hllj/quesmed huggingface dataset:
A 25 year old gives birth to a healthy boy on the labour ward.

This was her first pregnancy and first birth. She is deciding whether to breastfeed and asks you what benefits there are.

Which of these is NOT a recognised benefit?

Options:
explanation: preterm infants who receive human milk are up to 10 times less likely to develop necrotising enterocolitis.

This is a potentially fatal condition that involves inflammation of the tissues in the gut - this can lead to perforation.

Breastmilk is thought to contain bacteriocidal and immune-modulating effects.
name: Necrotising Enterocolitis
label: b
answer: no
explanation: Breastfeeding can improve bonding between mother and baby and decrease the risk of post-partum depression.
name: Reduces risk of post-partum depression
label: d
answer: no
explanation: Aspiration refers to material entering the airway and lungs by accident. This can just be due to the immaturity of the muscles in the mouth, larynx and top of the oesophagus.

Aspiration can occur with any food or liquid such as juice, milk or formula. Therefore, breastfeeding is not protective of this.
name: Reduces risk of aspiration
label: a
answer: yes
explanation: There us a lower risk of SIDS in those infants that have been breastfed compared to those who were never breastfed.

There is a positive correlation between the duration of exclusive breastfeeding and decreased risk of developing SIDS.
name: Reduces risk of sudden infant death syndrome (SIDS)
label: e
answer: no
explanation: Breastfeeding for 12 consecutive months results in a reduction in the mother's risk of breast cancer.
name: Reduces mother's risk of breast cancer
label: c
answer: no

Correct answer: a
56 year old presents to the GP with dyspepsia.

The GP discusses some lifestyle changes to improve the main presenting symptom.

The GP wants to explore more symptoms of the patient to make sure further investigations are not required.

Which of these would be seen as red flags symptoms and warrant further investigation with an upper gastrointestinal endoscopy?

Options:
explanation: H.pylori is a bacteria that causes infection and inflammation of the stomach and can cause reflux.

This can be treated with a PPI and 2 antibiotics and do not warrant an urgent cancer pathway investigation.
name: Positive stool test for H.pylori
label: d
answer: no
explanation: Cancer is most associated with weight loss.
name: Weight gain
label: b
answer: no
explanation: Platelets are seen raised in infection, inflammation and blood loss.

Therefore this would be important to investigate further however low platelets don't necessarily need investigating but followed up.
name: low platelet count
label: c
answer: no
explanation: Gaviscon is an antacid that neutralises stomach acid and reduces pain and discomfort.

A proton pump inhibitor (PPI) is better at controlling the symptoms by blocking the release of acid. this should be trialled prior to calling the dyspepsia treatment-resistant.
name: Symptoms not relieved by gaviscon
label: e
answer: no
explanation: Red flag symptoms is a warning symptom of cancer and warrant a 2-week referral for cancer.

This is a red flag symptom that, with being over 55 and dyspepsia warrants referral for an upper gastrointestinal endoscopy.

If this man also had weight loss, an urgent endoscopy would be required.
name: Iron deficiency anaemia
label: a
answer: yes

Correct answer: a
25 year old presents to the GP after experiencing 3 months of diarrhoea, abdominal bloating and rectal bleeding.

The GP suspects Ulcerative Colitis (UC).

Which of the following is associated with this condition?

Options:
explanation: Ulcerative colitis is located in the rectum and colon and does not spread past the ileum. You see continuous mucosal inflammation ascending from the colon.
name: Continuous inflammation in the bowel
label: a
answer: yes
explanation: superficial mucosal inflammation is seen in UC.

Transmural inflammation is seen in Crohn's disease. this results in increased goblet cells and granuloma formation.
name: Transmural inflammation
label: d
answer: no
explanation: Smoking is a protective factor in UC. This is not encouraged in people with UC in those that smoke, disease presentation may be later than expected.

Smoking is an aggrevating factor in Crohn's disease
name: History of smoking
label: c
answer: no
explanation: This can be seen in both types of IBD and can be seen in other gastrointestinal conditions such as Irritable bowel disease.

Therefore, is not characteristic of UC.
name: Abdominal pain
label: e
answer: no
explanation: Crohn's disease is the other subtype of IBD.

This results in patchy inflammation that can be present from the mouth to the anus.

