hllj/quesmed huggingface dataset:
A 70-year-old man presents to General Practice after a recent echocardiogram showed a reduced ejection fraction and left ventricular hypertrophy. He is experiencing shortness of breath on exertion but denies any pain.

Which of the following describes this patient's most likely diagnosis?

Options:
explanation: Wolff-Parkinson-White syndrome is a benign cardiac arrhythmia, characterised by palpitations and chest pain. It has a very specific ECG sign of QRS pre-excitation and biphasic or inverted T-waves.

It would not result in reduced ejection fraction or left ventricular hypertrophy.
name: Wolf-Parkinson-White Syndrome
label: b
answer: no
explanation: This patient is most likely suffering from heart failure. Heart failure occurs when the heart is no longer able to pump blood out of itself as much as it used to.

This results in a reduced ejection fraction because the heart is pumping out less blood compared to before. There will be less blood leaving the heart per pump.

The ejection fraction is calculated as Stroke Volume / End Diastolic Volume.

Due to this reduced ejection fraction, the heart left ventricle will begin to hypertrophy, as it is working harder in an attempt to increase the volume of blood leaving the heart.
name: Heart Failure
label: a
answer: yes
explanation: Unstable Angina is characterised by chest pain at rest. It is similar to angina in that it is chest pain. However, in angina, the chest pain is brought on through exercise. In unstable angina, it occurs even when the patient is at rest.

Our patient is not complaining of chest pain - they are unlikely to have unstable angina.
name: Unstable Angina
label: e
answer: no
explanation: Angina is a term used to describe chest pain upon exertion such as exercise. The patient is not experiencing angina as they are not reporting any chest pain.
name: Angina
label: d
answer: no
explanation: An ST elevated myocardial infarction (STEMI) is a myocardial infarction in which there is ST elevation on the ECG.

Patients suffering from a STEMI will often experience chest pain, radiating to the left arm and jaw, nausea and sweating. Our patient is not suffering from any of these symptoms, therefore they are unlikely to be having a STEMI.
name: ST-Elevation Myocardial Infarction
label: c
answer: no

Correct answer: a
Which of the following options best describes the Wolff-Chaikoff effect?

Options:
explanation: This describes Grave's disease, which is an autoimmune disease affecting the thyroid gland.  In Grave's disease, autoantibodies activate TSH receptors and cause excessive thyroid hormone synthesis and secretion.
name: Autoimmune activation of thyroid tissue leads to excessive thyroid hormone synthesis
label: e
answer: no
explanation: The Wolff-Chaikoff effect is an autoregulatory phenomenon where a high intake of iodine leads to a decrease in thyroid hormone synthesis. This occurs as a feedback mechanism to prevent the overproduction of thyroid hormones. This effect is considered to be transient.
name: A decrease in thyroid hormone synthesis that occurs in response to high levels of iodine
label: a
answer: yes
explanation: This does not correctly describe the Wolff-Chaikoff effect: it is, in fact, the opposite of the correct description. In the Wolff-Chaikoff effect, high levels of iodine intake acutely suppress thyroid hormone production.
name: An increase in thyroid hormone synthesis that occurs in response to low levels of iodine
label: b
answer: no
explanation: This describes Hashimoto's thyroiditis, which is an autoimmune disease affecting the thyroid gland. Here, antithyroid antibodies attack the thyroid tissue, causing fibrosis and insufficient thyroid hormone production.
name: Autoimmune attack of the thyroid gland causes deficient thyroid hormone production
label: d
answer: no
explanation: This describes the Jod-Basedow phenomenon: in individuals with iodine-deficient hypothyroidism, increased iodine exposure leads to excessive thyroid hormone synthesis. This does not occur in euthyroid individuals. The Jod-Dasedow effect produces iodine-induced hyperthyroidism. In the Wolff-Chaikoff effect, we see iodine-induced hypothyroidism.
name: Excessive thyroid hormone synthesis as a result of increased iodine exposure
label: c
answer: no

Correct answer: a
Which of the following microbes is the most common cause of infectious diarrhoea in hospitalised patients?

