hllj/quesmed huggingface dataset:
A 33 year old women is 32 weeks pregnant when she experiences a pre-labour rupture of her membranes. She has no past medical history of note and is nulliparous. Her pregnancy has been otherwise medically unremarkable. She is prescribed medication to delay the onset of labour, to allow time for corticosteroids to mature the foetal lungs.

Which of the following is a suitable tocolytic agent?

Options:
explanation: This is a beta-blocker that is used to control gestational hypertension. In this case, we need an agent to delay labour. Suitable tocolytic agents include nifedipine, atosiban (oxytocin receptor antagonist) and indomethacin (non-steroidal anti-inflammatory drug).
name: Labetalol
label: d
answer: no
explanation: This is a technique that is commonly used to induce labour; the opposite of the desired effect in this case. Suitable tocolytic agents include nifedipine, atosiban (oxytocin receptor antagonist) and indomethacin (non-steroidal anti-inflammatory drug).
name: Membrane sweep
label: c
answer: no
explanation: This is an agent that is commonly given when patients are in established labour, to speed up the process. In this case, we need an agent to delay labour. Suitable tocolytic agents include nifedipine, atosiban (oxytocin receptor antagonist) and indomethacin (non-steroidal anti-inflammatory drug).
name: Oxytocin
label: e
answer: no
explanation: Prostaglandins such as dinoprostone are used to induce labour; the opposite of the desired effect in this case. Suitable tocolytic agents include nifedipine, atosiban (oxytocin receptor antagonist) and indomethacin (non-steroidal anti-inflammatory drug).
name: Prostaglandin E2
label: b
answer: no
explanation: This is a type of calcium channel blocker that is commonly used to delay the onset of labour in pre-term cases. Other suitable agents include atosiban (oxytocin receptor antagonist) and indomethacin (non-steroidal anti-inflammatory drug). Contraindications to giving a tocolytic agent include being > 34 weeks pregnant, being in established labour (4 cm cervical dilation) and intra-uterine death.
name: Nifedipine
label: a
answer: yes

Correct answer: a
A 37 year old nulliparous woman who is 36 weeks pregnant is monitored on the labour ward. She has a past medical history of chronic hypertension, in addition to type 2 diabetes mellitus. She reports a severe, acute-onset headache. On examination, the patient has bilateral swelling of her legs. A urine dip is strongly positive for proteinuria, and blood tests show a haemoglobin of 140 g/L (normal range 115-155 g/L) with normal liver function tests.


Which of the following is the most likely underlying diagnosis?

Options:
explanation: Any pregnant woman with hypertension and proteinuria should raise suspicions of preeclampsia. These symptoms of headache and peripheral oedema also point towards preeclampsia. The patient's background of diabetes, chronic hypertension, increasing age and being nulliparous are all risk factors for developing preeclampsia.
name: Preeclampsia
label: a
answer: yes
explanation: HELLP syndrome, a condition affecting the liver and clotting function, is a form of preeclampsia. The patient is unlikely to have this as there is no evidence of haemolysis or elevated liver enzymes. Pre-eclampsia is therefore the most likely diagnosis.
name: HELLP (Haemolysis, Elevated Liver enzymes and Low Platelets) syndrome
label: b
answer: no
explanation: An amniotic fluid embolism is a rare obstetric emergency. It typically occurs during or after labour, when amniotic fluid or other foetal material enters the maternal pulmonary circulation. Symptoms include maternal tachycardia, tachypnoea, hypoxia and hypotension. It is a life-threatening emergency that requires intensive care transfer. It is not the most likely diagnosis in this case. Any pregnant woman with hypertension and proteinuria should raise suspicions of preeclampsia. These symptoms of headache and peripheral oedema also point towards preeclampsia.
name: Amniotic fluid embolism
label: d
answer: no
explanation: Gestational hypertension is a type of high blood pressure that comes on during pregnancy, and is expected to resolve after giving birth. This is unlikely to be the diagnosis in this case. The woman already has an established history of chronic hypertension before being pregnant, and the presence of proteinuria indicates preeclampsia rather than simple gestational hypertension. Any pregnant woman with hypertension and proteinuria should raise suspicions of preeclampsia. These symptoms of headache and peripheral oedema also point towards preeclampsia.
name: Gestational hypertension
label: c
answer: no
explanation: This is an emergency that occurs during labour. It is when the umbilical cord passes through the cervix before the passage of the baby, which can cause foetal hypoxia. It requires prompt instrumental delivery. It is not the most likely diagnosis in this case. Any pregnant woman with hypertension and proteinuria should raise suspicions of preeclampsia. These symptoms of headache and peripheral oedema also point towards preeclampsia.
name: Umbilical cord prolapse
label: e
answer: no