Transmural inflammation is seen.
name: Patchy inflammation throughtout small and large bowel
label: b
answer: no

Correct answer: a
50- year- old presents to GP with persistent dyspepsia.

The GP explores the patient's lifestyle and find that there are a few exacerbating factors. He discusses some changes she could make and prescribes a PPI.

Which of these is a risk factor for Gastro-oesophageal disease (GORD)?

Options:
explanation: This is not a risk factor. Having large meals and eating before bed and lying down can make reflux worse.

However, eating small meals throughout the day can reduce the amount of acid produced, making it beneficial for those who suffer with this.
name: Eating throughout the day
label: c
answer: no
explanation: Obesity can cause and worsen symptoms of acid reflux. Weight increases the pressure in the abdomen and causes fluid to travel up into the oesophagus.
name: Weight loss
label: d
answer: no
explanation: Age is not particularly a risk factor for GORD. It can develop at any age and is mainly triggered by lifestyle choices such as large meals, drinking alcohol, coffee and soda frequently and smoking.

It is common in babies and the elderly due to the immaturity/aging of the muscles in the lower oesophageal sphincter.
name: Age
label: b
answer: no
explanation: Smoking increases acid production and can worsen symptoms of acid reflux.
name: Smoking
label: a
answer: yes
explanation: Lying down immediately after a meal can exacerbate symptoms which is why doctors recommend keeping upright while digesting meals.
name: Sat down after a meal
label: e
answer: no

Correct answer: a
45 year old male presents to the GP with 3-month history of epigastric pain and heartburn.

He says that the pain is constantly there but worsens when he hasn't eaten for a while.

He does not vomit and his bowels are normal.

He works as a lawyer and has been reluctant to book time off work to make this appointment. He is now getting concerned as he believes he is putting on weight.

Which is the most likely cause of his symptoms?

Options:
explanation: Epigastric pain usually starts 2-3 hours after eating and the symptoms can be relieved by eating.

This is because the pyloric sphincter closes after eating to digest the food in the stomach. When the sphincter is closed, acid does not reach the duodenum to irritate the ulcer.

Pain can often wake people from sleep and cause weight gain.

Peptic ulcers can be associated with stress which is suggested by this man's high-pressure job.
name: Duodenal Ulcer
label: a
answer: yes
explanation: Peptic ulcer disease represented in this case is treated with proton pump inhibitors (PPIs) for up to 8 weeks. If left untreated, these can rupture.

The presentation would be sudden abdominal pain which is severe and present all over the abdomen.

On examination, they can be shocked with tachycardia and low blood pressure. They will be very still to avoid the pain in the peritoneum.
name: Perforated Peptic ulcer
label: e
answer: no
explanation: H.pylori is a bacterial infection of the stomach which erodes the mucosal layer and results in more acid production.

This can result in a gastric ulcer rather than a duodenal ulcer.

This infection with NSAID use is the main cause of gastric ulcers.
name: Helicobacter pylori
label: c
answer: no
explanation: This describes small pouches that form from the lining of the intestine. This is a common condition that occurs with age.

It can be asymptomatic but occasionally can cause some abdominal discomfort, constipation and diarrhoea.

You would not usually expect to see this in someone as young as 45 and pain would usually be felt in the left lower quadrant of the abdomen.
name: Diverticulosis
label: d
answer: no
explanation: Epigastric pain usually starts within an hour after eating.

This is because the pyloric sphincter closes after eating to digest the food in the stomach. When the sphincter is closed, acid accumulates in the stomach and causes irritation and pain.

More common in people >50 years old.

Associated with weight loss as people are reluctant to eat which makes the pain worse.

Can be associated with vomiting and haematemesis.
name: Gastric Ulcer
label: b
answer: no

Correct answer: a
A 30 year old attends clinic for a colonoscopy as he has a strong family history of bowel and pancreatic cancer and has recently experienced change in bowel habit with rectal bleeding.

During the procedure, 15 polyps were found.

The consultant is concerned that the family may have a mutation in the mismatch repair genes and have hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome. This can predispose to colon cancer as well as other malignancies in men and women.

Which of these cancers in females are also associated with this syndrome?

