hllj/quesmed huggingface dataset:
A 3-year-old boy presents to his GP with his parent. He has a barking cough and fever. His parent says he has been struggling to breathe at times over the last 2 days although this has resolved now. He is saturating appropriately on room air.

Given the likely diagnosis, which of the following is the most appropriate treatment?

Options:
explanation: This is an NSAID and has no place in treating croup here. Dexamethasone is necessary to treat mild cases of croup.
name: Ibuprofen
label: d
answer: no
explanation: Croup is typically an upper respiratory tract infection that needs to be treated with dexamethasone.
name: Rest and reassurance
label: b
answer: no
explanation: Whilst this may alleviate fever due to its anti-pyretic properties, croup needs to be treated with dexamethasone.
name: Paracetamol
label: c
answer: no
explanation: This patient is presenting with croup, a common illness that affects babies and young children. Most cases are caused by the parainfluenza virus and can be treated with a single dose of dexamethasone.
name: Dexamethasone
label: a
answer: yes
explanation: Oxygen may be required in severe cases of croup, however, as this patient’s dyspnoea has resolved and he is saturating appropriately he can be managed in primary care with dexamethasone.
name: Oxygen
label: e
answer: no

Correct answer: a
A 67-year-old male patient presents to his GP with a chronic cough and drooping eyelid. The GP notes he has a constricted pupil in his right eye. The patient is a known smoker and has been for 40 years.

Which of the following is the most likely diagnosis for this presentation?

Options:
explanation: This is an abnormal build-up of fluid in the pleural cavity and would present with dyspnoea, chest pain and reduced exercise tolerance.
name: Pleural effusion
label: d
answer: no
explanation: This is an autosomal recessive condition caused by a mutation in chromosome 7. It is present from birth and would have respiratory symptoms like sinusitis, cough and recurrent respiratory tract infections.
name: Cystic fibrosis
label: c
answer: no
explanation: The patient may have a Pancoast tumour in his lung, however, these symptoms correlate with Horner’s syndrome which is the direct diagnosis at this time. It cannot be confirmed yet whether the underlying cause of Horner’s syndrome is due to a Pancoast tumour.
name: Pancoast tumour
label: b
answer: no
explanation: This is air within the pleural space and may come on suddenly. Patients may experience sudden onset pleuritic chest pain and shortness of breath.
name: Pneumothorax
label: e
answer: no
explanation: This is characterised by ptosis, miosis and anhidrosis due to sympathetic chain ganglion disruption. Given that the patient is a smoker, he may have a Pancoast tumour at the lung apex which can affect the sympathetic chain and cause Horner’s syndrome, however, further testing and investigation would be necessary to determine this.
name: Horner’s syndrome
label: a
answer: yes

Correct answer: a
Which of the following is the scoring system used for infective endocarditis?

Options:
explanation: This is used to predict how soon a pregnant woman will be in labour.
name: Bishop’s score
label: b
answer: no
explanation: This is used as a diagnostic guide for infective endocarditis. It can be split into major and minor criteria.
name: Modified Duke's criteria
label: a
answer: yes
explanation: This is used to determine the severity of pneumonia.
name: CURB-65
label: c
answer: no
explanation: This is the scoring system for major bleeding risk.
name: HASBLED
label: d
answer: no
explanation: This is the scoring system for calculating stroke risk in patients with atrial fibrillation.
name: CHA2DS2-VASC
label: e
answer: no

Correct answer: a
A 48-year-old male presents to A&E with sudden onset chest pain that radiates down his left arm. An ECG was performed which showed ST elevation in leads II, III and aVF.

Which of the following vessels is most likely affected causing this presentation?

Options:
explanation: This would show ST elevation in leads V5-6 and/or I and aVL.
name: Left circumflex
label: c
answer: no
explanation: This is an inferior ST-elevation myocardial infarction showing ST elevation in leads II, III and aVF.
name: Right coronary artery
label: a
answer: yes
explanation: This would be an anterior ST-elevation myocardial infarction showing ST elevation in leads V3-4 and/or leads V5-6.
name: Left anterior descending artery
label: b
answer: no
explanation: This is typically used as a graft in coronary artery bypass graft surgery (CABG) when coronary arteries are severely occluded.
name: Left internal mammary artery
label: d
answer: no
explanation: This can be used as a graft in coronary artery bypass graft surgery (CABG).
name: Radial artery
label: e
answer: no

Correct answer: a
A 70-year-old female presents to her GP as she feels a ‘fluttering’ in her chest and has been feeling dizzy more regularly. She has a past medical history of hypertension and on examination, her pulse was irregularly irregular. An ECG shows an irregularly irregular rhythm with no P waves.

