hllj/quesmed huggingface dataset:
A 6-year-old girl is brought to the GP by her father. He has noticed she has been coughing more at night. During the day she appears fit and well, is doing well in school, and has no medical problems aside from a previous diagnosis of eczema.

Given the most likely diagnosis, which of the following immunoglobulins is most likely to be raised?

Options:
explanation: IgD has no involvement in the pathophysiology of asthma. Raised IgD levels can be caused by respiratory infections.
name: IgD
label: e
answer: no
explanation: IgG has no involvement in the pathophysiology of asthma. Raised IgG levels can be found in chronic infection or autoimmune conditions involving the central nervous system
name: IgG
label: c
answer: no
explanation: IgM has no involvement in the pathophysiology of asthma. Raised IgM levels are caused by viral infections, type 1 diabetes and multiple sclerosis.
name: IgM
label: d
answer: no
explanation: Asthma is the most likely diagnosis based on the patient's presentation. It is often associated with a family history of atopy, which is the genetic tendency to develop allergic diseases. The atopic triad includes asthma, allergic rhinitis and atopic eczema. Asthma is driven by a type I hypersensitivity reaction in which IgE levels are raised, making this the correct answer.
name: IgE
label: a
answer: yes
explanation: IgA has no involvement in the pathophysiology of asthma. Raised IgA levels can be found in chronic infections, chronic liver disease and some autoimmune conditions.
name: IgA
label: b
answer: no

Correct answer: a
A 5-year-old boy from Nigeria is brought to the GP by his mother as he has been reporting recurrent episodes of bone pain and abdominal pain. He is noted to be among the smallest in his class at school, and becomes very tired towards the end of the day.

The mother mentions that there is no post-natal screening for newborn babies in Nigeria therefore she is unsure whether or not he has any medical conditions.

Based on the most likely diagnosis, which of the following blood film findings are most likely to be seen?

Options:
explanation: The most likely diagnosis is sickle cell anaemia, a disease of red blood cells caused by an autosomal-recessive single gene defect in the beta chain of haemoglobin. It is most common in those of African, Hispanic, and Mediterranean origin. Sickled red blood cells cause symptoms of anaemia, and can clump together and obstruct blood flow, causing pain.

Sick cell anaemia is normally be picked up soon after birth, however was missed in this case due to the lack of screening in Nigeria. Based on this diagnosis, the most likely blood film finding is of sickle cells.
name: Sickle cells
label: a
answer: yes
explanation: Elliptocytes are an elongated oval-shaped version of red blood cells. They are usually seen in iron deficiency anaemia. They are not typically seen in sickle-cell anaemia, making this option incorrect.
name: Elliptocytes
label: d
answer: no
explanation: Spherocytes are a type of red blood cell most commonly seen in hereditary haemolytic anaemia. This is most commonly seen in people of northern European descent. They are not typically seen in sickle-cell anaemia, making this option incorrect.
name: Spherocytes
label: c
answer: no
explanation: Macrophages are a type of white blood cell. Levels are raised in acute infection. They are not indicative of sickle cell anaemia.
name: Macrophages
label: e
answer: no
explanation: The most likely diagnosis in this case is sickle cell anaemia. Target cells are usually seen in obstructive liver disease. Although they can be seen in sickle cell anaemia and thalassemia as well, they are not always present, and not seen in very high numbers.
name: Target cells
label: b
answer: no

Correct answer: a
A 55-year-old male is admitted to the emergency department with central chest pain. His ECG demonstrates ST-segment elevation, and he is diagnosed with a myocardial infarction (MI). He requires antiplatelet therapy for the prevention of a second MI, however unfortunately has a known sensitivity to aspirin. His doctor, therefore, prescribes clopidogrel as an alternative.

Which of the following describes the mechanism of action of clopidogrel?

