hllj/quesmed huggingface dataset:
Which of the following is an example of a obstructive lung disease?

Options:
explanation: COPD is an obstructive lung disease, typically occurring in smokers and is a combination of chronic bronchitis and emphysema.
name: COPD
label: a
answer: yes
explanation: This is a form of lung malignancy often occurring due to asbestos exposure. It is important in this instance to ask about occupation. It can present with a restrictive picture.
name: Mesothelioma
label: d
answer: no
explanation: Sarcoidosis is an example of a restrictive lung disease. It is a multisystem disorder characterised by widespread non-caseating granulomas and inflammation.
name: Sarcoidosis
label: b
answer: no
explanation: This occurs due to fluid buildup in the pleural space and may be classified as transudative or exudative. The buildup fluid can present as a restrictive picture.
name: Pleural Effusion
label: e
answer: no
explanation: Pulmonary fibrosis is a restrictive lung disease where there is scarring of the lung tissue. This makes the tissue less compliant and therefore presents with a restrictive picture.
name: Pulmonary fibrosis
label: c
answer: no

Correct answer: a
A patient is being treated for supraventricular tachycardia with amiodarone. They notice they've developed a large lump in the front of their neck and attend their GP.

Which of the following is a side effect of amiodarone?

Options:
explanation: Liver failure can be a side effect of taking amiodarone, not kidney failure.
name: Kidney failure
label: b
answer: no
explanation: Corneal deposits may be seen as a side effect of amiodarone. However, xanthelasma refers to lipid deposits around the eyelids and may occur in those with hyperlipidaemia.
name: Xanthelasma
label: e
answer: no
explanation: Grey skin discolouration can be quite profound in patients who experience side effects of amiodarone.
name: Purple skin discolouration
label: d
answer: no
explanation: Eczema is often associated with atopy and is not typically a side effect of amiodarone. Stevens-Johnson syndrome (SJS) may arise, however.
name: Eczema
label: c
answer: no
explanation: Hypothyroidism can develop as a result of taking amiodarone. Amiodarone can also cause hyperthyroidism. In both cases, a goitre may develop in patients.
name: Hypothyroidism
label: a
answer: yes

Correct answer: a
Which of the following is an ECG sign of cardiac tamponade?

Options:
explanation: This is typically seen in first-degree heart block.
name: PR interval >200ms
label: e
answer: no
explanation: This is seen in atrial flutter and is an example of a narrow complex tachycardia.
name: Sawtooth pattern
label: d
answer: no
explanation: QRS complexes alternate in height across the ECG. This occurs due to the heart moving back and forth in excessive fluid in
the pericardium.
name: Electrical alternans
label: a
answer: yes
explanation: Tall tented T-waves are present in hyperkalaemia.
name: Tall tented T waves
label: c
answer: no
explanation: These occur in Wolff-Parkinson-White syndrome and look like upstroke QRS complexes. A short PR interval and broad QRS would also be present.
name: Delta waves
label: b
answer: no

Correct answer: a
A 48-year-old male presents to his GP because he has been experiencing profound night sweats and fever after recently returning from a trip to India. He has also experienced unintentional weight loss.

Given the most likely diagnosis, which of the following is the most likely causative pathogen?

Options:
explanation: This is a bacteria which can cause respiratory illnesses like pneumonia or epiglottitis, however, does not cause tuberculosis.
name: *Haemophilus influenza*
label: e
answer: no
explanation: This is a bacteria which can cause tuberculosis (TB), a respiratory illness. TB often presents with fever, malaise, weight loss and night sweats. It is also important to ask about travel history, especially in endemic areas.
name: *Mycobacterium tuberculosis*
label: a
answer: yes
explanation: This is a fungus which acts as an opportunistic pathogen, commonly affecting those who are immunocompromised, for example, patients with HIV/AIDS.
name: *Pneumocystis jirovecii*
label: c
answer: no
explanation: This is a yeast-like fungus which can be opportunistic and causes conditions like vaginal candidiasis.
name: *Candida albicans*
label: d
answer: no
explanation: This is a gram-negative bacteria which often causes pneumonia in patients with alcoholism.
name: *Klebsiella pneumoniae*
label: b
answer: no

Correct answer: a
What is the inheritance pattern of cystic fibrosis?