Which of the following is the most likely diagnosis?

Options:
explanation: This condition is characterised by uncoordinated atrial contraction at a rate of around 300-600 bpm. Patients may have palpitations, dyspnoea, chest pain or dizziness and an irregularly irregular pulse in atrial fibrillation.
name: Atrial fibrillation
label: a
answer: yes
explanation: This is a genetic disorder of sodium channelopathies. It tends to occur in male Southeast Asian patients who may have sudden cardiac death.
name: Brugada syndrome
label: e
answer: no
explanation: This is the backflow of blood across the mitral valve. Patients often present with dyspnoea, fatigue and weakness.
name: Mitral regurgitation
label: d
answer: no
explanation: This is a common valvular pathology where the aortic valve becomes narrowed. It is associated with a classic triad of heart failure, syncope and angina. A slow rising pulse and narrow pulse pressure are other typical features.
name: Aortic stenosis
label: c
answer: no
explanation: This is a narrow complex tachycardia with atrial activity of > 300 bpm. Symptoms include palpitations, dizziness and chest pain, however, on ECG, a saw-tooth pattern is seen.
name: Atrial flutter
label: b
answer: no

Correct answer: a
Which of the following is a cause of aortic regurgitation?

Options:
explanation: This can cause mitral regurgitation due to abnormal left ventricle structure.
name: Hypertrophic cardiomyopathy
label: d
answer: no
explanation: Myxomas are benign and are composed of unspecialised mesenchymal cells. They are the most common type of primary cardiac tumour.
name: Cardiac myxoma
label: c
answer: no
explanation: This is a genetic condition which can cause pulmonary stenosis.
name: Noonan syndrome
label: e
answer: no
explanation: This has an increased risk of aortic stenosis and aortic dissection due to a bicuspid aortic valve and coarctation of the aorta respectively.
name: Turner's syndrome
label: b
answer: no
explanation: Marfan syndrome is a genetic cause of aortic root dilatation which can lead to incomplete aortic valve closure, therefore allowing the regurgitation of blood back into the left atrium.
name: Marfan syndrome
label: a
answer: yes

Correct answer: a
Which of the following can be used initially to achieve rate control in atrial fibrillation (AF)?

Options:
explanation: This is a beta-blocker, however, is not used for initial first line treatment for rate control in patients with AF. Sotalol has additional action in antagonising potassium channels.
name: Sotalol
label: e
answer: no
explanation: This can be used for rate and rhythm control although has a large side effect profile so is generally avoided where possible unless the patient is elderly and more sedentary.
name: Amiodarone
label: c
answer: no
explanation: This is a beta-blocker which can be used in initial rate control for patients with AF. A rate-limiting calcium channel blocker like diltiazem can also be used.
name: Bisoprolol
label: a
answer: yes
explanation: This is not used for initial rate control due to a large side effect profile. It is often used as a second line in conjunction with a beta-blocker.
name: Digoxin
label: d
answer: no
explanation: This is used to achieve rhythm control rather than rate.
name: Electrical cardioversion
label: b
answer: no

Correct answer: a
A 47-year-old male presents to his GP after experiencing multiple episodes of syncope recently. He has a past medical history of angina. On examination, an ejection systolic murmur is heard. An ECG is performed which shows increased QRS complex voltages.

Which of the following is the most likely diagnosis?

Options:
explanation: Aortic stenosis has a classic triad of symptoms - heart failure, syncope and angina. The patient may also have exertional dyspnoea and a slow rising pulse, narrow pulse pressure and ejection systolic murmur may be present.
name: Aortic stenosis
label: a
answer: yes
explanation: This is an impaired opening of the mitral valve. The most common cause is rheumatic heart disease and it can present with exertional dyspnoea and reduced exercise tolerance.
name: Mitral stenosis
label: e
answer: no
explanation: This is the backflow of blood into the left atrium and can present differently in acute vs chronic cases. Acute cases can present with sudden collapse, pulmonary oedema and sweating whilst chronic cases may present with exertional dyspnoea, orthopnoea and paroxysmal nocturnal dyspnoea. A Corrigan's pulse may be felt on examination and an early diastolic murmur will be heard.
name: Aortic regurgitation
label: c
answer: no
explanation: Patients with atrial flutter may present with symptoms such as palpitations, dizziness or chest pain. The patient may also be asymptomatic. On ECG, a saw-tooth pattern is seen with narrow QRS complexes and a heart rate > 300 bpm.
name: Atrial flutter
label: b
answer: no
explanation: This is the backflow of blood across the mitral valve. It may present with dyspnoea, fatigue and weakness in acute cases or may be asymptomatic in chronic cases.
name: Mitral regurgitation
label: d
answer: no

