hllj/quesmed huggingface dataset:
In an operating theatre, during a surgery on the abdomen, the surgeon points out an artery to you and says it has a tortuous route and lies in the left upper quadrant.

What is the name of this artery?

Options:
explanation: This is incorrect as the abdominal aorta lies slightly left to the midline and is straight until L4 where it bifurcates into the common iliac arteries.
name: Abdominal Aorta
label: b
answer: no
explanation: This is incorrect as the left renal artery supplies the kidney and is not torturous.
name: Left Renal Artery
label: e
answer: no
explanation: This is incorrect as the common hepatic artery originates at the coeliac trunk and then supplies structures on the right hand side.
name: Common Hepatic Artery
label: c
answer: no
explanation: This is incorrect as the inferior mesenteric artery supplies structures in the left lower quadrant.
name: Inferior Mesenteric Artery
label: d
answer: no
explanation: The splenic artery is correct as it has a tortuous route from the coeliac trunk to the spleen.
name: Splenic Artery
label: a
answer: yes

Correct answer: a
A 60-year-old female presents to her GP with a 3 month history of heartburn and progressively worsening dysphagia. She also notes she has lost some weight recently.

What is the most important step to take?

Options:
explanation: This is incorrect due to the red flag symptoms the patient is reporting. Whilst a Nissen fundoplication is a good surgical management option for GORD, this is usually offered after all Medical options have been exhausted and the patient is concerned with long-term side effects of medication.
name: Refer to surgery for a Nissen fundoplication
label: c
answer: no
explanation: This is the most important step to take as this woman is over the age of 55, has dysphagia and has weight loss, a diagnosis of cancer is highly suspected, so an urgent referral is necessary.
name: Referral to Endoscopy under urgent 2-week-wait
label: a
answer: yes
explanation: This is incorrect as this patient has many red flag symptoms indicating a cancer diagnosis is likely.
name: Prescribe 20mg of Omeprazole once a day and review in 4-8 weeks
label: b
answer: no
explanation: This is incorrect as the patient is displaying clear red flag symptoms that need urgent investigation. pH monitoring is useful in making an initial diagnosis of GORD.
name: 24-hour pH monitoring
label: e
answer: no
explanation: This is incorrect as this patient is presenting with many red flag symptoms indicative of a cancer diagnosis. Therefore, they must be referred to endoscopy as a matter of urgency.
name: Non-urgent referral to endoscopy
label: d
answer: no

Correct answer: a
A 46-year-old male presents to his GP with epigastric pain, dyspepsia and heartburn. On examination, the GP noted epigastric tenderness. The patient remarks he take ibuprofen almost every day for knee pain and is allergic to penicillin. The GP organises a stool antigen test which proves to be positive for *H. pylori* antigens.

What is the best course of management?

Options:
explanation: This is incorrect as the patient has a penicillin allergy. This combination of drugs can be used for *H.pylori* eradication in patients without a penicillin allergy.
name: Omeprazole, Amoxicillin and Clarithromycin
label: b
answer: no
explanation: This is incorrect as the patient has a penicillin allergy. This combination of drugs can be used for *H.pylori* eradication in patients without a penicillin allergy.
name: Omeprazole, Amoxicillin, Metronidazole
label: c
answer: no
explanation: This is incorrect as this would be a second-line management option for patients where a first-line management was unsuccessful.
name: Omeprazole, Bismuth subsalicylate, Metronidazole and Tetracycline
label: d
answer: no
explanation: A PPI and dual-therapy of antibiotics is the best course of action for PUD with *H.pylori* eradication therapy. As this patient is allergic to penicillins the correct antibiotic combination would be Clarithromycin and Metronidazole for first line therapy.
name: Omeprazole, Clarithromycin and Metronidazole
label: a
answer: yes
explanation: This is incorrect as this is a second-line treatment for the eradication of *H.pylori* and the patient is allergic to penicillins.
name: Omeprazole, Amoxicillin, Levofloxacin
label: e
answer: no

Correct answer: a
A 58-year-old male with a 3-month history of melaena is brought into the Emergency Department as he has become increasingly confused. You take some obs which are: BP - 75/46 mm/Hg, HR - 127 BPM, the temperature of 36.2. ECG is normal and the you note the patient has pale, cool hands.

What type of Shock is the patient in?