Options:
explanation: Rotavirus is a common viral cause of diarrhoea that primarily affects infants and young children, and causes severe diarrhoea and vomiting. However, it is not the most common cause of infectious diarrhoea in hospitalised patients.
name: Rotavirus
label: d
answer: no
explanation: Norovirus is a highly contagious virus that can cause stomach and intestinal inflammation and is often spread through contaminated food or water. While it is a possible cause, it is not the most common cause of infectious diarrhoea in hospitalised patients.
name: Norovirus
label: e
answer: no
explanation: Clostridium difficile (C. difficile) is a bacterial infection that can cause diarrhoea and colitis and is the most common cause of infectious diarrhoea in hospitalised patients. C. difficile is often acquired in healthcare settings and can occur as a complication of antibiotic use.
name: Clostridium difficile
label: a
answer: yes
explanation: Salmonella is a common cause of foodborne illness and can cause diarrhoea, fever and abdominal cramps. It is often found in undercooked meats, eggs and dairy products. However, it is not the most common cause of infectious diarrhoea in hospitalised patients.
name: Salmonella
label: b
answer: no
explanation: Escherichia coli (E.coli) is a type of bacteria that can cause diarrhoea, as well as urinary tract infections and sepsis. It is commonly found in the gastrointestinal tract and is often spread through contaminated food or water. However, it is not the most common cause of infectious diarrhoea in hospitalised patients.
name: Escherichia coli
label: c
answer: no

Correct answer: a
Which of the following descriptions correctly defines a systematic review?

Options:
explanation: A systematic review is a type of research methodology that involves a comprehensive and systematic analysis of multiple studies on a specific topic, using a rigorous and transparent methodology to identify, critically appraise and synthesise all relevant studies. It aims to provide a high-quality and reliable summary of the current evidence on a specific research question or topic.
name: A comprehensive analysis of available evidence on a specific topic, with a clearly defined search strategy
label: a
answer: yes
explanation: This is not a correct description of a systematic review. It describes a randomised controlled trial, which is a type of primary study and not a review at all.
name: A study in which subjects are randomly assigned to either an intervention or control group, with outcomes subsequently measured
label: e
answer: no
explanation: This best describes a narrative review, which looks to describe available evidence on a specific topic and synthesise a conclusion from this evidence. They often take a less formal approach compared to systematic reviews and do not usually require reporting methodology or search terms.
name: A comprehensive analysis of multiple studies, which is then used to construct a narrative on a specific topic
label: c
answer: no
explanation: This description best describes a case summary, which focuses on a single patient. In contrast, a systematic review would involve multiple studies on a specific topic.
name: An analysis of a single patient's medical history, providing an evidence-based discussion of the key topics within the history
label: b
answer: no
explanation: This is not a correct description of a systematic review, as this type of review looks to synthesise all available evidence of a specific topic regardless of what the study type is. Therefore, they will typically include other study types, such as observational studies, case-control studies etc.
name: A comprehensive analysis that specifically includes only randomised controlled trials
label: d
answer: no

Correct answer: a
Which of these best describes the pathophysiology of Benign Paroxysmal Positional Vertigo (BPPV)?

Options:
explanation: This does not correctly describe BPPV. While otoliths do indeed dislodge from the utricle, they float around fluid-filled areas such as the semicircular canals in the inner ear. The middle ear is not involved.
name: Otoliths dislodge from the utricle and float around the middle ear
label: c
answer: no
explanation: This is incorrect. BPPV involves otoliths dislodging from the utricle and floating around fluid-filled spaces such as the semicircular canals in the inner ear.
name: Otoliths dislodge from the semi-circular canals and float around the utricle
label: b
answer: no
explanation: This description best describes the potential pathophysiology of Meniere's disease. The exact mechanisms that cause Meniere's disease are contested. It presents clinically as dizziness, vertigo, tinnitus and aural fullness.
name: Excessive pressure accumulation in the endolymph
label: d
answer: no
explanation: This description best describes the pathophysiology of BPPV. BPPV is caused by the displacement of small calcium particles (otoliths) in the inner ear. These particles are normally located in the utricle within the inner ear. When they become displaced, they can move into the semicircular canals and cause abnormal signals to be sent to the brain, resulting in vertigo.
name: Otoliths dislodge from the utricle and float around the semi-circular canals
label: a
answer: yes
explanation: This description best describes the pathophysiology of a vestibular schwannoma. It is a benign tumour that carries a small risk of malignant transformation.
name: Development of a Schwann cell-derived tumour arising from the vestibulocochlear nerve
label: e
answer: no

Correct answer: a
Which of the following best describes a Mobitz II heart block?

