hllj/quesmed huggingface dataset:
A 22-year-old female presents to the GP after forgetting to take some of her oral contraceptive pills. She presents at 11 a.m. and usually takes her COCP pill at 9 a.m. every day. She missed her COCP pills on days 11 and 12 of her cycle. She is now on day 13 of her cycle. She has not had any recent unprotected sex.

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

Options:
explanation: Emergency contraception is not needed in this case because she has not had any recent unprotected sex since missing her COCP pills.
name: Take today's pill and yesterday's pill, and take an emergency contraceptive pill
label: d
answer: no
explanation: She should take today's pill and yesterday's pill, even if it means taking 2 pills in 24 hours to catch up on the missed doses. No emergency contraception is needed as she has not had any unprotected sex.
name: Take today's pill and yesterday's pill. No emergency contraception is needed
label: a
answer: yes
explanation: She should take today's pill and yesterday's pill. Emergency contraception is intended for use after unprotected sex, which has not occurred in this case.
name: Skip today's pill and take an emergency contraceptive pill
label: e
answer: no
explanation: Skipping today's pill and using condoms does not solve the issue at hand. She would need to take today's pill as normal and yesterday's missed pill. Although using condoms is good practice to protect against STIs, no additional contraceptive precautions would be needed if there was consistent, correct use in the previous 7 days.
name: Skip today's pill and use condoms for the next 7 days
label: c
answer: no
explanation: She should be advised to take today's pill **and** yesterday's missed pill.
name: Take today's pill only
label: b
answer: no

Correct answer: a
A 67-year-old man presents with a stooped posture and a history of falling twice in the last year, leading to a fractured arm.

He is not taking any medications and is independent at home.

On examination, there is a forward flexion of the thoracolumbar spine and a loss of height. There is no evidence of muscle weakness or sensory deficits.

What is the next appropriate step in the management of this patient's condition?

Options:
explanation: A DEXA scan measures bone mineral density and is used to diagnose osteoporosis. Whilst the patient has risk factors for osteoporosis (fracture and stooped posture), the forward flexion of the spine suggests an additional issue.
name: Order a DEXA scan
label: b
answer: no
explanation: Bisphosphonates are used to treat osteoporosis. The diagnosis should be confirmed first before starting treatment.
name: Prescribe bisphosphonate medication
label: d
answer: no
explanation: Lifestyle modifications are essential for overall health, but the stooped posture and fractures suggest an underlying condition requiring evaluation.
name: Recommend lifestyle modifications, including dietary changes
label: e
answer: no
explanation: This is a reasonable next step to address the patient's risk of falls. However, the underlying condition of the patient's presentation should be investigated first.
name: Initiate physiotherapy and balance exercises
label: c
answer: no
explanation: An MRI can help evaluate the spine for possible compression fractures and other structural abnormalities. Given the patient's stooped posture and fractures, this is the most appropriate step.
name: Order an MRI of the spine
label: a
answer: yes

Correct answer: a
A 35-year-old man presents to a respiratory clinic with a 2-month history of persistent cough, weight loss and night sweats. He mentions that he was in contact with a family member with confirmed pulmonary tuberculosis (TB) 6 months ago.

On examination, he has decreased breath sounds and dullness to percussion over the right upper lung field.

Which of the following investigations is the most specific for confirming the most likely diagnosis in this patient?

Options:
explanation: This would help detect features like anaemia and leukocytosis, which may be seen in TB. However, it is a non-specific test and alone cannot confirm the diagnosis of pulmonary tuberculosis.
name: Full blood count
label: b
answer: no
explanation: Although a chest X-ray is a valuable diagnostic tool and can show characteristic findings of TB, such as infiltrates, cavities and pleural effusions, it is not as specific as a sputum sample in confirming the presence of *Mycobacterium tuberculosis*.
name: Chest X-ray
label: d
answer: no
explanation: Pulmonary function tests are not typically used as the primary diagnostic tests for TB. PFTs are used to assess lung function and are more useful for conditions like COPD, asthma and interstitial lung diseases.
name: Pulmonary function tests (PFT)
label: e
answer: no
explanation: Serum urea and electrolytes is not a primary diagnostic test for TB.
name: Urea and electrolytes
label: c
answer: no
explanation: Sputum samples can be examined under microscopy for the presence of acid-fast bacilli, characteristic of *Mycobacterium tuberculosis*. It is a specific diagnostic test for confirming pulmonary TB.
name: Sputum samples and microscopy
label: a
answer: yes

Correct answer: a
A 32-year-old woman presents to the breast clinic after discovering a small fixed lump in her right breast six weeks ago.