Options:
explanation: This is incorrect, as there is no evidence of there being an obstruction of blood flow.
name: Obstructive Shock
label: d
answer: no
explanation: This is incorrect as there is no evidence of any heart damage, where the heart is unable to meet the demands of the body.
name: Cardiogenic Shock
label: c
answer: no
explanation: This is incorrect as there is no evidence of infection, as the patients is normothermic.
name: Septic Shock
label: b
answer: no
explanation: This is correct as the patient has a clear history of blood loss, the patient's blood pressure is dropping and his heart rate is increasing to try and compensate for this.
name: Hypovolaemic Shock
label: a
answer: yes
explanation: This is incorrect as there is no evidence of any allergic trigger, causing this patients' symptoms.
name: Anaphylactic Shock
label: e
answer: no

Correct answer: a
A 58-year-old male with a 3 month history of melaena is brought into the Emergency Department as he has become increasingly confused. You take some obs which are: BP - 75/46 mm/Hg, HR - 127 BPM, the temperature of 36.2. On examination the patient has pale, cool hands.

What is the most appropriate management?

Options:
explanation: This is incorrect s NICE guidelines recommend fluid resuscitation with crystalloids that have a sodium content of 130-154 mmol/l and 5% glucose solution contains 0 mmol/l of sodium chloride.
name: 500ml IV 5% glucose
label: d
answer: no
explanation: This is incorrect as NICE guidelines recommend fluid resuscitation with crystalloids that have a sodium content of 130-154 mmol/l and this only has 31 mmol/l.
name: 500ml IV Sodium chloride 0.18%/4% glucose
label: b
answer: no
explanation: This is correct. NICE guidelines recommends administering IV fluids, using crystalloids that contains sodium in the range 130-154 mmol/l. Giving a 500ml bolus in less than 15 mins.
name: 500ml IV Sodium chloride 0.9%
label: a
answer: yes
explanation: This is incorrect as NICE guidelines recommend fluid resuscitation with crystalloids that have a sodium content of 130-154 mmol/l and this only has 77 mmol/l.
name: 500ml IV 0.45% NaCl/4% glucose
label: c
answer: no
explanation: This is incorrect, human albumin solution is only considered in fluid resuscitation for patients with severe sepsis.
name: 500ml IV Human Albumin 4.5%
label: e
answer: no

Correct answer: a
A 68-year-old female has been admitted to the Acute Surgical Unit following severe generalised abdominal pain, accompanied by fever and vomiting. The patient reported that the pain has now localised to the left iliac fossa and is very severe. On examination, it is noted the patient is tachycardic and there is diffuse abdominal guarding.

What is the most likely diagnosis?

Options:
explanation: This is the correct answer as the history is indicative of peritonitis - generalized abdominal pain with guarding that localises to an area.
name: Peritonitis
label: a
answer: yes
explanation: This is unlikely to be pancreatitis, as pancreatitis localises in the epigastric region and the pain radiates to the back.
name: Pancreatitis
label: e
answer: no
explanation: This is an unlikely diagnosis as the pain has localised in the left iliac fossa. Ascending Cholangitis localises in the right hypochondrium.
name: Ascending Cholangitis
label: d
answer: no
explanation: Whilst a good differential to have in mind, there is no mention of right iliac fossa pain, which would lean the diagnosis to appendicitis.
name: Appendicitis
label: b
answer: no
explanation: Whilst a good differential to have, given this patients' age it is unlikely to be an ectopic pregnancy.
name: Ectopic Pregnancy
label: c
answer: no

Correct answer: a
You are on the ward and you notice a 72-year-old male, who had bowel repair surgery yesterday following perforation has suddenly become pyrexic, increased pain around the surgical site and is becoming confused.

What is the most likely diagnosis?

Options:
explanation: This is a rare, but feasible complication of surgery and a good complication to have as a differential in this case. However, the increased pain at the surgical site points more towards a post-operative sepsis.
name: Reaction to anaesthesia
label: c
answer: no
explanation: This is incorrect as there is no evidence of urinary retention in this history.
name: Urinary Retention
label: d
answer: no
explanation: This is incorrect as based on the history there is no evidence of hypovolaemic shock.
name: Hypovolaemic Shock
label: e
answer: no
explanation: This is the most likely diagnosis, given the type of surgery the patient had and the new onset symptoms.
name: Post-Operative Sepsis
label: a
answer: yes
explanation: Whilst this is an important complication post-surgery to remember, there are no clinical signs to point to PE at the moment.
name: Pulmonary Embolism (PE)
label: b
answer: no

Correct answer: a
A 57-year-old male developed sharp, right upper quadrant pain after dinner last night. Blood results show deranged LFTs. On examination, you notice the patient winces on inspiration when your hand is placed on their right costal margin.

