the drug concentration will be at 25% of it's maximum.
name: 72 hours
label: c
answer: no
explanation: The half-life of a drug represents the time taken for it's plasma concentration to fall to half of it's peak plasma concentration. A drug's concentration will fall to 1/32 or 3.125% of it's peak concentration in five half-lives. Given that the half-life for digoxin is 36 hours, it would fall to 25% of peak concentration at 72 hours, 12.5% at 108 hours, 6.25% at 144 hours, and 3.125% at 180 hours. This can be more easily calculated as 36 X 5.
name: 180 hours
label: a
answer: yes

Correct answer: a
A 65-year-old man attends the cardiology clinic following a recent diagnosis of heart failure. The patient asks if needs to stop taking any of his current medications given this diagnosis.

Which of the following medications may worsen the patient's heart failure due to it's negatively inotropic effects?

Options:
explanation: Adrenaline is mainly used in resuscitation after a cardiac arrest or more commonly in patients suffering from anaphylaxis. Adrenaline may be dangerous when used in heart failure patients due to the excess strain placed on the cardiac muscle, but it is positively inotropic making this incorrect.
name: Adrenaline
label: d
answer: no
explanation: Bisoprolol is used in the treatment of heart failure. Beta-blockers are negatively inotropic, but their effects are not as powerful as verapamil, and it is usually safe in heart failure patients. Its' effects help to reduce the oxygen demand of the heart. They are also commonly used to manage angina and atrial fibrillation.
name: Bisoprolol
label: b
answer: no
explanation: Digoxin is a powerful positive inotrope. This means that it causes the heart muscle to contract with greater force, increasing cardiac output. Digoxin may be used in heart failure and atrial fibrillation.
name: Digoxin
label: c
answer: no
explanation: Furosemide is a loop diuretic. It acts by increasing sodium and water excretion in the kidneys. It is used to treat symptomatic heart failure by reducing oedema/fluid overload. It is not ionotropic as it does not directly affect the force of contraction, but can reduce overall heart strain by reducing fluid.
name: Furosemide
label: e
answer: no
explanation: Verapamil is a highly negatively inotropic calcium channel blocker. A negative inotrope reduces the force of contraction by the heart, thereby reducing cardiac output. Verapamil is typically used for arrhythmias, angina and hypertension, where its negatively inotropic effects are beneficial. In heart failure, patients already have a reduced cardiac output, and therefore verapamil can exacerbate this and be dangerous.
name: Verapamil
label: a
answer: yes

Correct answer: a
A 59-year-old male undergoes investigations following a new diagnosis of angina. Blood tests reveal hypercholesterolaemia, and the patient is subsequently started on atorvastatin. The patient asks how this drug works.

What is the mechanism of action of atorvastatin?

Options:
explanation: Atorvastatin competitively inhibits HMG-CoA reductase. This prevents the conversion of HMG-CoA into mevalonate within the liver (which is the rate-limiting step of cholesterol synthesis). Statins aim to reduce LDL cholesterol, and increase HDL cholesterol. Statins are used to prevent cardiovascular events in patients with cardiac risk factors and abnormal lipid profiles.
name: HMG-CoA reductase inhibitor
label: a
answer: yes
explanation: Inhibition of folic acid synthesis is incorrect. This is the mechanism of antibiotics such as trimethoprim.
name: Inhibition of folic acid synthesis
label: e
answer: no
explanation: Phosphodiesterase inhibitors cause vasodilation, improving circulation and lowering blood pressure. They are used to treat a variety of conditions and contain a number of subtypes. For example, phosphodiesterase 5 (PDE-5) inhibitors primarily act upon the vasculature in the lungs and penis.
name: Phosphodiesterase inhibitor
label: d
answer: no
explanation: P2Y12 inhibitors include antiplatelet drugs such as clopidogrel, ticagrelor, and prasugrel. These drugs inhibit platelet activation and aggregation, preventing clot formation. These are used to prevent ischaemic events
name: P2Y12 inhibitor
label: b
answer: no
explanation: SGLT-2 inhibitors include empagliflozin and dapagliflozin, which are used to treat type 2 diabetes. These drugs work by inhibiting the sodium-glucose-cotransporter 2 in the proximal convoluted tubule to reduce glucose reabsorption. This results in increased urinary glucose excretion.
name: SGLT-2 inhibitor
label: c
answer: no

Correct answer: a
Which of the following antibiotics prevents bacterial replication through inhibition of folic acid synthesis?