Options:
explanation: This is the mechanism of action of dipyridamole, which inhibits the attachment of platelets to the endothelium. This in turn inhibits platelet aggregation. It does not describe the mechanism of action of clopidogrel.
name: Phosphodiesterase inhibitor
label: c
answer: no
explanation: This is the mechanism of action of aspirin. Aspirin inhibits COX-1 mediated production of thromboxane A2 (TXA2) and reduces platelet aggregation. It does not describe the mechanism of action of clopidogrel.
name: Cyclo-oxygenase inhibitor
label: b
answer: no
explanation: This is the mechanism of action of direct-acting anticoagulants (DOACs) such as apixaban. It does not describe the mechanism of action of clopidogrel.
name: Factor Xa inhibition
label: e
answer: no
explanation: This is the mechanism of action of abciximab. It blocks the binding of fibrinogen and von Willebrand factor, hence inhibiting platelet aggregation. It does not describe the mechanism of action of clopidogrel.
name: Glycoprotein IIb/IIIa inhibitors
label: d
answer: no
explanation: Clopidogrel selectively inhibits the binding of adenosine diphosphate (ADP) to its platelet P2Y12 receptor, therefore inhibiting the subsequent ADP-mediated activation of the glycoprotein GPIIb/IIIa complex. This in turn reduces platelet aggregation.
name: ADP receptor antagonist
label: a
answer: yes

Correct answer: a
An 85-year-old man is brought to the GP by his wife. She reports he has been more forgetful than usual, losing things around the house and occasionally forgetting the names of close friends. This began suddenly around 6 months ago and has not improved.

He has a past diagnosis of type II diabetes and suffered from a stroke five years ago. However, he remains independent and active, playing golf twice a week.

Which of the following is the most likely diagnosis?

Options:
explanation: Wernicke's encephalopathy is characterised by a tetrad of ataxia, ophthalmoplegia, nystagmus and an acute confusional state. It is associated with lesions in the mamillary bodies. This patient does not present with any of these symptoms, making Wernicke's encephalopathy a less likely diagnosis than vascular dementia.
name: Wernicke's encephalopathy
label: c
answer: no
explanation: In Lewy Body dementia, abnormal protein deposits called Lewy Bodies cause cognitive decline associated with parkinsonism (rigidity, tremor, bradykinesia). This patient does not have any parkinsonian features, making this a less likely diagnosis than vascular dementia.
name: Lewy Body Dementia
label: b
answer: no
explanation: Fronto-temporal dementia is characterised by atrophy of the frontal and temporal lobes. Patients therefore present with cognitive impairment, personality change and disinhibition. This patient is not suffering from any personality changes or disinhibition, making fronto-temporal dementia a less likely diagnosis than vascular dementia.
name: Fronto-temporal dementia
label: d
answer: no
explanation: The most common cause of dementia is Alzheimer's disease, a chronic and progressive form of dementia, characterised by neuropathological features such as amyloid plaques and tau proteins. It presents with gradual onset of memory loss, word-finding problems, and impaired motor function. The sudden onset of this patient’s cognitive deterioration makes vascular dementia a more likely diagnosis.
name: Alzheimer’s disease
label: e
answer: no
explanation: Vascular dementia is a type of cognitive impairment resulting from multiple infarcts in the brain. It presents with sudden onset cognitive difficulties and a stepwise deterioration that occurs with successive cerebrovascular events. It is more common in those with known cardiovascular risk factors such as diabetes, hypercholesterolaemia, or a raised BMI. This patient's sudden decline, previous stroke, and known diabetes make vascular dementia the most likely diagnosis.
name: Vascular dementia
label: a
answer: yes

Correct answer: a
A 2-year-old girl is brought to the GP surgery by her parents. She has been complaining of abdominal pain and recurrent episodes of vomiting and diarrhoea. She has also lost some weight since her last GP visit, despite an apparently good diet.

On examination, she is pale and small in stature. The doctor suspects she is suffering from coeliac disease.

Which of the following is the most appropriate first line investigation?

Options:
explanation: IgA levels can be measured in conjunction with anti-TTG IgA antibody level but it is not the first line investigation.
name: IgA level
label: b
answer: no
explanation: Abdominal x-rays would most likely be unremarkable in a patient with coeliac disease, therefore this is not the most appropriate first line investigation.
name: Abdominal x-ray
label: c
answer: no
explanation: This is the first-line test used for the diagnosis of coeliac disease and is therefore the correct answer.
name: Anti-TTG IgA antibody level
label: a
answer: yes
explanation: An abdominal ultrasound would most likely be unremarkable in a patient with coeliac disease, therefore this is not the most appropriate first-line investigation.
name: Abdominal ultrasound
label: d
answer: no
explanation: Carcinoembryonic antigen can be used to monitor therapeutic response in patients with colorectal cancer. It is not a first-line investigation for coeliac disease.
name: Carcinoembryonic antigen
label: e
answer: no

Correct answer: a
A 22-year-old rugby player receives a blow to the side of his head during a match. Following this, he suffers from a brief loss of consciousness which resolves after a few minutes. After this, he reports localised pain over the site of injury but no other symptoms. Later that day, he develops a severe headache.