Options:
explanation: This is incorrect as it best describes a third-degree heart block, also known as a complete heart block. P waves and QRS complexes here are regular but have no relationship.
name: A type of heart block characterised by a complete failure of an electrical impulse to reach the ventricles
label: b
answer: no
explanation: This is incorrect as it best describes a left bundle branch block. It can indicate underlying heart diseases, such as dilated cardiomyopathy or hypertrophic cardiomyopathy.
name: A type of heart block characterised by a delay or block in the bundle of His on the left side of the heart
label: c
answer: no
explanation: This is correct as it best describes a Mobitz II heart block. This is a type of second-degree heart block where QRS complexes are either randomly or regularly (e.g. 2:1) dropped after regular P waves. There is no PR interval prolongation. It can rapidly deteriorate into 3rd-degree heart block.
name: A type of heart block characterised by the presence of some P waves which are followed by QRS complexes. P waves are regular, and there is no prolongation of PR intervals
label: a
answer: yes
explanation: This is incorrect as it best describes a first-degree heart block. Here, the PR interval is simply prolonged with no dropped QRS complexes. It is the most benign heart block.
name: A type of heart block characterised by prolonged PR intervals with a regular rhythm and 1:1 ratio of P waves to QRS complexes
label: d
answer: no
explanation: This is incorrect as it best describes a Mobitz-type I heart block. This is also a type of second-degree heart block, but here there is variation in PR interval length. It is also known as Wenckebach heart block.
name: A type of heart block where gradual prolongation of PR intervals is seen until a QRS complex is dropped
label: e
answer: no

Correct answer: a
Which of the following skin conditions is most likely to be seen in Crohn's disease?

Options:
explanation: Psoriasis is a chronic skin condition characterised by red, scaly patches on the skin. Some patients with psoriasis may develop psoriatic arthritis. It is not a cutaneous manifestation of Crohn's disease.
name: Psoriasis
label: b
answer: no
explanation: Dermatitis herpetiformis is a cutaneous manifestation of Coeliac disease, not Crohn's disease. It presents as a chronic, itchy skin rash.
name: Dermatitis herpetiformis
label: e
answer: no
explanation: Kaposi's sarcoma is a rare disease that develops from the endothelial cells of the lymphatic system and blood vessels. It manifests in the skin as dark, discoloured patches. It is not a cutaneous manifestation of Crohn's disease.
name: Kaposi's sarcoma
label: c
answer: no
explanation: Molluscum contagiosum is a viral skin infection caused by the Molluscum contagiosum virus (MCV) that results in the formation of small, round, raised, and often itchy, benign papules on the skin. While it can be seen in patients with immune-compromising conditions, is not the most likely cutaneous manifestation of Crohn's disease out of the options given.
name: Molluscum contagiosum
label: d
answer: no
explanation: Erythema nodosum is a type of inflammatory skin condition characterised by tender, red and swollen nodules on the legs. It is a common cutaneous manifestation of Crohn's disease. It is therefore most likely to be seen alongside Crohn's disease.
name: Erythema nodosum
label: a
answer: yes

Correct answer: a
Which of the following is the most common cause of oesophageal perforation?

Options:
explanation: Boerhaave's syndrome, also known as spontaneous oesophageal rupture, is a cause of oesophageal perforations. It occurs when the oesophageal ruptures due to a sudden increase in pressure, such as from vomiting or heavy lifting. It is usually seen in middle-aged or older men who have an underlying oesophageal disease or previous history of heavy alcohol consumption. They account for approximately 15% of all oesophageal perforations.
name: Boerhaave's syndrome
label: c
answer: no
explanation: Oesophageal malignancy can cause perforations but accounts for <1% of all perforations, therefore it is not the most common cause.
name: Malignancy
label: d
answer: no
explanation: While foreign body ingestion can cause oesophageal perforations, it leads to approximately 12% of all perforations and is therefore not the most common cause.
name: Foreign body ingestion
label: e
answer: no
explanation: Iatrogenic perforation refers to perforation caused by medical or surgical procedures. This can include perforations caused by endoscopic procedures such as oesophagogastroduodenoscopy (OGD), but can also refer to perforations caused by other medical or surgical procedures as well. Iatrogenic perforations are the most common cause of oesophageal perforations. They account for over 50% of all oesophageal perforations.
name: Iatrogenic
label: a
answer: yes
explanation: Trauma, such as a car accident or fall, can cause oesophageal perforations, but it is not the most common cause. They account for <10% of all oesophageal perforations.
name: Trauma
label: b
answer: no