Correct answer: a
Which of the following is a key clinical feature of chronic obstructive pulmonary disease (COPD)?

Options:
explanation: A chronic productive cough lasting over 3 months in at least 2 consecutive years is a key clinical feature and must be present.
name: Chronic productive cough lasting over 2 months in at least 2 consecutive years
label: b
answer: no
explanation: A chronic productive cough lasting over 3 months in at least 2 consecutive years is a key clinical feature for diagnosis.
name: Chronic productive cough lasting over 1 month in at least 1 consecutive year
label: c
answer: no
explanation: A chronic productive cough lasting over 3 months in at least 2 consecutive years is a key clinical feature of COPD. Purulent sputum, hypoxia and hypercapnia may also be present.
name: Chronic productive cough lasting over 3 months in at least 2 consecutive years
label: a
answer: yes
explanation: A chronic productive cough lasting over 3 months in at least 2 consecutive years is a key clinical feature for diagnosis.
name: Chronic productive cough lasting over 2 months in at least 2 consecutive years
label: e
answer: no
explanation: A chronic productive cough lasting over 3 months in at least 2 consecutive years is a key clinical feature for diagnosis.
name: Chronic productive cough lasting over 2 months in at least 1 consecutive year
label: d
answer: no

Correct answer: a
Which of the following pathogens is most likely to be found in a patient with known alcoholism who has developed pneumonia?

Options:
explanation: This bacterium primarily infects younger patients who may present with a flu-like illness.
name: *Mycoplasma pneumoniae*
label: b
answer: no
explanation: This pathogen often causes pneumonia in patients who have been exposed to poor hotel air conditioning. It is important in this case to ask about travel.
name: *Legionella pneumoniae*
label: c
answer: no
explanation: *Klebsiella pneumoniae* often infects patients who are elderly, and have alcoholism or diabetes due to a weakened immune system.
name: *Klebsiella pneumoniae*
label: a
answer: yes
explanation: This bacterium can cause psittacosis and is acquired from infected birds, like parrots, or cattle.
name: *Chlamydophila psittaci*
label: d
answer: no
explanation: This pathogen often occurs in patients who are immunosuppressed because of malignancy, chemotherapy or who are HIV positive.
name: *Pneumocystis jirovecii*
label: e
answer: no

Correct answer: a
A 65-year-old man presents to his GP as he is finding it difficult to sleep well and is struggling to concentrate at work. He has a BMI of 40 and a 50-pack-year history.

Which of the following is the gold-standard diagnostic investigation for the most likely diagnosis?

Options:
explanation: This is a useful investigation to track heart rate and activity, however, polysomnography is more useful to diagnose obstructive sleep apnoea as it measures heart rate, oxygen levels and breathing.
name: ECG
label: d
answer: no
explanation: This is not the gold standard and would not be necessary to determine whether the patient has obstructive sleep apnoea at this time.
name: CT
label: c
answer: no
explanation: This would not be necessary at this time to determine whether the patient has obstructive sleep apnoea.
name: MRI
label: b
answer: no
explanation: This is the gold-standard investigation for obstructive sleep apnoea, measuring physiological parameters while the patient sleeps. This patient has risk factors of being overweight, male and has a smoking history.
name: Polysomnography
label: a
answer: yes
explanation: This imaging technique would not be necessary at this time to determine if the patient has obstructive sleep apnoea.
name: X-ray
label: e
answer: no

Correct answer: a
A 76-year-old female has a productive cough and haemoptysis. She also has an audible wheeze and finger clubbing on examination.

Which of the following is the likely diagnosis?