Options:
explanation: Penicillin works by targeting the beta-lactam ring in the bacterial cell wall, leading to bacterial cell death.
name: Penicillin
label: b
answer: no
explanation: Erythromycin is a macrolide antibiotic, which works by binding to the 50S subunit of bacterial cell ribosomes to inhibit protein synthesis.
name: Erythromycin
label: c
answer: no
explanation: Doxycycline is a tetracycline antibiotic, which binds to the 30S subunit of ribosomes to inhibit protein synthesis.
name: Doxycycline
label: e
answer: no
explanation: Rifampicin inhibits RNA synthesis in bacteria.
name: Rifampicin
label: d
answer: no
explanation: Trimethoprim is an inhibitor of folic acid synthesis, which is needed by bacteria in order to survive. Trimethoprim is contraindicated in patients with pre-existing folic acid deficiency and in women aiming to become pregnant due to it's teratogenic effects.
name: Trimethoprim
label: a
answer: yes

Correct answer: a
Deontology is an approach to ethics which focuses on the correctness or wrongness of an action, without taking into account any other considerations.

Which of the following ethical theories is considered deontological?

Options:
explanation: Utilitarianism is incorrect. It is a theory of morality which advocates actions which foster happiness or pleasure, while opposing actions which cause unhappiness or harm for all parties. It is a subset of consequentialism, which takes into account the outcome for everyone affected.
name: Utilitarianism
label: b
answer: no
explanation: Ethical egoism is incorrect. This is a subset of consequentialism, where the emphasis is put on the outcome for the agent performing the action only, rather than everyone affected.
name: Ethical egoism
label: e
answer: no
explanation: Teleology is incorrect. Teleology describes a theory of morality which derives duty/moral obligation from what is a desirable end result.
name: Teleology
label: d
answer: no
explanation: Consequentialism is incorrect. This ethical theory supports the idea that the right action in a given situation is determined solely by its consequences. In consequentialism, outcomes justify the means to achieve it, contrasting from deontology where the moral principles themselves take precedence.
name: Consequentialism
label: c
answer: no
explanation: Kantianism is correct. Kantianism stems from the belief that humans possess the ability to reason and understand universal moral laws which they can apply in all situations. It does not take into account the consequences of individual actions. In deontological ethics, duties/obligations are the primary importance (even when outcomes may not justify the needs).
name: Kantianism
label: a
answer: yes

Correct answer: a
A clinical trial for a new test to detect deep vein thrombosis (DVT) is carried out on 196 participants. The results of the trial are shown below:
67 Patients with confirmed DVT received a positive test result, while 7 patients with confirmed DVT had a negative test result.
28 of the patients without DVT received a positive result, while 94 patients without a DVT received a negative result.

Which of the following values represents the sensitivity of this test?

Options:
explanation: This is the positive predictive value for this test. This is the proportion of patients with a positive test who truly have the condition. It is calculated as patients with DVT AND a positive test (67) / total number of patients with a positive test (95).
name: 0.71 (71%)
label: d
answer: no
explanation: This would be the correct answer for specificity. This is a measure of the proportion of patients without the disease who are correctly excluded by the test. It is calculated as patients without DVT with a negative test (94) / total number of patients without DVT (122).
name: 0.77 (77%)
label: b
answer: no
explanation: This is the negative predictive value (NPV) for this test. This is the proportion of patients with a negative test who truly do not have the condition. It is calculated as patients without DVT AND a negative test (94) / the total number of patients with a negative result (101).
name: 0.93 (93%)
label: c
answer: no
explanation: 10% would be correct as the false negative rate, or the proportion of those with the condition who will test negative. This is calculated using the formula 1 - sensitivity (1-0.90).
name: 0.10 (10%)
label: e
answer: no
explanation: Sensitivity is the proportion of people with the condition who have a positive test result. In this question, the correct methodology would be patients correctly identified as having DVT (67) / all patients with DVT (74). This means that for every 100 people with DVT, 90 will have a positive test result.
name: 0.90 (90%)
label: a
answer: yes

Correct answer: a
A patient is admitted for surgery for an indirect inguinal hernia. During the operation, the spermatic cord is identified and appears to be compressed by the hernia.