Correct answer: a
A 33 year old woman attends a GP appointment after suffering from lethargy, shortness of breath and generalised weakness for the past 6 weeks. She denies any visible blood loss, change in bowel habits or weight loss. She has a past medical history of type 2 diabetes. She has no relevant family history. Her observations are within the normal limit, and a neurological examination is normal.

Concerned by her symptoms, her doctor orders a blood test that shows a haemoglobin level of 10.5 g/dL and mean cell volume (MCV) of 110 fL.

Which of the following is the most likely cause of this patient's symptoms?

Options:
explanation: Metformin is a biguanide medication used as first line treatment in type 2 diabetes. There is an established link between taking this metformin and the development of macrocytic anaemia. The patient's clinical picture of fatigue, weakness and shortness of breath all point towards anaemia, which is confirmed by the low haemoglobin levels. The mean cell volume above 100 fL reveals this as a macrocytic anaemia.
name: Taking mformin
label: a
answer: yes
explanation: Individuals with heavy periods are likely to develop iron deficiency anaemia due to the high levels of blood loss. This patient is unlikely to have an iron-deficiency anaemia as the mean cell volume is > 100 fL, indicating macrocytic anaemia. Iron-deficiency anaemia is typically microcytic, with mean cell volume levels <80 fL.
name: Menorrhagia
label: d
answer: no
explanation: Chronic usage of laughing gas can lead to raised homocysteine levels, which can occasionally cause macrocytic anaemia. Raised homocysteine commonly causes neurological symptoms, for example, sensory disturbance as in subacute combined spinal cord degeneration. This is therefore a less likely explanation for this patient's presentation compared to metformin use.
name: Chronic nitrous oxide (laughing gas) usage
label: b
answer: no
explanation: Whilst this patient is displaying signs of anaemia (fatigue, weakness etc) as well as presenting with low haemoglobin levels, it is unlikely this is related to an underlying iron deficiency. This is due to the mean cell volume being > 100 fL, a typical sign of macrocytic anaemia. Iron-deficiency anaemia is typically microcytic, with mean cell volume levels  <80 fL.
name: Poor dietary intake of Iron
label: c
answer: no
explanation: Whilst there are no signs this woman is pregnant, it is reasonable to check this possibility in a female patient of child-bearing age. Iron deficiency anaemia is the most common form of anaemia in pregnancy. This case is unlikely to be iron-deficiency related due to the mean cell volume being > 100 fL, indicating macrocytic anaemia. Iron-deficiency anaemia is typically microcytic, with mean cell volume levels <80 fL.
name: Pregnancy
label: e
answer: no

Correct answer: a
A 29 year old man presents to his local emergency department in extreme pain. He is unable to sit down and is pacing around the triage unit. He describes a sharp pain in his right flank that radiates down into the right side of his groin, which has been present for the past 3 hours. He has never experienced pain like this before. A CT scan identifies staghorn calculi within the renal pelvis.

What is the composition of a staghorn renal calculi?

Options:
explanation: Struvite stones account for roughly 5 - 10% of all cases of renal colic and are typically formed in individuals with a recent upper respiratory tract infection (specifically proteus bacteria). They form characteristic staghorn calculi.
name: Struvite
label: a
answer: yes
explanation: Individuals with this type of renal stone typically suffer from recurrent renal colic and urinary tract infections. Cysteine calculi are linked to a genetic defect in the reabsorption of cysteine in the kidney. They are a very rare cause of renal colic.
name: Cysteine
label: e
answer: no
explanation: Whilst it is true that the majority of cases of renal stones will be composed of calcium oxalate, the presence of staghorn calculi on CT imaging make these stones more likely to be composed of struvite instead.
name: Calcium oxalate
label: c
answer: no
explanation: This is a very rare form of renal stone composition. It typically occurs in patients using the anti-viral drug indinavir e.g, as part of HIV management. The presence of staghorn calculi on CT imaging makes these stones more likely to be composed of struvite instead.
name: Indinavir
label: d
answer: no
explanation: These types of renal stones are typically seen in individuals with a history of gout. They account for roughly 5-10% of all renal colic cases. The presence of staghorn calculi on CT imaging makes these stones more likely to be composed of struvite instead of uric acid.
name: Uric acid
label: b
answer: no