Correct answer: a
Which of the following statements about type I errors is correct?

Options:
explanation: This is the correct definition of a type I error. It occurs when a test detects a difference or effect that, in actuality, does not exist.
name: A type I error is a statistical error that occurs when a test concludes that a difference or effect exists when one does not exist
label: a
answer: yes
explanation: This is the definition of a type II error, also known as a false negative.
name: A type I error is a statistical error that occurs when a test fails to detect a difference or effect that actually exists
label: d
answer: no
explanation: In statistics, precision refers to how close multiple measurements of the same quantity are to one another. It does not cause type I errors. A type I error is caused by setting a low threshold for rejecting the null hypothesis, which results in an increased likelihood of falsely identifying an effect when there is none.
name: A type I error is a statistical error that occurs when a test is too precise
label: e
answer: no
explanation: In statistics, sensitivity is the ability of a test to correctly identify positive cases. It does not cause type I errors. A type I error is caused by setting a low threshold for rejecting the null hypothesis, which results in an increased likelihood of falsely identifying an effect when there is none.
name: A type I error is a statistical error that occurs when a test is too sensitive
label: c
answer: no
explanation: In statistics, specificity refers to the ability of a test to correctly identify negative cases. It does not cause type I errors. A type I error is caused by setting a low threshold for rejecting the null hypothesis, which results in an increased likelihood of falsely identifying an effect when there is none.
name: A type I error is a statistical error that occurs when a test is too specific
label: b
answer: no

Correct answer: a
Which of these is the correct genotype for Turner's Syndrome?

Options:
explanation: The typical genotype for females is XX, which means they have two copies of the X chromosome. However, Turner's syndrome is a genetic disorder that affects females with one X chromosome and no second sex chromosome, leading to a genotype of XO.
name: XX
label: b
answer: no
explanation: Turner's syndrome is a genetic disorder that affects females with one X chromosome and no second sex chromosome, leading to a genotype of XO. This genotype is caused by the complete or partial loss of one X chromosome. It presents with symptoms such as a wide or weblike neck, low-set ears, a broad chest etc.
name: XO
label: a
answer: yes
explanation: Triple X syndrome is a genetic disorder that affects females and is caused by an extra X chromosome, resulting in a genotype of XXX. Turner's syndrome only affects females with one X chromosome and no second sex chromosome, leading to a genotype of XO. It presents with delayed development of speech and language skills, as well as motor skills. Individuals can also present with behavioural issues.
name: XXX
label: e
answer: no
explanation: The typical genotype for males is XY, which means they have one X and one Y chromosome. However, Turner's syndrome only affects females with one X chromosome and no second sex chromosome, leading to a genotype of XO.
name: XY
label: c
answer: no
explanation: Klinefelter syndrome is a genetic disorder that affects males and is caused by an extra X chromosome, resulting in a genotype of XXY. Turner's syndrome only affects females with one X chromosome and no second sex chromosome, leading to a genotype of XO. It can present as a low sperm count and a smaller penis/testicles in males, as well as reduced libido, weak bones and reduced body hair.
name: XXY
label: d
answer: no

Correct answer: a
Which of the following cells is most likely to be seen on a blood film in iron deficiency anaemia?