What is the name of this sign?

Options:
explanation: This is incorrect. Kehr's sign is acute shoulder tip pain most commonly due to blood irritating the diaphragm. This is a common presentation of both ruptured ectopic pregnancy and a ruptured spleen.
name: Kehr's sign
label: e
answer: no
explanation: This is incorrect. Rovsing's sign occurs in appendicitis when there is pain in the Right Iliac Fossa on palpating the Left Iliac Fossa.
name: Rovsing's Sign
label: b
answer: no
explanation: This is incorrect. Dunphy's sign is where abdominal pain is increased with coughing. It is associated with appendicitis and peritonitis.
name: Dunphy's Sign
label: c
answer: no
explanation: This is correct. Murphy's sign is a good way to differentiate between RUQ differentials as it is generally only positive in Cholecystitis. Murphy's sign is positive when you ask the patient to breathe out, place your hand on their right costal margin and they feel pain when the gallbladder (which is being pushed down by inspiration) comes into contact with the examiners' hand. This sign is only positive when it occurs on the right hand side.
name: Murphy's Sign
label: a
answer: yes
explanation: This is incorrect as Blumberg's sign is associated with pain upon removal of pressure (rebound tenderness). This is indicative of appendicitis.
name: Blumberg's Sign
label: d
answer: no

Correct answer: a
Which is the correct lineage of a Macrophage?

Options:
explanation: This answer is correct. Macrophages are derived from Myeloid Progenitor Cells.
name: Common Myeloid Progenitor, Myeloblast, Monocyte, Macrophage
label: a
answer: yes
explanation: This is incorrect as Megakaryocytes break up to form platelets, not macrophages.
name: Common Myeloid Progenitor, Megakaryocyte, Macrophage
label: c
answer: no
explanation: This is incorrect as neither Common Lymphoid Progenitors nor Neutrophils are involved in the lineage of Macrophages.
name: Common Lymphoid Progenitor, Myeloblast, Neutrophil, Macophage
label: e
answer: no
explanation: This is incorrect as Macrophages are derived from Myeloid Progenitor Cells, not lymphoid progenitor cells.
name: Common Lymphoid Progenitor, Small Lymphocyte, B Lymphocyte, Macrophage
label: b
answer: no
explanation: This is incorrect as whilst all of the  cells in this answer are correct, they are not in the correct order. The correct order is: Common Myeloid Progenitor, Myeloblast, Monocyte, Macrophage
name: Common Myeloid Progenitor, Monocyte, Myeloblast, Macrophage
label: d
answer: no

Correct answer: a
A 42-year-old Female, who follows a vegan diet presents to her GP feeling tired all of the time. FBC and blood film show a Haemoglobin of 8.8 g/dL, Mean Cell volume of 62 fL and hypochromic cells.

What is the most likely diagnosis?

Options:
explanation: This is incorrect as although a vitamin B12 deficiency is common in those who follow a vegan diet, B12 deficiency anaemia would have Macrocytic (increased MCV) cells.
name: Vitamin B12 Deficiency Anaemia
label: b
answer: no
explanation: This is incorrect as although a Folate deficiency is common in those who follow a vegan diet, Folate deficiency anaemia would have Macrocytic (increased MCV) cells.
name: Folate Deficiency Anaemia
label: c
answer: no
explanation: This is incorrect as Acute Blood Loss Anaemia would have normocytic cells, whereas this patient has microcytic cells.
name: Acute Blood Loss Anaemia
label: e
answer: no
explanation: This is correct, as the patient has a reduced haemoglobin, a reduced Mean cell volume (Microcytic cells) and hypochromic cells, all which point to Iron deficiency Anaemia.
name: Iron Deficiency Anaemia
label: a
answer: yes
explanation: This is incorrect as this patient has a Microcytic anaemia, and sickle cell anaemia has normocytic anaemia.
name: Sickle Cell Anaemia
label: d
answer: no

Correct answer: a
A 79-year-old female on the respiratory ward who was prescribed Co-amoxiclav for mild hospital-acquired pneumonia has passed five loose, watery stools in the past 24 hours and is pyrexic.

What is the most appropriate management?