Options:
explanation: Cystic fibrosis (CF) is an autosomal recessive inheritance pattern caused by inheriting 2 recessive alleles from the parents. CF is caused by a mutation on chromosome 7 affecting the CFTR gene. Chloride is therefore secreted abnormally and there is increased sodium absorption resulting in thick mucus lining the airways causing cilia impairment.
name: Autosomal recessive
label: a
answer: yes
explanation: Cystic fibrosis is an autosomal recessive disease. An example of an x-linked recessive disorder would be Duchenne muscular dystrophy.
name: X-linked recessive
label: c
answer: no
explanation: Cystic fibrosis is an autosomal recessive disease. An example of autosomal dominant inheritance would be Huntington's disease.
name: Autosomal dominant
label: b
answer: no
explanation: Cystic fibrosis is an autosomal recessive disease. An example of a mitochondrial inherited disorder would be chronic progressive external ophthalmoplegia (CPEO) characterised by weak eye muscles.
name: Mitochondrial
label: e
answer: no
explanation: Cystic fibrosis is an autosomal recessive disease. An example of an x-linked dominant disorder would be Fragile X syndrome resulting in issues with brain development.
name: X-linked dominant
label: d
answer: no

Correct answer: a
An athlete is having a routine health screening check including routine blood tests and an ECG. The findings on ECG show a PR interval of >200ms.

Which of the following is the most likely diagnosis?

Options:
explanation: This is a narrow complex tachycardia with atrial activity >300bpm. A 'saw-tooth' pattern would be seen on ECG.
name: Atrial flutter
label: e
answer: no
explanation: This is 3rd degree or complete heart block whereby atrial impulses do not pass to the ventricles. Patients require a permanent pacemaker as definitive management due to the severity of this condition.
name: Complete heart block
label: d
answer: no
explanation: Mobitz type I (Wenckebach phenomenon) is a type of 2nd-degree heart block due to a block in conduction through the AV node. This would present as **progressive PR interval lengthening** and then would drop off, failing to conduct a QRS complex.
name: Mobitz type I
label: b
answer: no
explanation: This is a type of 2nd-degree heart block where P waves fail to be conducted. The PR interval remains at a constant length however it is not consistently conducted and may or may not show a fixed ratio e.g. 2:1.
name: Mobitz type II
label: c
answer: no
explanation: Electrical activity is being prolonged through the AV node and therefore causes a prolonged PR interval (>200ms). 1st-degree heart block can occur in those with a high vagal tone e.g. athletes.
name: 1st-degree heart block
label: a
answer: yes

Correct answer: a
A 66-year-old male patient presents to A&E with syncope. An ECG is performed showing a rate of 34 bpm and no relationship between the P and QRS complexes.

Which of the following is the most likely diagnosis?

Options:
explanation: Mobitz type I (Wenckebach phenomenon) is a type of 2nd-degree heart block due to a block in conduction through the AV node. This would present as **progressive PR interval lengthening** and then would drop off, failing to conduct a QRS complex.
name: Mobitz type I
label: c
answer: no
explanation: Patients would present with crushing chest pain and show ST elevation in leads V3-4. ST depression in inferior leads may also be seen (II, III and aVF).
name: Anterior STEMI
label: e
answer: no
explanation: This is a type of 2nd-degree heart block where P waves fail to be conducted. The PR interval remains at a constant length however it is not consistently conducted and may or may not show a fixed ratio e.g. 2:1.
name: Mobitz type II
label: d
answer: no
explanation: Complete (3rd degree) heart block occurs due to atrial impulses failing to pass to the ventricles. Patients can present with syncope or cardiac arrest and have bradycardia on ECG. There is no relationship between P and QRS complexes.
name: Complete heart block
label: a
answer: yes
explanation: Electrical activity is being prolonged through the AV node and therefore causes a prolonged PR interval (>200ms). 1st-degree heart block can occur in those with a high vagal tone, after an acute inferior MI, hyperkalaemia and drugs e.g. digoxin.
name: 1st-degree heart block
label: b
answer: no

Correct answer: a
Which of the following is an ECG feature of Wolff-Parkinson-White (WPW) syndrome?

Options:
explanation: This is a feature of cardiac tamponade due to the heart moving back and forth in excessive fluid in the pericardial space.
name: Electrical alternans
label: d
answer: no
explanation: Congenital long QT syndrome is autosomal dominant although long QT can also be acquired due to certain drugs e.g. antibiotics like erythromycin.
name: Long QT interval
label: e
answer: no
explanation: This is a feature of hyperkalaemia. Sinus bradycardia and conduction blocks may also be present.
name: Tall T waves
label: c
answer: no
explanation: This is a feature of 1st-degree heart block whereby electrical activity is prolonged through the AV node.
name: PR interval >200ms
label: b
answer: no
explanation: Delta waves appear as an upstroke QRS complex and are a feature of WPW syndrome. A short PR interval (<120ms) and broad QRS complexes may also be seen.
name: Delta waves
label: a
answer: yes

Correct answer: a
Which of the following is the most likely cause of a stroke?