She has no significant past medical history.

After taking a thorough history and doing a clinical examination of the lump, which of the following is most appropriate for further evaluation of the breast lump?

Options:
explanation: Given this patient's age, an ultrasound of the breast is the most appropriate next step. An ultrasound is used over a mammogram in women under 40 as younger individuals have denser breast tissue.
name: Ultrasound of the breast
label: a
answer: yes
explanation: Breast tomosynthesis is an advanced form of mammography that can provide 3D images of the breast tissue. It may be used along standard mammography but is not typically performed first-line.
name: Breast tomosynthesis
label: e
answer: no
explanation: Thermography is not a recommended initial imaging test for the evaluation of breast lumps. It is considered less reliable than other imaging methods for diagnosing breast cancer.
name: Breast thermography
label: d
answer: no
explanation: An MRI of the breast is a highly sensitive test used to evaluate breast lesions. It is typically used when mammography or ultrasound findings are inconclusive.
name: Breast MRI
label: c
answer: no
explanation: Mammography is commonly used for breast lump screening in women over 40. Mammograms are less sensitive in younger individuals who have denser breast tissue.
name: Mammogram
label: b
answer: no

Correct answer: a
A 23-year-old female presents to the GP with a history of intermittent abdominal pain, bloating and fatigue.

She also reports having an itchy rash on her knees and her buttocks.

[lightgallery]

What is the most likely diagnosis for this patient?

Options:
explanation: Coeliac disease is an autoimmune condition triggered by gluten consumption. It can lead to gastrointestinal symptoms (abdominal pain, bloating) and systemic symptoms, like fatigue. Dermatitis herpetiformis, an itchy skin rash, is a characteristic feature of coeliac diseases.
name: Coeliac disease
label: a
answer: yes
explanation: Crohn's disease is a type of inflammatory bowel disease that can cause abdominal symptoms. However, it is less likely to present with an itchy rash.
name: Crohn's Disease
label: e
answer: no
explanation: Food allergies can cause various symptoms, including skin rashes. However, coeliac disease is specifically associated with gluten, not other food allergens. The combination of abdominal symptoms and a rash is more suggestive of coeliac disease.
name: Food allergy
label: c
answer: no
explanation: Gastroenteritis can cause abdominal pain and sometimes fatigue, but it is typically associated with diarrhoea and vomiting rather than a persistent itchy rash.
name: Gastroenteritis
label: b
answer: no
explanation: IBS can cause abdominal pain and bloating; however, it does not present with an itchy rash. It is a diagnosis of exclusion.
name: Irritable bowel syndrome (IBS)
label: d
answer: no

Correct answer: a
A 70-year-old male presents to the urology clinic with lower urinary tract symptoms of increased frequency, nocturia and a weak urinary stream.

On digital rectal examination (DRE), his prostate feels firm and nodular. His prostate-specific antigen (PSA) level is found to be elevated at 7.5 ng/mL.

Which of the following is the most appropriate next step?