Which of the following is not contained within the spermatic cord?

Options:
explanation: The external and internal spermatic arteries are both found within the spermatic cord.
name: External spermatic artery
label: d
answer: no
explanation: The ductus deferens (vas deferens) is found within the spermatic cord. This is the tube which transports sperm from the epididymis to the ipsilateral ejaculatory duct.
name: Ductus deferens
label: b
answer: no
explanation: The ilio-inguinal nerve passes through part of the inguinal canal but is not contained within the spermatic cord. The spermatic cord consists of the ductus deferens, cremaster muscle, external/internal spermatic arteries, artery to ductus deferens, spermatic nerve, remnants of the processus vaginalis, and lymphatics.
name: Ilio-inguinal nerve
label: a
answer: yes
explanation: The remnant of the processus vaginalis is found within the spermatic cord.
name: Processus vaginalis
label: e
answer: no
explanation: The cremasteric artery is found within the spermatic cord.
name: Cremasteric artery
label: c
answer: no

Correct answer: a
A 26-year-old male presents complaining of worsening back pain over the past 18 months. He has been to see a chiropractor and a physiotherapist previously, but has not seen significant improvement. Following further investigations, a diagnosis of ankylosing spondylitis (AS) is suspected.

Which of the following findings is most likely present in this patient?

Options:
explanation: Pain in ankylosing spondylitis typically improves with use, as with other causes of inflammatory back pain. Patients do usually complain of stiffness with rest, particularly in the morning. Pain which worsens with use would be more in line with a diagnosis of osteoarthritis.
name: Pain gets worse with activity
label: b
answer: no
explanation: Ankylosing spondylitis typically causes loss of lumbar lordosis, with increased kyphosis. A reduced range of lumbar motion is observed in AS, which is tested for using Schober's test.
name: Increased lumbar lordosis
label: c
answer: no
explanation: Erythema nodosum is not associated with AS, but does have an association with sarcoidosis. It is caused by swollen fat under the skin which causes dark bumps and patches.
name: Erythema nodosum
label: d
answer: no
explanation: Psoriatic plaques are a key finding in patients with psoriasis and psoriatic arthritis, which may present with similar features to AS, but more commonly involves the small joints of the hands and feet.
name: Psoriatic plaques
label: e
answer: no
explanation: Ankylosing spondylitis typically causes reduced flexion of the lumbar spine. This can be confirmed using Schober's test. This is caused by new bone formation at the level of joint capsules and cartilage resulting in the characteristic "bamboo spine" appearance.
name: Reduced flexion of the lumbar spine
label: a
answer: yes

Correct answer: a
A 46-year-old man with a known history of Gilbert's syndrome presents with fever, dry cough, shortness of breath and jaundice. A COVID-19 test is performed which is positive.

Which of the following blood test results would you most expect to see in this patient?

Options:
explanation: Gilbert's syndrome typically does not cause damage to hepatocytes and thus would not result in a rise in ALT.
name: Increased unconjugated bilirubin and raised ALT
label: c
answer: no
explanation: Gilbert's disease is a cause of prehepatic jaundice due to reduced bilirubin conjugation enzyme (UGT) activity during times of stress. In this patient, with known Gilbert's syndrome, the COVID-19 infection is likely to be the trigger for his jaundice. Blood tests would show an unconjugated hyperbilirubinaemia. However, there is typically no damage to liver cells so other liver function tests would remain normal.
name: Increased unconjugated bilirubin only
label: a
answer: yes
explanation: Gilbert's syndrome would result in a high unconjugated bilirubin and a normal ALT.
name: Normal bilirubin and high ALT
label: e
answer: no
explanation: Increased conjugated bilirubin would occur in hepatic or post-hepatic causes of jaundice. However, Gilbert's syndrome is a pre-hepatic cause resulting in an unconjugated hyperbilirubinaemia. Hepatic and post-hepatic causes of jaundice may also be associated with damage to hepatocytes resulting in deranged liver function tests.
name: Increased conjugated bilirubin only
label: b
answer: no
explanation: Gilbert's syndrome would not cause a conjugated hyperbilirubinaemia or a rise in ALT.
name: Increased conjugated bilirubin and high ALT
label: d
answer: no

Correct answer: a
A 34-year-old man presents with shortness of breath, haemoptysis, and chest pain. A urine dip also demonstrates proteinuria and microhaematuria. Blood tests reveal anaemia, with elevated urea and creatinine. Anti-GBM antibodies are identified on further testing and, subsequently, a diagnosis of Goodpasture's syndrome is made.