Options:
explanation: Hypertension is the leading cause of stroke. Hypertension results from reduced elasticity in arteries due to older age and atheroma and calcification build up in the arteries.
name: Hypertension
label: a
answer: yes
explanation: Diabetes mellitus type 2 is linked to other co-morbidities like hypertension and obesity, however, it is not the leading cause of stroke.
name: Diabetes mellitus type 2
label: d
answer: no
explanation: Obesity is linked to hypertension and other co-morbidities like type 2 diabetes mellitus and atherosclerosis, however, hypertension is still the leading cause of stroke.
name: Obesity
label: c
answer: no
explanation: Whilst smoking can lead to hypertension, smoking itself is not the biggest cause of stroke.
name: Smoking
label: b
answer: no
explanation: Depression has been linked to stroke, however, it is more common to have depression after a stroke occurs. Hypertension is the leading cause of stroke.
name: Depression
label: e
answer: no

Correct answer: a
A 50-year-old man presents to his GP with haemoptysis and a cough which he has had for 10 weeks. He is a smoker and has been for 29 years. The GP also notes unintentional weight loss of 6kg in the last 2 months.

Which of the following is the most likely diagnosis?

Options:
explanation: Red flag symptoms for lung cancer are weight loss and haemoptysis. The patient is not particularly old, however, he is a smoker which increases his risk of lung cancer and is displaying clinical features (unintentional weight loss) which require urgent investigation.
name: Lung cancer
label: a
answer: yes
explanation: Whilst this can present with haemoptysis and cough, unintentional weight loss is more concerning for malignancy and must be explored. Patients with bronchiectasis would also likely have purulent sputum.
name: Bronchiectasis
label: b
answer: no
explanation: A patient with asthma would not typically present with haemoptysis and weight loss. A cough may be present although other symptoms such as wheeze, dyspnoea and chest tightness would often be present.
name: Asthma
label: c
answer: no
explanation: Haemoptysis and cough can be present in pneumonia, however, the unintentional weight loss and smoking history are more concerning for malignancy.
name: Pneumonia
label: d
answer: no
explanation: This is often a more acute presentation and would present with sudden onset dyspnoea and pleuritic chest pain. Patients with a pulmonary embolism can have haemoptysis although in this case, the symptoms are more gradual and the weight loss is more indicative of malignancy.
name: Pulmonary embolism
label: e
answer: no

Correct answer: a
Which of the following is a shockable heart rhythm in cardiac arrest?

Options:
explanation: This is a shockable rhythm alongside ventricular fibrillation. Non-shockable rhythms include asystole and pulseless electrical activity.
name: Ventricular tachycardia
label: a
answer: yes
explanation: This is a normal part of the cardiac cycle where the ventricles are contracting.
name: Systole
label: d
answer: no
explanation: This is a non-shockable rhythm.
name: Asystole
label: b
answer: no
explanation: This is a normal part of the cardiac cycle where the chambers are filling with blood in a relaxed state.
name: Diastole
label: e
answer: no
explanation: This is a non-shockable rhythm.
name: Pulseless electrical activity
label: c
answer: no

Correct answer: a
Which of the following conditions is associated with pulmonary stenosis?

Options:
explanation: Pulmonary stenosis is often congenital and associated with Noonan syndrome.
name: Noonan syndrome
label: a
answer: yes
explanation: Klinefelter Syndrome is where males have an extra X chromosome and have the karyotype of XXY. These patient's are often tall and have small genitalia.
name: Klinefelter syndrome
label: c
answer: no
explanation: This is trisomy 21 and up to 15% of these patients have an atrioventricular septal defect.
name: Down syndrome
label: d
answer: no
explanation: Marfan syndrome can be associated with an aortic aneurysm and also affects the skeleton and eyes.
name: Marfan syndrome
label: b
answer: no
explanation: Patients have a karyotype of 45X0 and present with coarctation of the aorta, short stature and gonadal dysgenesis.
name: Turner syndrome
label: e
answer: no

Correct answer: a
Which of the following is a complication of Turner's syndrome?