Options:
explanation: This patient's symptoms and DRE findings are more suggestive of prostate cancer than prostatitis. Prostatitis symptoms include fever, pelvic pain or discomfort, urinary symptoms (frequency, urgency, dysuria, haematuria, hesitancy) and flu-like symptoms.
name: Prescribe antibiotics for prostatitis
label: b
answer: no
explanation: 5-alpha reductase inhibitors are typically used to treat benign prostatic hyperplasia, not prostate cancer. Initiating treatment without a confirmed diagnosis would not be appropriate.
name: Initiate treatment with a 5-alpha reductase inhibitor
label: d
answer: no
explanation: These findings are concerning for prostate cancer. To get a definitive diagnosis or rule out prostate cancer, a transrectal ultrasound-guided prostate biopsy is needed. This procedure involves taking small samples of prostate tissue to determine if cancer cells are present. This is the most appropriate next step in the evaluation of a patient with suspected prostate cancer.
name: Perform a transrectal ultrasound-guided prostate biopsy
label: a
answer: yes
explanation: Radiotherapy is a treatment option for prostate cancer but would not be attempted before a confirmed diagnosis and discussion of appropriate treatment options.
name: Refer the patient for radiotherapy
label: c
answer: no
explanation: Bone scans are important for staging cancers but are typically done after a confirmed diagnosis. The initial step is to obtain a tissue diagnosis through a biopsy.
name: Order a bone scan to evaluate for metastatic disease
label: e
answer: no

Correct answer: a
An 8-year-old boy presents with a mobile midline mass in the neck.

The mass is painless, soft and fluctuant.

What is the most likely cause of the mass?

Options:
explanation: Sialadenitis is an inflammation of the salivary glands and does not typically result in a midline neck mass.
name: Sialadenitis
label: d
answer: no
explanation: Lymphoma is a type of cancer. It can present as a neck mass but does not have the same soft, painless and fluctuant characteristics described in this case.
name: Lymphoma
label: c
answer: no
explanation: Dermoid cysts can occur in various locations, including the neck, but they are typically firm and may contain various tissue types, including skin, hair and sebaceous material.
name: Dermoid cyst
label: b
answer: no
explanation: The thyroglossal duct is an embryological structure that connects the thyroid gland to the tongue during development. Sometimes, a remnant of this duct can persist, forming a midline neck mass, often near the hyoid bone. These masses are typically soft and fluctuant.
name: Thyroglossal duct
label: a
answer: yes
explanation: Branchial cysts are typically lateral neck masses that result from developmental remnants of the branchial arches.
name: Branchial cyst
label: e
answer: no

Correct answer: a
An 81-year-old woman presents to the emergency department reporting a high fever, chills and weakness. She has a medical history of breast cancer and is receiving chemotherapy. She has no known allergies.


Physical examination reveals hypotension and signs of sepsis. Blood tests show a neutrophil count of 0.2 x 10^9/L *(normal range = 2.0-7.5 x 10^9/L)*.


Which of the following is the most appropriate initial treatment for this patient?

Options:
explanation: Piperacillin/tazobactam could be used to treat neutropenic sepsis as it provides adequate coverage for the range of pathogens that can cause sepsis in neutropenic sepsis. However, it is not commonly used in combination with doxycycline.
name: Doxycycline and piperacillin/tazobactam
label: e
answer: no
explanation: Gentamicin is an aminoglycoside antibiotic that may be used in combination therapy for neutropenic sepsis, but it is typically combined with a beta-lactam antibiotic like cefepime, not clindamycin. This combination does not provide broad coverage.
name: Gentamicin and clindamycin
label: b
answer: no
explanation: This patient has neutropenic sepsis and active breast cancer. She is a high-risk patient, so she should be treated with empirical broad-spectrum antibiotics and hospitalised for further management. Treatment with piperacillin/tazobactam (Tazocin) is used as empiric therapy for febrile neutropenia in cancer patients because it provides coverage against a wide range of potential pathogens. Note: You should always check your local hospital guidelines and healthcare institution algorithms before deciding which antibiotics to prescribe.
name: Piperacillin/tazobactam
label: a
answer: yes
explanation: Amoxicillin-clavulanate (Co-amoxiclav) is not typically used as initial empiric therapy for neutropenic sepsis, as it lacks the broad-spectrum coverage needed for this high-risk condition.
name: Amoxicillin-clavulanate
label: c
answer: no
explanation: This combination lacks coverage against resistant Gram-positive bacteria and some Gram-negative pathogens.
name: Azithromycin and ceftriaxone
label: d
answer: no

Correct answer: a
A 35-year-old woman who is G1P2 is offered the combined screening test when she is 11+2 weeks.