He is usually fit and well with no regular medications.

Which of the following is the most likely diagnosis?

Options:
explanation: An extradural haemorrhage is characterised by bleeding between the outer dura mater and the inner surface of the skull. The most common source of bleeding is a tear of the middle meningeal artery following head injury. There is typically a brief loss of consciousness, followed by regaining of normal consciousness level (the lucid interval), with subsequent deterioration of consciousness and headache.
name: Extradural haemorrhage
label: a
answer: yes
explanation: An intracerebral (or intraparenchymal) haemorrhage is a collection of blood within the substance of the brain. It can be caused by hypertension, a vascular lesion, trauma, brain tumour, or infarct. Patients will present similarly to an ischaemic stroke. This answer is not correct as it does not reflect the presentation described above.
name: Intracranial haemorrhage
label: c
answer: no
explanation: An ischaemic stroke occurs when the brain is deprived of oxygen and blood supply. They are more common in older people and those with cardiovascular risk factors (e.g. smoking, obesity, diabetes), and are not generally precipitated by trauma. Presentation depends on the region of ischaemic damage, but can include sudden onset motor weakness, speech impairment, visual field defects and balance problems. This is not in line with the scenario and therefore not the correct answer.
name: Ischaemic stroke
label: e
answer: no
explanation: A subarachnoid haemorrhage classically causes a sudden occipital headache. It usually occurs spontaneously in the context of a ruptured cerebral aneurysm but may be seen in association with other injuries when a patient has sustained a traumatic brain injury. This does not match the scenario above and is therefore incorrect.
name: Subarachnoid haemorrhage
label: d
answer: no
explanation: A subdural haemorrhage involves bleeding into the outermost meningeal layer. This most commonly occurs around the frontal and parietal lobes. Risk factors include old age, alcoholism and anticoagulation, none of which are present in this patient. There is a slower onset of symptoms and may be fluctuating confusion/consciousness, making this a less likely underlying diagnosis compared to an extradural haemorrhage.
name: Subdural haemorrhage
label: b
answer: no

Correct answer: a
A 16-year-old girl is brought to the emergency department by ambulance, after experiencing acute shortness of breath, coughing, and chest pain during a netball match. She has a previous diagnosis of asthma.

On examination she appears visibly short of breath and is unable to complete sentences in one breath. Her pulse is mildly elevated at 110 beats per minute, and she is saturating at 95% on room air. She has a respiratory rate (RR) of 29 and a blood pressure of 144/98 mmHg. Her peak expiratory flow rate (PEFR) is measured at 40%.

Which of the following describe the severity of her asthma exacerbation?

Options:
explanation: According to the British Thoracic Society guidelines, there are only 4 categories of asthma exacerbation severity (moderate, severe, life-threatening, and near-fatal), and ‘mild’ exacerbation is not one of them. Therefore, this answer is incorrect.
name: Mild
label: b
answer: no
explanation: Near-fatal asthma is usually associated with respiratory arrest and impaired consciousness, generally requiring artificial ventilation. This is not the case for the patient in this scenario. Therefore, this answer is incorrect.
name: Near-fatal
label: e
answer: no
explanation: Moderate asthma is characterised by a PEF of 50-75%, respiratory rate lower than 25, pulse lower than 110, and normal speech. This answer is not correct.
name: Moderate
label: c
answer: no
explanation: Life-threatening asthma is characterised by a PEF value lower than 33% and oxygen saturations lower than 92%. Patients would also have a silent chest, signs of cyanosis, confusion, a low pulse, and a low heart rate. The patient in this scenario does not have these features. Therefore, this answer is not correct.
name: Life-threatening
label: d
answer: no
explanation: A severe asthma exacerbation can be described as:

- PEF 33-55%
- Respiratory rate of more than or equal to 25
- Heart rate more than or equal to 110
- Inability to complete sentences in one breath

The patient in this scenario meets all of the above criteria, making this the correct answer.
name: Severe
label: a
answer: yes

Correct answer: a
A 25-year-old man attends the Medical Assessment Unit with abdominal pain that started suddenly earlier that morning. The pain is primarily in his loin region with some radiation into his groin. He reports nausea and reduced appetite, but no vomiting so far.