Options:
explanation: This is a reversible obstruction of the airways resulting in bronchoconstriction. It would be less commonly diagnosed for the first time in a 76-year-old patient and would not typically present with haemoptysis. It is not associated with finger clubbing.
name: Asthma
label: b
answer: no
explanation: This often presents with sudden onset pleuritic chest pain, dyspnoea and haemoptysis. The patient would be acutely unwell and may have tachypnoea and tachycardia.
name: Pulmonary embolism
label: e
answer: no
explanation: This is an autosomal recessive condition often diagnosed in childhood. Patients may develop bronchiectasis as a result of cystic fibrosis (CF) however CF is less likely to be diagnosed at this age.
name: Cystic fibrosis
label: d
answer: no
explanation: This is a restrictive lung condition characterised by granuloma formation and inflammation. It may present with dry cough and dyspnoea. It is important to look out for erythema nodosum and bilateral hilar lymphadenopathy.
name: Sarcoidosis
label: c
answer: no
explanation: This is a permanent dilatation of the bronchi due to chronic infection. A productive cough, purulent sputum and haemoptysis would be symptoms of bronchiectasis. Finger clubbing, inspiratory crepitations, dyspnoea and wheeze may be signs found on examination.
name: Bronchiectasis
label: a
answer: yes

Correct answer: a
A 70-year-old male presents to his GP with a dry cough and dyspnoea. He has been a smoker since he was 16. He has no weight loss or haemoptysis. On examination, end-inspiratory crackles are heard.

Which of the following is the most likely diagnosis?

Options:
explanation: This is a progressive and restrictive lung disease. It often presents in male patients around the age of 70 and is more common in smokers. Dry cough, shortness of breath and fatigue are classic symptoms alongside cyanosis and end-inspiratory crackles as signs.
name: Idiopathic pulmonary fibrosis
label: a
answer: yes
explanation: This is an autosomal recessive condition often detected in neonates. It is a multisystem disorder although respiratory features including chronic sinusitis and thick mucus are common.
name: Cystic fibrosis
label: c
answer: no
explanation: Lung cancer usually presents with red-flag symptoms such as weight loss and haemoptysis, however, it is always important to consider malignancy as a differential diagnosis.
name: Lung cancer
label: d
answer: no
explanation: This is an abnormal build-up of fluid in the pleural cavity and patients may present with dyspnoea, reduced exercise tolerance and chest pain.
name: Pleural effusion
label: e
answer: no
explanation: This is an infection of the upper airway and is more common in children. It presents with a seal-bark cough.
name: Croup
label: b
answer: no

Correct answer: a
Which of the following is the most common cause of mitral stenosis?

Options:
explanation: This is an infection of the heart valves, however, patients may have predisposing factors like intravenous drug use, poor dentition or dental infections which cause IE. IE does not typically cause mitral stenosis.
name: Infective endocarditis (IE)
label: b
answer: no
explanation: This is an acute inflammation of the pericardium around the heart. Complications include cardiac tamponade or pericardial effusion. It is not associated with mitral stenosis.
name: Pericarditis
label: c
answer: no
explanation: This is a genetic condition which can often result in aortic stenosis or aortic dissection as a complication.
name: Turner's syndrome
label: d
answer: no
explanation: This is the most common cause of mitral stenosis. Streptococcal antigens secondary to bacterial infection can cause damage to the mitral valve.
name: Rheumatic heart disease
label: a
answer: yes
explanation: This is a genetic condition caused by sodium channelopathies and can result in arrhythmias, typically AV nodal re-entrant tachycardias, ventricular fibrillation or ventricular tachycardia. It is not associated with mitral stenosis.
name: Brugada syndrome
label: e
answer: no

Correct answer: a
A 68-year-old male patient was recently diagnosed with angina by his GP.

He has been following lifestyle advice from his GP to help reduce his risk factors for cardiovascular disease.

Which of the following management options would be useful to relieve symptoms of angina quickly?

Options:
explanation: This is a conservative measure and is used first line, however, the scenario mentions the patient is already undertaking a change in lifestyle measures to help the condition. This would not result in the alleviation of symptoms rapidly.
name: Smoking cessation
label: e
answer: no
explanation: GTN spray can be used sublingually to quickly relieve symptoms of angina such as chest pain that occurs from physical activity. This works in minutes and is useful as a 1st line management option to relieve symptoms.
name: Glyceryl trinitrate (GTN) spray
label: a
answer: yes
explanation: This is often used second-line in the management of angina. Examples include nifedipine or felodipine.
name: Long-acting calcium channel blockers
label: b
answer: no
explanation: CABG operations can be used for those with more complex cases of angina which are not adequately managed by medical treatment for example if they have complex 3-vessel disease or left main stem stenosis.
name: Coronary artery bypass graft (CABG)
label: c
answer: no
explanation: Digoxin is often used in patients with atrial fibrillation and heart failure or hypotension. It inhibits the Na/K ATPase pump in the myocardium.
name: Digoxin
label: d
answer: no

Correct answer: a
Which of the following accurately described the mechanism of digoxin?