What type of hypersensitivity reaction is the underlying cause for this patient's presentation?

Options:
explanation: A type IV hypersensitivity reaction is a delayed reaction mediated by T-cells. It is involved in contact dermatitis as well as the tuberculin skin test (Mantoux test). The reaction would typically occur 24 to 72 hours following antigen exposure.
name: Type IV hypersensitivity reaction
label: c
answer: no
explanation: There is no type V hypersensitivity reaction.
name: Type V hypersensitivity reaction
label: e
answer: no
explanation: Type I hypersensitivity reactions are immediate reactions mediated by IgE. These reactions are involved in allergy, anaphylaxis, and atopic disease.
name: Type I hypersensitivity reaction
label: b
answer: no
explanation: Type III hypersensitivity reactions are antigen-antibody immune complex-mediated reactions, resulting in complement activation and local inflammation. This may occur in serum sickness, rheumatoid arthritis, SLE, and post-streptococcal glomerulonephritis.
name: Type III hypersensitivity reaction
label: d
answer: no
explanation: This patient has Goodpasture's syndrome, characterised by the presence of anti-GBM antibodies which target the basement membrane of the glomerulus and lungs. This is a type II hypersensitivity reaction, which are IgG- or IgM-antibody-mediated immune reactions that damage normal cells and may occur over hours to days.
name: Type II hypersensitivity reaction
label: a
answer: yes

Correct answer: a
A 69-year-old male patient on a respiratory inpatient ward with a past medical history of bronchiectasis has sputum cultures analysed. Cultures demonstrate gram-positive diplococci. The organism is found to be alpha-haemolytic and optochin sensitive.

What is the most likely organism which has been identified on the patient's sputum culture?

Options:
explanation: This patient is infected with streptococcus pneumoniae, likely causing pneumonia and necessitating his admission. His history of bronchiectasis puts him at increased risk of developing respiratory infections. S. pneumoniae is a gram-positive diplococci, which is alpha-haemolytic, and optochin sensitive. Optochin testing tests specifically for s.pneumoniae - with optochin sensitivity indicating the presence of s.pneumoniae.
name: Streptococcus pneumoniae
label: a
answer: yes
explanation: Staphylococcus aureus is a gram-positive cocci. However, it would not respond to haemolysis testing and would not be optochin-sensitive. It would also not typically cause a respiratory infection (likely in this patient due to the history of bronchiectasis).
name: Staphylococcus aureus
label: c
answer: no
explanation: Neisseria meningitidis is a cause of meningitis. However, there is no evidence supporting a diagnosis of meningitis in this patient. Neisseria is a gram-negative diplococci.
name: Neisseria meningitidis
label: e
answer: no
explanation: Mycoplasma pneumoniae can cause pneumonia in rare cases. However, it is a short rod, and does not have a cell wall, and therefore is not visible on gram-staining.
name: Mycoplasma pneumoniae
label: d
answer: no
explanation: Haemophilus influenzae is the second most common cause of pneumonia following S. pneumoniae. However, it is a gram-negative rod, and would not respond to haemolysis or optochin testing.
name: Haemophilus influenzae
label: b
answer: no

Correct answer: a
A patient is diagnosed with an abdominal aortic aneurysm. The patient is counselled on the risk of this rupturing and bleeding into the retroperitoneal space.

Which of the following is not a retroperitoneal organ?

Options:
explanation: The pancreas is an entirely retroperitoneal organ.
name: Pancreas
label: e
answer: no
explanation: The descending colon is entirely retroperitoneal.
name: Descending colon
label: b
answer: no
explanation: The kidneys are both retroperitoneal organs.
name: Kidneys
label: d
answer: no
explanation: The liver is an intraperitoneal organ.
name: Liver
label: a
answer: yes
explanation: The adrenal glands are both entirely retroperitoneal organs.
name: Adrenal glands
label: c
answer: no

Correct answer: a