Correct answer: a
A 30 year old woman presents to her GP with recurrent headaches that have been present intermittently for the past 2 months. She describes seeing spots and zig zags in her vision before developing a pulsating, unilateral headache that can last for several hours. Alongside the, she reports bouts of nausea & vomiting. She takes paracetamol as needed, with little benefit.

She has no past medical history, but notes feeling particularly stressed since starting a new job 2 months ago. She does not smoke or drink alcohol, but notes her diet is 'not the best'.

Which of the following is the most likely underlying diagnosis?

Options:
explanation: Cluster headaches tend to appear intermittently in irregular 'clusters', and are often described as unilateral pain around the orbit of the eye. The auras this patient experiences alongside the pulsatile, long-lasting nature of the headaches, make it more likely these are migraines.
name: Cluster
label: c
answer: no
explanation: Tension headaches tend to be bilateral and non-pulsatile, feeling like a 'tight band'. They do not tend to present with auras beforehand. Migraines are therefore a more likely underlying diagnosis in this case.
name: Tension
label: b
answer: no
explanation: This type of headache typically presents as bilateral and non-pulsatile. In addition, they are often found to be worse in the morning. Cushing's reflex may be seen in cases of raised ICP; this is characterised by a triad of increased blood pressure, decreased heart rate and irregular breathing. The absence of these features and the presence of an aura makes migraines the more likely underlying diagnosis.
name: Raised Intra-cranial-pressure (ICP)
label: d
answer: no
explanation: The presence of a visual aura preceding a severe headache that is unilateral and pulsatile in nature is characteristic of a migraine. The nausea and vomiting also support this diagnosis. Stress is a common trigger for migraines, as alluded to by this patient changing jobs at a similar time to when the headaches first appeared.
name: Migraine
label: a
answer: yes
explanation: Trigeminal neuralgia is more prevalent in those over 50. It presents with sharp, stabbing pain that follows the distribution of the trigeminal nerve across one side of the face. The absence of these features and the presence of an aura makes migraines the more likely underlying diagnosis.
name: Trigeminal neuralgia
label: e
answer: no

Correct answer: a
An 8 year old girl is brought to see her GP by her father, who is concerned that her urine has become 'frothy'. There is no blood, and the child denies any dysuria. She is otherwise fit and well and takes no regular medications.

On examination, oedema is noted on both legs. Her face appears swollen, particularly around the eyes. The father confirms this is a change from her usual appearance.

Which of the following is the most likely underlying diagnosis?

Options:
explanation: This patient demonstrates classic features of nephrotic syndrome. The most common cause of nephrotic syndrome in young children is minimal change disease. By contrast, haemolytic uraemic syndrome is more likely to present with acute kidney injury, thrombocytopenia, and microangiopathic haemolytic anaemia. This option is therefore incorrect.
name: Haemolytic uraemic syndrome
label: e
answer: no
explanation: This patient demonstrates classic features of nephrotic syndrome. The most common cause of nephrotic syndrome in young children is minimal change disease. By contrast, Henoch-Schönlein purpura causes nephritic syndrome. Symptoms include a purpuric skin rash, joint pain, and gastrointestinal symptoms. This option is therefore incorrect.
name: Henoch-Schönlein purpura
label: d
answer: no
explanation: This patient demonstrates classic features of nephrotic syndrome. Whilst membranous nephropathy is another cause of nephrotic syndrome, the most common cause in children is minimal change disease.
name: Membranous nephropathy
label: b
answer: no
explanation: This patient demonstrates classic features of nephrotic syndrome. Whilst diabetes mellitus is another cause of nephrotic syndrome, the most common cause in children is minimal change disease. It is less common for a child with no past medical history to present with nephrotic syndrome secondary to diabetes.
name: Diabetes mellitus
label: c
answer: no
explanation: This patient demonstrates classic features of nephrotic syndrome. The frothy urine indicates marked proteinuria and the swelling is due to oedema. Blood results would be expected to show hypoalbuminaemia. The most common cause of nephrotic syndrome in young children is minimal change disease. Whilst not specified in this question, it often occurs after an upper respiratory tract infection.
name: Minimal change disease
label: a
answer: yes