Options:
explanation: This is incorrect as Fidaxomicin is prescribed as a second-line antibiotic only when Vancomycin has been tried and is ineffective or if there is a relapse in *C.difficile* infection.
name: 200mg Fidaxomicin Orally 2 times a day for 10 days
label: c
answer: no
explanation: This is incorrect. The *C. diff* needs to be treated with Vancomycin to avoid the spread throughout the rest of the ward and to relieve the patient's symptoms.
name: Let the patient finish the current course of Co-amoxiclav
label: b
answer: no
explanation: This is the correct first-line treatment for severe *C.difficile* as per NICE guidelines.
name: 125mg Vancomycin Orally 4 times a day for 10 days
label: a
answer: yes
explanation: This is incorrect. This combination of aggressive antibiotics is generally only given by specialists after both First- and Second-line antibiotics have been ineffective or when there is a life-threatening infection.
name: 500mg Vancomycin orally 4 times a day and 500mg Metronidazole IV 3 times a day both for 10 days
label: d
answer: no
explanation: This is incorrect as FMT is only recommended in refractory or recurrent *C.diff* infections.
name: Faecal microbiota transplantation (FMT)
label: e
answer: no

Correct answer: a
A 46-year-old female with a history of Type 2 Diabetes Mellitus, that is normally controlled with Metformin, presents to her GP with polyuria, polydipsia and headache. Her blood glucose is 17.9 mmol/L (normal <6.1 mmol/L) and on urinalysis there are ++ for ketones.


What is the diagnosis and what steps should be taken to manage this patient?

Options:
explanation: This is correct.  Patients with DKA will require IV fluid replacement due to dehydration, Insulin to lower hyperglycaemia, and potassium to prevent hypokalaemia associated with insulin therapy.
name: Diabetic Ketoacidosis - Fluids, Insulin, Potassium
label: a
answer: yes
explanation: This is incorrect. Hypoglycaemia is defined as blood glucose <4.0 mmol/L. Treating this patient with FLuids, Insulin and Potassium is correct though.
name: Hypoglycaemia - Fluids, Insulin, Potassium
label: e
answer: no
explanation: This is incorrect. Hypergylcaemic Hyperosmolar State is when the patient's blood glucose is >30mmol/L. The treatment options are correct.
name: Hyperglycaemic Hyperosmolic State - Fluids, Insulin, Potassium
label: c
answer: no
explanation: Whilst the diagnosis and Insulin therapy are correct, large amounts of insulin should always be given with potassium to prevent hypokalaemia. Fluids should also be given as DKA patients are generally dehydrated.
name: Diabetic Ketoacidosis - Insulin
label: b
answer: no
explanation: This is incorrect. Hypoglycaemia is defined as blood glucose <4.0 mmol/L. Treating this patient with an oral glucose load and a complex carbohydrate meal will only exacerbate their current condition.
name: Hypoglycaemia - oral glucose load and complex carbohydrate meal
label: d
answer: no

Correct answer: a
A 42-year-old woman presents to her GP as she has been recently putting on weight, and has large visible stretch marks across her abdomen. Her arms and legs are disproportionately thin compared to her abdomen and she is noticing she is easily bruised. The GP performs her blood pressure and notes she is hypertensive.

What is the most likely diagnosis?

Options:
explanation: Although Hypertension is an indicator for Conn's syndrome, weight gain and easy bruising are not. Therfore, this answer is incorrect.
name: Conn's Syndrome
label: c
answer: no
explanation: This is correct as the patient's symptoms mirror that of someone who has had prolonged exposure of an excess of glucocorticoids such as that in Cushing's Syndrome.
name: Cushing's Syndrome
label: a
answer: yes
explanation: This is incorrect as hyperthyroidism is associated with weight loss, not gain as seen in this patient.
name: Hyperthyroidism
label: e
answer: no
explanation: This is incorrect. Although hypertension is associated with acromegaly the ease of bruising seen in this patient is not.
name: Acromegaly
label: d
answer: no
explanation: This is incorrect. Addison's disease typically presents with weight loss, muscle wasting, depression and postural hypotension.
name: Addison's Disease
label: b
answer: no

Correct answer: a
When there is hypoperfusion to the kidney, juxtaglomerular cells in the kidneys secrete a substance called renin into the circulation. Renin release eventually causes another substance to act on the adrenal gland which releases a mineralocorticoid.

Which layer of the adrenal gland is this released from and what is the mineralocorticoid?