Options:
explanation: Breast cancer is most commonly associated with mutations in the BRCA gene.
name: Breast
label: b
answer: no
explanation: This is a benign tumour in the brain which can result in hormonal disruption and can press on the optic chiasm causing bitemporal hemianopia.

This can be associated with multiple endocrine neoplasia syndrome (MEN) type 1.
name: Pituitary Adenoma
label: e
answer: no
explanation: These are small bumps that can be found under the skin and on nerve cells.

They are associated with Neurofibromatosis which is a group of genetic disorders that cause tumours on the nerve cells. This syndrome can also be associated with cafe au lait spots on the skin usually present in childhood.
name: Neurofibromas
label: d
answer: no
explanation: Cancers in the small intestine can be associated with Familial adenomatous polyposis (FAP).

This syndrome is due to mutations in the APC gene that regulates cell proliferation. This results in many polyps throughout the large intestine that can turn cancerous with an additional mutation.

This syndrome can also be associated with upper gastrointestinal cancers including those within the duodenum.
name: Duodenal
label: c
answer: no
explanation: The cancers associated with lynch syndrome which results from mutation from the mismatch repair genes include ovarian and uterine, urinary tract, colorectal, stomach and pancreas.

Ovarian along with breast and pancreatic can also be associated with inheritance of the BRCA mutations.
name: Ovarian
label: a
answer: yes

Correct answer: a
70 year old presents with crushing chest pain, nausea, sweating and shortness of breath.

A myocardial infarction is suspected and bloods and an ECG trace is ordered.

Which blood marker would you expect to be raised?

Options:
explanation: Bilirubin is formed when red blood cells are broken down.

This can be raised when there is an increased turnover of red blood cells such as in sickle cell anaemia, the liver cannot process the protein due to liver cirrhosis or there us an obstruction from the gallbldder such as in cholelithiasis.
name: Bilirubin
label: d
answer: no
explanation: This is a protein made by the liver that is raised in infection.
name: C- reactive protein (CRP)
label: c
answer: no
explanation: High cholesterol is a risk factor for cardiovascular disease.

This blood test is useful to carry out at presentation to aid long term management. However, in this acute setting with an MI you would most likely expect the troponin to be raised which is more sensitive adnd specific for this presentation.
name: Hypercholesterolemia
label: e
answer: no
explanation: Troponin is a protein that participates in muscle contraction.

Myocardial infarction is due to insufficient blood supply to myocardium causing necrosis. This leads to the release of troponin when dmaage to the myocytes have occured.
name: Troponin
label: a
answer: yes
explanation: This is secreted by cardiomyocytes in the ventricles in response to stretching.

This is released and raised in heart failure.
name: Brain Natriuretic Peptide (BNP)
label: b
answer: no

Correct answer: a
A 70 year old is discharged from hospital following a Myocardial Infarction (MI)

He is prescribed secondary prevention.

What is NOT included in this?

Options:
explanation: This medication uses nitrates to relieve the symptoms of angina by dilating coronary vessels.

1-2 sprays should be used under the tongue when symptoms start. if unsuccessful, another dose can be given after 5 minutes. If symptoms persistent after three doses every 5 minutes, the patient should seek medical attention.

This is not used as secondary prevention for cardiovascular disease but as symptomatic relief for angina pain.
name: Glyceryl trinitrate (GTN) spray
label: a
answer: yes
explanation: This is an antiplatelet medication; 75mg is taken once daily. This is used along with another antiplatelet such as clopidogrel for 12 months.

there is evidence that this helps prevent another such event and the current disease from worsening.

This is outdated as primary prevention and is no longer used in these cases.
name: Aspirin
label: c
answer: no
explanation: Atorvastatin 80mg once daily are advised following an acute coronary syndrome. This medication aims to reduce the cholesterol and has been found to reduce the rate of recurrent disease and the need for revascularisation procedures.
name: Atorvastatin
label: b
answer: no
explanation: Secondary prevention can be easily remembered by the 6As:

> Aspirin 75mg daily
>
> Another antiplatelet such as clopidogrel for up to 12 months
>
> ACE Inhibitor such as ramipril
>
> Atenolol
>
> Atorvastatin 80mg once daily
>
> Aldosterone antagonist for those with clinical heart failure
name: Atenolol
label: e
answer: no
explanation: These reduce the effects of the renin-angiotensin- aldosterone system and therefore can help treat and prevent hypertension.