Options:
explanation: There is an increased risk of aortic stenosis due to a bicuspid valve abnormality. Aortic dissection is also a potential complication.
name: Aortic stenosis
label: a
answer: yes
explanation: Aortic stenosis is a complication of Turner's syndrome, not mitral. Mitral stenosis is commonly caused by rheumatic heart disease.
name: Mitral stenosis
label: e
answer: no
explanation: This often occurs in patients with Noonan syndrome.
name: Pulmonary stenosis
label: b
answer: no
explanation: This is inflammation of the pericardium which can be caused by numerous things including infection, malignancy and rheumatic disease and is not associated with Turner's syndrome.
name: Pericarditis
label: d
answer: no
explanation: This often occurs in patients with Marfan syndrome.
name: Aortic aneurysm
label: c
answer: no

Correct answer: a
An 84-year-old male who is a retired construction worker develops dyspnoea and a cough. On examination, he has finger clubbing and reduced chest expansion. He is also a smoker.

Which of the following is the most likely diagnosis?

Options:
explanation: This is an abnormal build-up of fluid in the pleural cavity and can be caused by exudative or transudative causes like infection or congestive heart failure respectively.
name: Pleural effusion
label: c
answer: no
explanation: This would present as snoring when asleep, lack of concentration, irritability and excessive daytime sleepiness.
name: Obstructive sleep apnoea
label: e
answer: no
explanation: This is the dilatation of bronchi due to chronic infection. Patients would display similar symptoms to those mentioned above, however, purulent sputum, productive cough and haemoptysis would be more indicative of bronchiectasis. Also, given that this patient is a retired construction worker, it is important to consider asbestos exposure.
name: Bronchiectasis
label: d
answer: no
explanation: This is a type of lung malignancy and is associated with asbestos exposure. However, this patient is not displaying any red flag signs of malignancy at this stage such as weight loss or haemoptysis.
name: Mesothelioma
label: b
answer: no
explanation: This is a diffuse interstitial lung fibrosis with pleural plaques present due to excessive asbestos exposure. This patient is a retired construction worker who would likely have been exposed to asbestos.
name: Asbestosis
label: a
answer: yes

Correct answer: a
A 57-year-old male presents to A&E with severe sudden onset chest pain that radiates to his back. He has a past medical history of hypertension and type 2 diabetes mellitus.

Which of the following is the most likely diagnosis?

Options:
explanation: Aortic dissection is when a tear in the tunica intima of the aorta occurs thereby letting blood flow in between the inner and outer layers of the aorta walls. Risk factors include hypertension and a classical presentation is a man typically >50 years old with sudden onset chest pain that radiates to the back.
name: Aortic dissection
label: a
answer: yes
explanation: Chest pain in this case is often centralised and radiates down the left arm or up the jaw. It is classically a 'crushing' chest pain rather than 'tearing' as seen in aortic dissection.
name: Non-ST-elevated Myocardial Infarction
label: e
answer: no
explanation: Atrial fibrillation is when there is uncoordinated atrial contraction. Patients would often have chest pain, palpitations, and dyspnoea and on examination, an irregularly irregular pulse would be felt.
name: Atrial fibrillation
label: c
answer: no
explanation: Fluid or blood can accumulate in the pericardial space causing chest pain and dyspnoea. This is a medical emergency, however, as the chest pain, in this case, radiates to the back, it is more indicative of aortic dissection.
name: Cardiac tamponade
label: d
answer: no
explanation: Marfan's syndrome is a connective tissue disorder and is a risk factor for aortic dissection, however, there are no features in this question which indicate Marfan's syndrome.
name: Marfan's syndrome
label: b
answer: no

Correct answer: a
A 59-year-old patient presents to A&E with severe chest pain. He reports the pain is worse lying down and when he breathes in. He had a cold last week.

Which of the following would be the most likely finding on ECG?