Options:
explanation: This is an example of a class 3 anti-arrhythmic like amiodarone which delays repolarisation by blocking potassium channels and is used to treat arrhythmias such as ventricular fibrillation.
name: Inhibiting K+ channels
label: e
answer: no
explanation: This is an example of beta-blockers like atenolol or bisoprolol. They block the sympathetic action of the heart by agonising beta-1 receptors and therefore slowing the AV conduction in the heart.
name: Activate beta-1 receptors to block sympathetic stimulation of the heart
label: d
answer: no
explanation: This describes the mechanism of a sodium channel blocker such as flecainide used to reduce depolarisation and action potential amplitude in arrhythmias like atrial fibrillation.
name: Inhibit Na+ thus reducing the amplitude of action potentials
label: c
answer: no
explanation: The pericardium is the sac around the heart. Whilst the Na/K ATPase pump is inhibited by digoxin, this occurs in the myocardium, not the pericardium.
name: Inhibition of Na/K ATPase ion pumps in the pericardium
label: b
answer: no
explanation: Digoxin is used for patients with atrial fibrillation, heart failure and hypotension and works by inhibiting the Na/K ATPase pump in the myocardium resulting in negative chronotropy and positive ionotropy.
name: Inhibition of Na/K ATPase ion pumps in the myocardium
label: a
answer: yes

Correct answer: a
A 4-year-old girl is seen by her GP. Her mum describes that she struggles to catch her breath sometimes and has been coughing more. The mum mentions that her daughter has had eczema in the past and that her husband suffers from hay fever.

Which of the following is the most likely diagnosis?

Options:
explanation: This is an infection of the upper airway and is common in children. It presents with a seal-bark cough and fever, typically in the winter months.
name: Croup
label: d
answer: no
explanation: This is an autosomal recessive condition often diagnosed in childhood. Patients would present with cough, excessive sputum/mucus and recurrent lower respiratory tract infections.
name: Cystic fibrosis
label: c
answer: no
explanation: This is a permanent dilatation of the bronchi and often presents in older patients as a productive cough, haemoptysis and purulent sputum.
name: Bronchiectasis
label: b
answer: no
explanation: This is an upper respiratory tract infection most often resulting in a sore throat as the primary symptom. It may be viral or bacterial and a throat swab may be necessary to determine this.
name: Tonsillitis
label: e
answer: no
explanation: In children, asthma can present with cough, breathlessness, wheezing and chest tightness. Risk factors include a family history of asthma and atopy including hayfever, asthma and eczema.
name: Asthma
label: a
answer: yes

Correct answer: a
An 89-year-old male presents to his GP with a chronic productive cough. Yesterday, he has an episode of haemoptysis with a large amount of blood-stained sputum.

Which of the following investigations is the most appropriate diagnostic investigation for the underlying condition?

Options:
explanation: This is the best diagnostic investigation for bronchiectasis. On CT, dilated bronchi, 'signet' ring sign and opacities may be seen indicating possible infection.
name: CT
label: a
answer: yes
explanation: This is a useful investigation to determine the pattern of respiratory illness i.e. whether it is obstructive or restrictive, however, it does not necessarily determine what specific disease is present.
name: Spirometry
label: b
answer: no
explanation: X-ray is a useful imaging modality to detect lung nodules, effusion and consolidation and is usually done 1st line, however, CT gives a more detailed image and in this case, is a more useful diagnostic imaging tool.
name: X-ray
label: e
answer: no
explanation: This is a useful investigation to determine whether a patient has cystic fibrosis, however, it is more often carried out in younger children rather than elderly patients.
name: Sweat test
label: d
answer: no
explanation: This is useful to determine potential infection and pathogens present which can therefore guide specific treatment options like antibiotics, however, CT is the best for diagnosis of bronchiectasis.
name: Sputum culture
label: c
answer: no

Correct answer: a