Research has also shown that they improve oxidative stress, endothelial and ventricular function.
name: ACE inhibitors
label: d
answer: no

Correct answer: a
A 69 year old man is diagnosed with microcytic anaemia. This is determined by the low haemaglobin count and low mean corpuscular volume (MCV).

What is the most common cause of this finding?

Options:
explanation: Iron is crucial for the synthesis of haemoglobin in red blood cells. When iron is lacking, the critical haemoglobin concentration is not achieved causing the red blood cells to look smaller than they should do.
name: Iron deficiency anaemia
label: a
answer: yes
explanation: In sickle cell disease, red blood cells formed are an unusual shape and so not transfer oxygen as efficiently and do not live as long as normal healthy red blood cells.

This results in a normocytic anaemia as there is just a reduced number of red blood cells with normal MCV.
name: Sickle cell disease
label: e
answer: no
explanation: This is an inherited condition that results in the formation of faulty haemaglobin that doesn't function normally.

This does result in microcytic anaemia similarly to iron defiency but is not as common.
name: Thalassaemia
label: c
answer: no
explanation: Folate plays a role in the synthesis of DNA and maintanence of normal erythropoiesis.

Similarly to vitamin B12,abnormal cells called megaloblasts are formed that do not divide and mature to healthy red blood cells.

This causes a macrocytic anaemia.
name: Folate deficiency
label: d
answer: no
explanation: Vitamin B12 helps synthesise DNA and plays a crucial role in the formation of mature red blood cells.

When there is a lack of vitamin B12, abnormal cells called megaloblasts are formed that do not divide and mature to healthy red blood cells.

This causes a macrocytic anaemia
name: Vitamin B12 deficiency
label: b
answer: no

Correct answer: a
65 year old female with existing diagnosis of heart failure describes episodes where she will wake up suddenly with severe attack of shortness of breath and cough.

Which of the following best descibes this symptom?

Options:
explanation: This describes heart failure that is caused by high blood pressure.

Prolonged, uncontrolled hypertension can cause left ventricular diastolic dysfunction and reduced ejection fraction.

This can lead to congestive heart failure and therefore pulmonary oedema and paroxysmal nocturnal dyspnoea.
name: Hypertensive Heart failure
label: e
answer: no
explanation: This is the sensation of shortness of breath when lying flat compared to be woken from sleep.

This occurs in heart failure due to the pulmonary oedema. The fluid covers the whole of the surface area whilst lying flat which is what causes this sensation and is relieved when upright.
name: Orthopnoea
label: b
answer: no
explanation: This is the sensation of shortness of breath that wakes a person from sleep and is relieved by sitting upright.

This occurs in heart failure due to the pulmonary oedema. The fluid covers the whole of the surface area whilst lying flat which is what causes this sensation.
name: Paroxysmal nocturnal dyspnoea  (PND)
label: a
answer: yes
explanation: Dysphagia is defined as swallowing difficulty.

This can be caused by the impairment of the muscles of the mouth and pharynx to coordinate swallow.

This can result from a stroke, head injury and dementia.
name: Dysphagia
label: c
answer: no
explanation: These are dreams that feel intense and real. They can be described as pleasant, strange and even frightening.

This is a common symptom of Parkinson's disease.

In REM sleep, the patient can often act out the dream. They may leap out of bed.

This patient is unlikely to have this as there is a past medical history of heart failure and the main feature is waking up with severe shortness of breath, relieved by sitting up which is a feature of pulmonary oedema.
name: A vivid dream
label: d
answer: no

Correct answer: a
A 50 year old attends the GP with palpitations, dizziness and describes his heart 'racing' at times. These episodes are worsened by exercise and have stopped running as he is scared to faint.

The GP performs an ECG and the patient is subsequently diagnosed with atrial fibrillation (AF).

What is a feature of atrial fibrillation (AF) on an ECG?

Options:
explanation: T waves on an ECG represents the repolarisation of the ventricles.
Tall tented T waves are characteristic of hyperkalaemia and can be an early sign of an acute coronary syndrome.
name: Tall tented T waves
label: e
answer: no
explanation: Atrial fibrillation results from multiple chaotic impulses being generated from the inside of the atrium. This results in fibrillation of the atria and impaired contraction.