Options:
explanation: This is incorrect as dehydroepiandrosterone is an androgen. Androgens are produced and secreted by the Zona reticularis.
name: Zona Glomerulosa - dehydroepiandosterone
label: c
answer: no
explanation: This is incorrect as the Zona Fasciculata produces and secretes cortisol and cortisol is a corticosteroid not a mineralocorticoid.
name: Zona Glomerulosa - Cortisol
label: b
answer: no
explanation: This is incorrect. Cortisol is a corticosteroid that is produced and secreted by the Zona Fasciculata.
name: Zona Fasciculata - Cortisol
label: e
answer: no
explanation: This is correct. Renin causes the conversion of Angiotensinogen to Angiotensin I in the blood stream. Angiotensin I is then converted to Angiotensin II by ACE (angiotensin-converting enzyme) in the lungs. Angiotensin II then acts on the Zona Glomerulosa in the adrenal cortex to release Aldosterone. Aldosterone causes the renal tubules to increase reabsorption of sodium, subsequently causing the reabsorption of water into the bloodstream.
name: Zona Glomerulosa - Aldosterone
label: a
answer: yes
explanation: This is incorrect. The adrenal medulla produces and secretes catecholamines such as adrenaline. Aldosterone is the correct mineralocorticoid but it is produced and secreted by the Zona Glomerulosa.
name: Adrenal Medulla - Aldosterone
label: d
answer: no

Correct answer: a
A 35-year-old female gave birth via an uncomplicated vaginal delivery 1 week ago. There were no complications during the pregnancy or birth. However, she has no noticed that when she coughs, she has some urine incontinence.

What type of incontinence is this?

Options:
explanation: This is incorrect as there is no evidence of this patient having an urge to urinate.
name: Urgency Incontinence
label: b
answer: no
explanation: Stress incontinence is correct. The pregnancy and vaginal birth would have caused some weakening of the patients' pelvic floor muscles and the coughing causes an increase in intra-abdominal pressure which leads to the incontinence.
name: Stress Incontinence
label: a
answer: yes
explanation: This is incorrect as there is no evidence of bladder outlet obstruction or an underactive detrusor muscle in this patient.
name: Overflow Incontinence
label: d
answer: no
explanation: This is incorrect as although this patient has elements of stress incontinence, there is no evidence of Urgency Incontinence.
name: Mixed Incontinence
label: c
answer: no
explanation: This is incorrect, as there is no evidence of this patient not being able to store any urine at all which would be the case in total incontinence.
name: Total Incontinence
label: e
answer: no

Correct answer: a
A 69-year-old male presents to his GP with peripheral oedema and a feeling of being tired all of the time. The GP performs a urine dip which shows +++ for protein, however there is no haematuria. Leukocytes and Nitrites are negative too.


Blood shows albumin levels of 27 g/L (normal range 35 - 50 g/L).


What is the underlying cause?

Options:
explanation: Nephritic syndrome is incorrect as there is no proteinuria.
name: Nephritic Syndrome
label: b
answer: no
explanation: While heart failure is a good differential, there are no other signs such as breathlessness or cyanosis.
name: Heart Failure
label: d
answer: no
explanation: Nephrotic Syndrome is correct as this patient presents with the classical triad of: Oedema, hypoalbuminaemia and proteinuria.
name: Nephrotic Syndrome
label: a
answer: yes
explanation: AKI is incorrect as there is no decline in renal function in the history, such as reduced urine output.
name: Acute Kidney Injury (AKI)
label: e
answer: no
explanation: UTI is incorrect as there is no systemic signs of infection and the urine is negative for both leukocytes and nitrites.
name: Urinary Tract Infection (UTI)
label: c
answer: no

Correct answer: a
A 38-year-old female has dysuria, nocturia and cloudy urine. Urine dipstick shows ++ for both leukocytes and nitrites. The doctor diagnoses a UTI. The patient is not currently known to be pregnant.

What is the best treatment?

Options:
explanation: This is incorrect as Amoxicillin is only given in pregnant women as second-line management when a urine culture has been performed and the causative organism is sensitive to amoxicillin.
name: Amoxicillin 500mg three times a day for 7 days
label: d
answer: no
explanation: This is incorrect as Cefalexin at this dose is indicated in acute Pyelonephritis.
name: Cefalexin 500mg 2/3 times a day for 7-10 days
label: e
answer: no
explanation: This is incorrect as this is the treatment for UTIs in men or pregnant women.
name: Nitrofurantoin 100mg twice a day for 7 days
label: c
answer: no
explanation: This is incorrect as Pivmecillinam is indicated as second-line management for lower UTIs in non-pregnant women.
name: Pivmecillinam 400mg initially, then 200mg three times a day for 3 days
label: b
answer: no
explanation: This is correct. Nitrofurantoin is the first line antibiotic for lower UTIs in non-pregnant women.
name: Nitrofurantoin 100mg twice a day for 3 days
label: a
answer: yes

Correct answer: a