Correct answer: a
A 10 year old boy attends a community paediatric clinic with his mother. She describes her son as easily distractible and very fidgety. He often forgets to complete his homework, and can have trouble organising his belongings. More recently, he received a worrying report from his school teacher, describing concentration problems that can disrupt other students and impair his ability to complete tasks.

They discuss conservative management of the boy's symptoms, however these have already been trialled with limited results. Both mother and son are keen to try medication.

Given the likely diagnosis, which of the following medications can be prescribed to manage the boy's symptoms?

Options:
explanation: This is a typical presentation of attention deficit hyperactivity disorder (ADHD). Dexamethasone is a glucocorticoid medication. It is not typically used in the management of ADHD.
name: Dexamethasone
label: b
answer: no
explanation: This is a typical presentation of attention deficit hyperactivity disorder (ADHD). Haloperidol is a first-generation antipsychotic medication. It is not typically used in the management of ADHD.
name: Haloperidol
label: e
answer: no
explanation: This is a typical presentation of attention deficit hyperactivity disorder (ADHD). Diazepam is a benzodiazepine. Although it can be used to manage significant agitation, it is not typically used in the management of ADHD.
name: Diazepam
label: d
answer: no
explanation: This is a typical presentation of attention deficit hyperactivity disorder (ADHD). Lorazepam is a benzodiazepine. Although it can be used to manage significant agitation, it is not typically used in the management of ADHD.
name: Lorazepam
label: c
answer: no
explanation: This is a typical presentation of attention deficit hyperactivity disorder (ADHD). In order for a diagnosis of ADHD to be confirmed, symptoms such as inattention and restlessness must be present in more than 1 setting, as they are for this child (home and at school). Conservative management of ADHD includes cognitive behavioural therapy (CBT), psychoeducation and extra school support. Medication is typically used if conservative options prove ineffective. These are stimulant medications such as methylphenidate or amphetamines. They work primarily in the frontal lobe, increasing executive function and attention, and reducing impulsivity.
name: Methylphenidate
label: a
answer: yes

Correct answer: a
A 43 year old man with a long-standing history of gastro-oesophageal reflux disease (GORD) receives the results of a recent oesophago-gastro duodenoscopy. The clinician explains that they found evidence of a condition known as Barrett's oesophagus.

Which of the following epithelial changes is found in Barrett's oesophagus?

Options:
explanation: Whilst the epithelium lining the oesophagus is squamous, the metaplastic change in Barrett's oesophagus is to columnar not glandular epithelium. This is because the oesophagus has to adapt to chronic acid exposure and so the epithelium becomes like that of the stomach; columnar. A glandular epithelium is found in organs that have secretory functions such as the pancreas.
name: Stratified squamous to glandular
label: c
answer: no
explanation: Whilst the epithelium lining the oesophagus is squamous, the metaplastic change in Barrett's oesophagus is to columnar rather than cuboidal epithelium. This is because the oesophagus has to adapt to chronic acid exposure, and so the epithelium becomes like that of the stomach; columnar.
name: Stratified squamous to cuboidal
label: b
answer: no
explanation: Barrett's oesophagus involves a metaplastic change of the normal squamous epithelium of the distal oesophagus to a columnar epithelium. This is because the oesophagus has to adapt to chronic acid exposure and so the epithelium becomes like that of the stomach; columnar.
name: Glandular to stratified squamous
label: e
answer: no
explanation: Barrett's oesophagus involves a metaplastic change of the normal squamous epithelium of the distal oesophagus to a columnar epithelium. This is because the oesophagus has to adapt to chronic acid exposure and so the epithelium becomes like that of the stomach; columnar.
name: Cuboidal to stratified squamous
label: d
answer: no
explanation: Barrett's oesophagus involves a metaplastic change of the normal squamous epithelium of the distal oesophagus to a columnar epithelium. This typically occurs when oesophageal cells are chronically exposed to acidic stomach contents, as in the case of GORD. Metaplasia is a broad term in histology used to refer to the change from one differentiated cell type to another differentiated cell type.
name: Stratified squamous to columnar
label: a
answer: yes

Correct answer: a
A 65 year old man presents to the emergency department with sudden onset left-sided weakness. Neurological examination reveals a range of upper motor neuron signs. A CT head shows a hypo-dense region focused on the majority of the middle cerebral artery (MCA).  An ischaemic MCA stroke is diagnosed.