Options:
explanation: Congenital long QT syndrome is autosomal dominant, although a long QT interval can also be acquired due to certain drugs e.g. antibiotics like erythromycin.
name: Long QT interval
label: e
answer: no
explanation: This is a feature of 1st-degree heart block whereby electrical activity is prolonged through the AV node.
name: PR interval >200ms
label: c
answer: no
explanation: Delta waves appear as an upstroke QRS complex and are a feature of WPW syndrome. A short PR interval (<120ms) and broad QRS complexes may also be seen.
name: Delta waves
label: b
answer: no
explanation: Inflammation of the pericardium can occur for many reasons including infection, malignancy and drug side effects. A classic presentation is pleuritic chest pain that is worse when lying flat and on ECG a saddle-shaped ST elevation would be seen alongside PR depression.
name: Saddle-shaped ST elevation
label: a
answer: yes
explanation: This is a feature of hyperkalaemia. Sinus bradycardia and conduction blocks may also be present.
name: Tall Tented T waves
label: d
answer: no

Correct answer: a
Which of the following lung cancers is the most common in the UK?

Options:
explanation: This is a type of cancer that often affects the lungs and is related to asbestos exposure, although is not the most common type.
name: Mesothelioma
label: d
answer: no
explanation: Lung cancers can be divided into 2 groups, small-cell and non-small-cell. Adenocarcinoma is a non-small cell lung cancer (NSCLC) and the most common sub-type of the NSCLCs.
name: Adenocarcinoma
label: a
answer: yes
explanation: This is not the most common type in the UK. It is often associated with paraneoplastic endocrine disorders like Cushing's disease or Addison's. It typically has a poor prognosis and is most common in patients who smoke.
name: Small cell carcinoma
label: b
answer: no
explanation: This is a type of non-small cell lung cancer but is not the most common in the UK. It often presents with obstruction to the bronchi causing infection.
name: Squamous cell carcinoma
label: c
answer: no
explanation: This is a type of non-small cell lung cancer but is not the most common in the UK>
name: Large cell carcinoma
label: e
answer: no

Correct answer: a
A 76-year-old male patient presents to A&E as he is acutely confused, has a fever and reports pleuritic chest pain. His partner mentions he has been coughing up blood and 'green phlegm' over the last few days. On examination, he is tachypnoeic with a respiratory rate of 32 and a BP of 96/62. His urea was measured at 6.8 mmol/L (normal range 2.5-7.8 mmol/L).


Which of the following is this patient's CURB-65 score?

Options:
explanation: This patient has 3/5 of the possible points for CURB-65. He is >65 years old, confused and has a respiratory rate of 32, giving him 3 points. A score of 1 gives a 3.2% chance of mortality.
name: 1
label: b
answer: no
explanation: This patient has 3/5 of the possible points for CURB-65. He is >65 years old, confused and has a respiratory rate of 32, giving him 3 points. A score of 2 gives a 13% chance of mortality.
name: 2
label: c
answer: no
explanation: This patient has 3/5 of the possible points for CURB-65. He is >65 years old, confused and has a respiratory rate of 32, giving him 3 points. A score of 5 gives a 57% chance of mortality.
name: 5
label: d
answer: no
explanation: This patient has 3/5 of the possible points for CURB-65. He is >65 years old, confused and has a respiratory rate of 32, giving him 3 points. A score of 4 gives a 41.5% chance of morality.
name: 4
label: e
answer: no
explanation: This patient is >65 years old, confused and has a respiratory rate of >30. This gives a score of 3. His blood pressure is above 90 systolic and above 60 diastolic and his urea is < 7 mmol/L. A score of 3 gives a 17% chance of mortality.
name: 3
label: a
answer: yes

Correct answer: a
A 32-year-old female patient who is a known IV drug user (IVDU) presents to A&E with a high fever. On examination, splinter haemorrhages and Janeway lesions are noted.

Which of the following pathogens is the most likely cause of this diagnosis?

Options:
explanation: This is the most common pathogen seen in IVDU with infective endocarditis due to potential contamination of needles and skin sites.
name: *Staphylococcus aureus*
label: a
answer: yes
explanation: This pathogen is often seen in patients with colonic lesions as seen in inflammatory bowel disease or colorectal carcinoma.
name: *Streptococcus bovis*
label: d
answer: no
explanation: This is a fungus which acts as an opportunistic pathogen and is not typically associated with infective endocarditis. It commonly affects those who are immunocompromised, for example, patients with HIV/AIDS.
name: *Pneumocystis jirovecii*
label: e
answer: no
explanation: This is also a common pathogen causing infective endocarditis. However, it is more commonly seen in patients with poor dentition or dental infections.
name: *Streptococcus viridans*
label: b
answer: no
explanation: This is part of the HACEK organism group which can cause infective endocarditis, however, it is not as common as *Staphylococcus aureus* in IVDU.
name: *Haemophilus influenzae*
label: c
answer: no

Correct answer: a