Options:
explanation: Macrocytes are abnormally large red blood cells, which can be seen in vitamin B12 and folate deficiency, but not in iron deficiency anaemia.
name: Macrocytes
label: b
answer: no
explanation: Target cells are most likely to be seen on a blood film in iron deficiency anaemia. Target cells are red blood cells that have a characteristic bull's-eye appearance on a blood film, caused by a decrease in the amount of haemoglobin in the cells. They are seen in iron deficiency anaemia due to a lack of iron available for the production of haemoglobin, and thus a decreased amount of haemoglobin in cells. The bull's-eye appearance is caused by a relative excess of cell membrane due to a reduced intracellular haemoglobin content (increased cell membrane area to volume ratio).
name: Target cells
label: a
answer: yes
explanation: Sickle cells are crescent-shaped red blood cells which are seen in sickle cell anaemia. They are caused by a genetic mutation in the beta-globin gene, which leads to the formation of abnormal haemoglobin. They are not typically seen in iron deficiency anaemia.
name: Sickle cells
label: c
answer: no
explanation: Keratocytes, or bite cells, are red blood cells with a bite-like defect in their membrane. They occur as a result of the phagocytosis of a Heinz body (which is made up of denatured haemoglobin), which leaves a bite-like deformity in the cell. They are not typically seen in iron deficiency anaemia.
name: Keratocytes
label: d
answer: no
explanation: Schistocytes are fragmented red blood cells which can be seen in certain types of haemolytic anaemia, such as haemolytic uraemic syndrome (HUS), disseminated intravascular coagulation (DIC) and thrombotic thrombocytopenic purpura (TTP). They are not typically seen in iron deficiency anaemia.
name: Schistocytes
label: e
answer: no

Correct answer: a
A 60-year-old patient is brought to the emergency department after experiencing sudden onset weakness on the right side of his body and difficulty forming words and sentences. He is suspected of having had a stroke.

Based on the patient's symptoms, which region of the brain is most likely affected?

Options:
explanation: Broca's area is located in the left hemisphere, hence a stroke in this area would cause right-sided weakness. Furthermore, Broca's area is associated with speech production which explains this patient's inability to form words and sentences after his stroke.
name: The left frontal lobe, specifically Broca's area
label: a
answer: yes
explanation: Whilst a stroke in Wernicke's area would cause right-sided weakness, Wernicke's area is associated with comprehension of speech, rather than formation of speech.
name: The temporal lobe, specifically Wernicke's area
label: c
answer: no
explanation: A stroke in the left parietal lobe is more likely to cause contralateral neglect as well as a lack of awareness on the right side.
name: The left parietal lobe
label: b
answer: no
explanation: A stroke in the cerebellum is more likely to cause non-specific symptoms such as headache, dizziness, nausea and vomiting.
name: The cerebellum
label: e
answer: no
explanation: A stroke in the occipital lobe is more likely to cause visual disturbances, blindness or defects in the interpretation of visual information e.g. prosopagnosia ('face blindness').
name: The occipital lobe
label: d
answer: no

Correct answer: a
What triad of symptoms is seen in Horner's Syndrome?

Options:
explanation: Ptosis (eyelid droop), miosis (pupillary constriction) and anhydrosis (decreased sweating) are the main symptoms seen in Horner's syndrome, which is a neurological disorder often caused by an apical lung tumour compressing the sympathetic nervous chain.
name: Ptosis, miosis and anhydrosis
label: a
answer: yes
explanation: None of these are symptoms of Horner's syndrome. Proptosis describes protruding eyeballs, mydriasis is pupillary dilatation, and hyperhidrosis is excessive sweating.
name: Proptosis, mydriasis and hyperhidrosis
label: c
answer: no
explanation: While ptosis (eyelid droop) and anhydrosis (decreased sweating) are symptoms of Horner's syndrome, mydriasis (pupillary dilatation) is not.
name: Ptosis, mydriasis and anhydrosis
label: b
answer: no
explanation: Both ptosis (eyelid droop) and miosis (pupillary constriction) are symptoms of Horner's syndrome, which occurs due to compression of the sympathetic nervous chain. However, hyperhidrosis (excessive sweating) is not associated with Horner's syndrome.
name: Ptosis, miosis and hyperhidrosis
label: d
answer: no
explanation: Both miosis (pupillary constriction) and anhydrosis (decreased sweating) are symptoms of Horner's syndrome, which occurs due to compression of the sympathetic nervous chain. However, proptosis (protruding eyeballs) is not associated with Horner's syndrome.
name: Proptosis, miosis and anhydrosis
label: e
answer: no

Correct answer: a