Which of the following is an example of an upper motor neuron sign?

Options:
explanation: Hypotonia is a lower motor neuron pathological sign. It occurs as a result of damage to gamma motor neurons. Examples of diseases causing lower motor neuron pathology include progressive muscular atrophy (a type of motor neuron disease) and poliomyelitis.
name: Hypotonia
label: c
answer: no
explanation: Muscular atrophy is a lower motor neuron pathological sign. It commonly occurs due to disuse of the musculature following paresis. Examples of diseases causing lower motor neuron pathology include progressive muscular atrophy (a type of motor neuron disease) and poliomyelitis.
name: Muscular atrophy
label: b
answer: no
explanation: Flaccid paralysis is a lower motor neuron pathological sign. It occurs as a result of damage to gamma motor neurons. Examples of diseases causing lower motor neuron pathology include progressive muscular atrophy (a type of motor neuron disease) and poliomyelitis.
name: Flaccid paralysis
label: d
answer: no
explanation: Fasciculations are a lower motor neuron pathological sign. This involves twitching of small groups of muscle fibres due to the spontaneous discharge of motor units. Examples of diseases causing lower motor neuron pathology include progressive muscular atrophy (a type of motor neuron disease) and poliomyelitis.
name: Fasciculations
label: e
answer: no
explanation: A positive Babinski sign, in which stroking the sole of the foot causes dorsiflexion with extension of the hallux, is a key indicator of an upper motor neuron lesion. In healthy individuals, the foot deviates downwards or does not move. Other upper motor neuron signs include spasticity and hyperreflexia.
name: Upgoing plantar reflex
label: a
answer: yes

Correct answer: a
A 36 year old man attends a colorectal clinic to discuss a recent diagnosis of colorectal cancer. When asked about his family history, he reports having both an uncle and a brother who were similarly diagnosed with colorectal cancer at a young age. The clinician suspects a genetic cancer syndrome.

Which of the following best describes the genetic inheritance pattern of familial adenomatous polyposis?

Options:
explanation: Familial adenomatous polyposis is an autosomal dominant condition. This means that an individual needs to inherit just one copy of the defective allele for it to be reflected in the person's phenotype. It is encoded by alleles on the numbered non-sex chromosomes rather than through mitochondrial DNA, making this answer incorrect.
name: Mitochondrial
label: e
answer: no
explanation: Familial adenomatous polyposis is an autosomal dominant condition. This means that an individual needs to inherit just one copy of the defective allele for it to be reflected in the person's phenotype. It is encoded by alleles on the numbered non-sex chromosomes, making this answer incorrect.
name: X-linked recessive
label: c
answer: no
explanation: Familial adenomatous polyposis is an autosomal dominant condition. This means that an individual needs to inherit just one copy of the defective allele for it to be reflected in the person's phenotype.
name: Autosomal recessive
label: b
answer: no
explanation: Familial adenomatous polyposis is an inherited disorder characterised by the growth of multiple colorectal polyps. This carries a high risk of malignant transformation and thus colorectal cancer development.

It is an autosomal dominant condition. This means that an individual needs to inherit just one copy of the defective allele for it to be reflected in the person's phenotype, meaning they have the disease. It also means that roughly 50% of children of an affected parent will inherit the condition. Individuals with familial adenomatous polyposis often first find out when they are genetically tested following the colorectal cancer diagnosis of a close relative.
name: Autosomal dominant
label: a
answer: yes
explanation: Familial adenomatous polyposis is an autosomal dominant condition. This means that an individual needs to inherit just one copy of the defective allele for it to be reflected in the person's phenotype. It is encoded by alleles on the numbered non-sex chromosomes, making this answer incorrect.
name: X-linked dominant
label: d
answer: no

Correct answer: a