**Her results show:**

* Thickened nuchal translucency
* Increased serum B-HCG
* Reduced pregnancy-associated plasma protein A (PAPP-A)

Which of the following conditions is her baby at higher risk of?

Options:
explanation: All pregnant women in England who are carriers of the sickle cell gene are offered a screening test for sickle cell disease. This is a different test from the combined screening test.
name: Sickle cell disease
label: e
answer: no
explanation: Patau's syndrome also gives similar results. However, serum B-HCG is low, not increased.
name: Patau's Syndrome
label: c
answer: no
explanation: Klinefelter syndrome is not screened for in the combined test.
name: Klinefelter syndrome
label: d
answer: no
explanation: Edwards' syndrome gives similar results. However, serum B-HCG is low, not increased.
name: Edwards' syndrome
label: b
answer: no
explanation: The combined test screens for Down's, Edwards', and Patau's syndromes. It is offered to pregnant women between 11 and 14 weeks. These test results are suggestive of the baby having a higher chance of Down's syndrome.
name: Down's syndrome
label: a
answer: yes

Correct answer: a
A 19-year-old male is brought to the emergency department with a decreased respiratory rate, constricted pupils and confusion.

On examination, there is evidence of needle track marks on his right arm.

What is the most appropriate management?

Options:
explanation: Diazepam is a benzodiazepine used to treat conditions like anxiety and seizures.
name: Administer diazepam
label: c
answer: no
explanation: Atropine is used to treat conditions such as bradycardia and to counteract the effects of excessive cholinergic stimulation.
name: Administer atropine
label: e
answer: no
explanation: Performing a chest X-ray may help diagnose certain respiratory conditions or chest injuries, but is not the primary intervention for opioid overdose.
name: Perform a chest X-ray
label: d
answer: no
explanation: The clinical presentation of decreased respiratory rate, constricted pupils, confusion and evidence of needle marks is highly suggestive of opioid overdose. Naloxone is an opioid receptor antagonist that can rapidly reverse the effects of opioids.
name: Administer naloxone
label: a
answer: yes
explanation: Epinephrine (adrenaline) is used in other situations, such as severe allergic reactions.
name: Administer epinephrine
label: b
answer: no

Correct answer: a
A 12-month-old child attends the GP with his parents. They are concerned that although he is walking, he is unsteady. He can say "mama" and "dada", waves "bye-bye" with his left hand and primarily picks up toys in his left hand.

What is the most appropriate next step?

Options:
explanation: This wait-and-see approach without immediate intervention would not be the best choice as there are concerns about potential cerebral palsy due to the child showing hand preference prematurely.
name: Reassure the parents and continue monitoring the child's development
label: b
answer: no
explanation: This child is showing a preference for one hand, which may be suggestive of spastic hemiplegia, which is a type of cerebral palsy. Referral to OT, PT, and speech therapy is a comprehensive approach involving specialised assessments and interventions to support the child's motor and language development.
name: Referral to occupational therapy (OT), physiotherapy (PT) and speech therapy
label: a
answer: yes
explanation: Evaluating the child's language skills to determine if there are any language-related delays or concerns is a valid consideration, but recognising and addressing the hand preference is more important in this case.
name: Evaluate the child's language development
label: e
answer: no
explanation: This option would not address the fine motor developmental concerns in this child.
name: Perform a hearing assessment
label: c
answer: no
explanation: In some cases, observing the child's development over an extended period can be valuable. However, early intervention is advised if there are concerns about cerebral palsy or developmental delays.
name: Observe the child's development for the next 6 months
label: d
answer: no

Correct answer: a
A 39-year-old man presents with a sore, painful eye. He also reports that he has been feeling feverish and has had changes in his vision.

On examination, you note swelling and erythema around his right eye. The pain in his eye is worse upon movement.

Given his symptoms, what is the most appropriate initial investigation to confirm the diagnosis?