A fibrillating baseline is seen and there is an absence of clear P waves.
name: Absence of P waves
label: a
answer: yes
explanation: This suggests that there is an irregular rhythm originating from the atria.

This can be seen in sinus arrhythmia. This is a physiological change seen in heart rate due to respiratory cycle. Seen in younger people.

Even though atrial fibrillation is an irregular rhythm from the atria, p waves tend to be absent from the chaotic impulses.
name: Variation in P - P wave interval
label: c
answer: no
explanation: This is due to atrial flutter which is a macro-reentry circuit within the atria.

This results in a high rate of depolarisation of the atria > 250 bpm.

The AV node undergoes its normal function and blocks some of these impulses and only lets some through. Therefore, a ratio can be seen between sawtooth waves and QRS complexes - this can be regular and irregular.
name: Sawtooth waveform
label: b
answer: no
explanation: This means that the P wave on an ECG is not followed by a QRS complex.

This is due to pathology in the AV node that relays the signal to ventricle. This is known as a heart block.
name: Non propagated P wave
label: d
answer: no

Correct answer: a
12 year old boy presents to accident and emergency with polydipsia and polyuria. Preceding this he had 3 episodes of vomiting with abdominal pain.

He is diagnosed with diabetic ketoacidosis (DKA) and started on treatment including fluids and insulin infusion.

Which antibody is associated with Type 1 diabetes mellitus?

Options:
explanation: This antibody is present in coeliac disease. This is tested for along with IgA antibodies to see the proportionate rise of anti-TTG.
name: Anti- tissue transglutaminase (Anti- TTG)
label: e
answer: no
explanation: These are autoantibodies to the TSH receptor on the thyroid gland.

This can lead to Hashimoto's thyroiditis (hypothyroid) and Graves' disease (hyperthyroid).
name: Antithyroid peroxidase (anti-TPO)
label: b
answer: no
explanation: This antibody helps to discover whether someone has either type 1 diabetes mellitus or latent autoimmune diabetes of the adulthood (LADA).

GAD is present in the beta cells of the pancreas and therefore show that these are damaged in this autoimmune condition leading to little to no insulin production.

This test has a high positive predictive value.
name: Anti- glutamic acid decarboxylase (anti-GAD)
label: a
answer: yes
explanation: This measures how much insulin is made in the body. It is not an antibody but a protein made when insulin is synthesised in the beta cells of the pancreas.

If no C-peptide is present, this suggests that the pancreas is producing little to no insulin.
name: C-peptide
label: c
answer: no
explanation: This is positive in myasthenia gravis disease which causes muscle weakness which progressively becomes worse throughout the day.
name: Acetylcholine receptor antibody
label: d
answer: no

Correct answer: a
A 40 year old woman presents to accident and emergency with severe nausea and abdominal pain.

It is noticed by the nurse that she appears dehydrated and has some tanning of the skin.

The patient says that for the past few weeks she has lost weight and feels really low and hasn't got out of bed most days.

She is found to have a low cortisol level in her blood.

What part of the adrenal gland produces cortisol?

Options:
explanation: This woman has Addison's disease - this is an autoimmune condition that damages the adrenal gland.

This leads to a reduction in the production of aldosterone and cortisol (mineralocorticoids).

Cortisol is a glucocorticoid and is formed from the middle area of the adrenal gland called the zona fasiculata.

This disease can lead to symptoms as described in this case; depression, weight loss, nausea, hyperpigmentation and weight loss.
name: Zona fasiculata
label: a
answer: yes
explanation: This is the outer zone of the cortex of the adrenal gland this is reponsible for secreting mineralocorticoids such as aldosterone.
name: Zona glomerulosa
label: b
answer: no
explanation: The adrenal capsule surrounds the adrenal gland and ensures that the damaged cells are replaced and the integrity of the gland is maintained.
name: capsule
label: d
answer: no
explanation: This is the inner most layer of the adrenal gland that secretes androgens such as estrogens and testosterone
name: Zona reticularis
label: c
answer: no
explanation: This is the innermost part of the adrenal gland. This releases epinephrine (adrenaline) and norepinephrine (noradrenaline).

These hormones are important in autonomic functions such as regulating heart rate and plays a crucial role in the fight or flight response.
name: Medulla
label: e
answer: no

Correct answer: a