A urine dipstick displays 2+ for blood but is otherwise unremarkable. He undergoes CT imaging which reveals that he has two small stones in his left ureter.

Which of the following is the most likely composition of renal stones?

Options:
explanation: Only 5-10% of renal stones are made up of uric acid. Therefore, this is not the correct answer.
name: Uric acid
label: b
answer: no
explanation: Only 5-10% of renal stones are made up of struvite. Struvite stones usually lead to the formation of a single, large staghorn calculus. Therefore, this is not the correct answer.
name: Struvite
label: c
answer: no
explanation: 80% of renal stones are made up of calcium oxalate or calcium phosphate, making this is the correct answer.
name: Calcium
label: a
answer: yes
explanation: This is a very rare form of renal stone that forms following treatment with indinavir – an HIV medication. This therefore not the correct answer.
name: Indinavir
label: e
answer: no
explanation: Only about 1% of renal stones are made out of cysteine. They usually occur in people suffering from homocystinuria; an autosomal recessive inherited metabolic disorder. This is therefore not the correct answer.
name: Cysteine
label: d
answer: no

Correct answer: a
A 6-year-old boy is diagnosed with cystic fibrosis after suffering from recurrent chest infections and falling behind on his developmental milestones.

Which of the following describes the inheritance pattern and affected chromosome in cystic fibrosis?

Options:
explanation: While the pattern of inheritance is correct, the chromosome affected in cystic fibrosis is 7, not 8. Therefore, this answer is incorrect.
name: X linked recessive, chromosome 8
label: d
answer: no
explanation: While the pattern of inheritance is correct, the chromosome affected in cystic fibrosis is 7, not 6. Therefore this answer is incorrect.
name: Autosomal recessive, chromosome 6
label: b
answer: no
explanation: This answer is incorrect as both the pattern of inheritance and the chromosome are not correct.
name: Autosomal dominant, chromosome 6
label: e
answer: no
explanation: Cystic fibrosis is a progressive, autosomal recessive disorder that causes persistent lung infections and limits the ability to breathe over time. It is caused by a mutation in a gene located on chromosome 7. Therefore, this is the correct answer.
name: Autosomal recessive, chromosome 7
label: a
answer: yes
explanation: While the chromosome affected is correct, the pattern of inheritance is not. Therefore, this answer is not correct.
name: Autosomal dominant, chromosome 7
label: c
answer: no

Correct answer: a
A 25-year-old woman visits the GP practice for her first smear test. The GP briefly describes to her the anatomy of the female reproductive system while explaining the upcoming procedure.

Which of the following sets of lymph nodes drains the ovaries?

Options:
explanation: This is the correct answer. Lymph from the ovaries drains into the para-aortic nodes, reflecting their developmental origin.
name: Para-aortic lymph nodes
label: a
answer: yes
explanation: This answer is incorrect as ovaries do not drain into the external iliac lymph nodes.
name: External iliac lymph nodes
label: c
answer: no
explanation: This answer is incorrect as ovaries do not drain into the inguinal lymph nodes.
name: Inguinal lymph nodes
label: e
answer: no
explanation: This answer is incorrect as ovaries do not drain into the sacral lymph nodes.
name: Sacral lymph nodes
label: b
answer: no
explanation: This answer is incorrect as ovaries do not drain into the internal iliac lymph nodes.
name: Internal iliac lymph nodes
label: d
answer: no

Correct answer: a
A 75-year-old man visits the GP surgery. Over the past 6 months, he has noticed some changes in his bowel habits. His stools have become looser, and he describes a feeling of incomplete evacuation. Upon questioning, he also reports one episode of bleeding from his rectum.

He is otherwise healthy, with no medical conditions other than type II diabetes. He drinks about 16 units of alcohol a week and is a life-long smoker.

Which of the following is the most likely diagnosis?