Options:
explanation: MRI can provide detailed imaging of soft tissues but is not the initial choice in cases of suspected orbital cellulitis.
name: MRI brain
label: c
answer: no
explanation: Blood cultures are important for identifying the causative pathogen in systemic infections and would be obtained before starting antibiotic therapy when starting treatment.
name: Blood culture
label: b
answer: no
explanation: These symptoms are suggestive of orbital cellulitis - an infection involving the tissues behind the orbital septum. It is important to differentiate orbital cellulitis from periorbital cellulitis because the latter requires emergency admission under ophthalmology and can lead to loss of sight. A CT with contrast can help to identify the extent of the infection and assess for the presence of abscesses or other complications.
name: CT sinus and orbits with contrast
label: a
answer: yes
explanation: A slit lamp examination is a specialised examination which assesses the anterior segment of the eye, including the cornea, anterior chamber, iris and lens. However, orbital cellulitis primarily involves tissues within the orbit located behind the orbital septum.
name: Slit lamp examination
label: e
answer: no
explanation: Visual field testing is used to assess a patient's field of vision. It may be considered later to assess the impact of the orbital cellulitis on the patient's vision, but it is not the first-line investigation in this case.
name: Visual field testing
label: d
answer: no

Correct answer: a
A 59-year-old man presents with a 6-month history of retrosternal chest pain, regurgitation of undigested food and progressive dysphagia. The symptoms worsen when lying down and improve when sitting upright.

On examination, the patient has no abdominal tenderness and no masses are found.

Upper endoscopy reveals a dilated oesophagus with retained food.

What is the most likely diagnosis?

Options:
explanation: Endoscopic findings in eosinophilic oesophagitis are more likely to show oesophageal rings, furrows and white exudates.
name: Eosinophilic oesophagitis
label: e
answer: no
explanation: Achalasia is characterised by dysphagia, regurgitation and chest pain. It occurs due to a failure of lower oesophageal sphincter relaxation and the loss of oesophagal peristalsis. This results in the accumulation of food and liquid in the oesophagus.
name: Achalasia
label: a
answer: yes
explanation: Oesophageal cancer can present with dysphagia but is commonly associated with a variety of other systemic symptoms. The endoscopic findings described are not typical for oesophageal cancer.
name: Oesophageal cancer
label: d
answer: no
explanation: Whilst GORD can cause symptoms such as heartburn and regurgitation, the classic symptoms of GORD usually do not include progressive dysphagia.
name: Gastroesophageal reflux disease (GORD)
label: b
answer: no
explanation: Oesophageal strictures can lead to dysphagia, but endoscopic findings would likely reveal a narrow or scarred oesophagus rather than dilatation.
name: Oesophageal stricture
label: c
answer: no

Correct answer: a
A 19-year-old male presents to an urgent care clinic after experiencing a sore throat, fever and difficulty swallowing for the past two days.

On examination, he has a temperature of 38.6 C. His throat is erythematous, and there are white, pus-like spots on his tonsils.

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

Options:
explanation: EBV can cause a sore throat. It is more commonly associated with symptoms such as swollen lymph nodes and severe fatigue.
name: Epstein-Barr virus (EBV)
label: b
answer: no
explanation: Allergic rhinitis primarily presents with symptoms like sneezing, itchy or watery eyes and nasal congestion.
name: Allergic rhinitis
label: e
answer: no
explanation: HSV can cause oral lesions but is less likely to cause a sore throat with white spots on the tonsils. Infection with HSV usually presents with painful oral ulcers.
name: Herpes simplex virus (HSV)
label: d
answer: no
explanation: Adenovirus can cause a sore throat but typically presents with symptoms like conjunctivitis.
name: Adenovirus
label: c
answer: no
explanation: These symptoms are consistent with streptococcal pharyngitis, commonly caused by Group A streptococcus. The presence of pus-like spots on the tonsils is characteristic of bacterial infections. It is often referred to as "strep throat."
name: Group A Streptococcus
label: a
answer: yes

Correct answer: a