Options:
explanation: Peptic ulcer disease would not present with the features described above. It would present as epigastric pain, bloating, nausea and reflux. This is therefore not the correct answer.
name: Peptic ulcer disease
label: e
answer: no
explanation: This is not the correct answer. Crohn’s disease typically presents with crampy abdominal pain in addition to diarrhoea. It is usually diagnosed in people between 15 and 40 years old.
name: Crohn’s disease
label: c
answer: no
explanation: Although haemorrhoids can account for rectal bleeding, they do not typically cause a change in bowel habits and are not associated with smoking. Therefore, this answer is not correct.
name: Haemorrhoids
label: d
answer: no
explanation: Colorectal cancer is the fourth most common cancer in the UK. Strong risk factors include increasing age, increased alcohol intake, and smoking. All of these are present in this patient. The presentation of this patient is also consistent with the presentation of colorectal cancer, with a change in bowel habits and rectal bleeding.
name: Colorectal cancer
label: a
answer: yes
explanation: While some features of this case are in line with the features of ulcerative colitis, this is not the correct answer. The presentation of ulcerative colitis commonly includes diarrhoea stained with mucus or blood which this patient does not have. Ulcerative colitis also tends to cause pain in the left iliac fossa.
name: Ulcerative colitis
label: b
answer: no

Correct answer: a
A 41-year-old women attends the GP surgery with pain in the small joints of her hands. This has been ongoing for the past 4 months. She is also experiencing prolonged stiffness when waking up, however she mentions that using her hands at work seems to alleviate the pain.

She is usually fit and well, with no other medical conditions. However, she does smoke up to 20 cigarettes per day.

Given the most likely diagnosis, which of the following auto-antibodies will be raised?

Options:
explanation: The most likely diagnosis is rheumatoid arthritis. This is a chronic inflammatory autoimmune disease, typically presenting as a symmetrical, polyarticular inflammatory arthritis involving the small joints of the hands. Risk factors for this patient include female sex and a history of smoking. The most common autoantibody present in the blood of patients with rheumatoid arthritis is anti-rheumatoid factor.
name: Anti-rheumatoid factor antibodies
label: a
answer: yes
explanation: Anti-thyroid peroxidase antibody is most commonly found in Hashimoto’s disease. This is an autoimmune condition affecting the thyroid gland, with patients typically presenting with symptoms of hypothyroidism. These symptoms are not present in this patient, making this option incorrect.
name: Anti-thyroid peroxidase antibody
label: b
answer: no
explanation: Anti-thyroid stimulating hormone receptor antibody  is most commonly found in Grave’s disease. This is an autoimmune condition affecting the thyroid gland, with patients typically presenting with symptoms of hyperthyroidism. These symptoms are not present in this patient, making this option incorrect.
name: Anti-thyroid stimulating hormone receptor antibody
label: c
answer: no
explanation: Anti-double stranded DNA antibodies are a specific maker of systemic lupus erythematosus (SLE). Although SLE can present with join problems, there is also typically evidence of systemic upset (e.g. fever, fatigue or myalgia). SLE is also much less common than rheumatoid arthritis, making this option incorrect.
name: Anti-double stranded DNA antibodies
label: d
answer: no
explanation: This answer is incorrect as these antibodies are most commonly found in coeliac disease. Coeliac disease is characterised by gastrointestinal symptoms such as abdominal pain, nausea, and diarrhoea, none of which are present in this patient.
name: Anti-tissue transglutaminase IgA antibodies
label: e
answer: no

Correct answer: a
A 65-year man with a history of hypertension visits his GP for a routine blood pressure check. This reveals a blood pressure of 155/99 mmHg. He is currently on amlodipine for control of his blood pressure but the GP would like to introduce another medication.

Which of the following medications should be added next?

Options:
explanation: Indapamide is a thiazide-like diuretic which can be added as a third step when step 2 has failed to control blood pressure or was not tolerated. This is therefore not the correct answer.
name: Indapamide
label: b
answer: no
explanation: Doxazosin is an alpha blocker that can be used as the fourth step in the management of hypertension. This is therefore not the correct answer.
name: Doxazosin
label: e
answer: no
explanation: Spironolactone can be used as the fourth step in the management of hypertension in someone with a serum potassium < 4.5 mmol/L. This is therefore not the correct answer.
name: Spironolactone
label: d
answer: no
explanation: This would be the right choice for this patient. According to NICE, step 2 for hypertension management in people over 65 is the addition of an ACE inhibitor (i.e. ramipril) or an angiotensin receptor blocker in addition to a calcium channel blocker.
name: Ramipril
label: a
answer: yes
explanation: Atenolol is a beta-blocker that can be used as step 4 as part of the management of hypertension. This is therefore not the correct answer.
name: Atenolol
label: c
answer: no

Correct answer: a