hllj/quesmed huggingface dataset:
A 52 year old woman is commenced on peritoneal dialysis (PD) due to her end stage kidney disease. Shortly after starting PD, she develops sudden abdominal pain. It is noted that the contents of her dialysis bag has turned cloudy.

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

Options:
explanation: Sudden abdominal pain with cloudy dialysate is a hallmark of PD peritonitis. Patients should be given intra-peritoneal antibiotics as soon as possible.
name: PD peritonitis
label: a
answer: yes
explanation: Sudden abdominal pain with a cloudy dialysis bag is a hallmark of PD peritonitis. By contrast, fluid overload would not be expected to cause these symptoms and is not a common complication of starting peritoneal dialysis.
name: Fluid overload
label: d
answer: no
explanation: Sudden abdominal pain with a cloudy dialysis bag is a hallmark of PD peritonitis. By contrast, hyperbilirubinaemia is characterised by yellowing of the skin (jaundice) and is not a common complication of peritoneal dialysis.
name: Hyperbilirubinaemia
label: e
answer: no
explanation: Sudden abdominal pain with a cloudy dialysis bag is a hallmark of PD peritonitis. By contrast, an exit-site infection is characterised by erythema and possible discharge at the catheter site.
name: Exit-site infection
label: b
answer: no
explanation: Sudden abdominal pain with a cloudy dialysis bag is a hallmark of PD peritonitis. By contrast, a tunnel infection is indicated by swelling and erythema at the catheter site.
name: Tunnel infection
label: c
answer: no

Correct answer: a
A 57 year old man is prescribed ciprofloxacin for an infected diabetic ulcer. The GP explains that ciprofloxacin is a member of the quinolone family of antibiotics.

Which of the following best describes the mechanism of action of ciprofloxacin?

Options:
explanation: Aminoglycosides such as gentamicin work by binding to ribosomes to inhibit bacterial protein synthesis. This does not describe the mechanism of action of ciprofloxacin. Quinolones such as ciprofloxacin work by inhibiting bacterial DNA synthesis.
name: Inhibition of protein synthesis
label: e
answer: no
explanation: Programmed cell death of bacteria is not a recognised method of bacterial destruction by conventional antibiotics. This does not describe the mechanism of action of ciprofloxacin. Quinolones such as ciprofloxacin work by inhibiting bacterial DNA synthesis.
name: Programmed cell death of bacteria
label: d
answer: no
explanation: Bacterial protein synthesis inhibition describes the mechanism of action of tetracycline, macrolide and aminoglycoside antibiotics. By contrast, quinolones such as ciprofloxacin work by inhibiting bacterial DNA synthesis.
name: Bacterial protein synthesis inhibition
label: c
answer: no
explanation: Quinolones (including ciprofloxacin), sulphonamides and nitroimidazoles work by inhibiting bacterial DNA synthesis. This answer is therefore correct.
name: Inhibition of nucleic acid synthesis
label: a
answer: yes
explanation: Inhibition of bacterial cell wall synthesis describes the mechanism of action of penicillins and cephalosporins. By contrast, quinolones such as ciprofloxacin work by inhibiting bacterial DNA synthesis.
name: Inhibition of bacterial cell wall synthesis
label: b
answer: no

Correct answer: a
A 21 year old woman is brought to A&E after consuming a litre of vodka and losing consciousness in the street. The clinical team discusses the process of alcohol metabolism.

Which of the following enzymes is responsible for converting ethanol to acetaldehyde?

Options:
explanation: Alcohol dehydrogenase is responsible for converting ethanol to acetaldehyde.
name: Alcohol dehydrogenase
label: a
answer: yes
explanation: Acetaldehyde dehydrogenase is the enzyme responsible for converting acetaldehyde to acetyl CoA. Alcohol dehydrogenase is responsible for converting ethanol to acetaldehyde.
name: Acetaldehyde dehydrogenase
label: b
answer: no
explanation: Isocitrate is a substrate found within within the Krebs cycle. Alcohol dehydrogenase is responsible for converting ethanol to acetaldehyde
name: Isocitrate
label: e
answer: no
explanation: Oxaloacetate is a substrate found within the Krebs cycle. Alcohol dehydrogenase is responsible for converting ethanol to acetaldehyde.
name: Oxaloacetate
label: d
answer: no
explanation: Acetyl CoA is the product arising from the joining of co-enzyme A to acetate after its production from acetaldehyde. Acetyl CoA can then go into the Krebs cycle or be converted into fatty acids. By contrast, alcohol dehydrogenase is responsible for converting ethanol to acetaldehyde.
name: Acetyl CoA
label: c
answer: no

Correct answer: a
A 22 year old woman presents to her GP with 5 days of burning pain when urinating. She also feels the urge to urinate more frequently. A urine pregnancy test is negative, but the urine dip is positive for leucocytes and nitrites. She is otherwise fit and well with normal renal function, and her observations are all within the normal range.

Which of the following antibiotic treatment regimes is most appropriate?

Options:
explanation: The symptoms of dysuria and frequency point towards a urinary tract infection (UTI). Standard treatment for an uncomplicated UTI is a 3 day oral course of trimethoprim/nitrofurantoin in a non-pregnant woman. A 7 day course of nitrofurantoin is appropriate for pregnant women, however given the negative urine pregnancy test this option is incorrect.
name: Oral nitrofurantoin twice daily for 7 days
label: d
answer: no
explanation: The symptoms of dysuria and urinary frequency point towards a urinary tract infection (UTI). Standard treatment for an uncomplicated UTI is a 3 day oral course of trimethoprim/nitrofurantoin in a non-pregnant woman. This option is therefore correct.
name: Oral trimethoprim twice daily for 3 days
label: a
answer: yes
explanation: The symptoms of dysuria and frequency point towards a urinary tract infection (UTI). Standard treatment for an uncomplicated UTI is a 3 day oral course of trimethoprim/nitrofurantoin in a non-pregnant woman.
name: Oral gentamicin twice daily for 3 days
label: e
answer: no
explanation: The symptoms of dysuria and frequency point towards a urinary tract infection (UTI). Standard treatment for an uncomplicated UTI is a 3 day oral course of trimethoprim/nitrofurantoin in a non-pregnant woman.
name: Oral amoxicillin twice daily for 3 days
label: c
answer: no
explanation: The symptoms of dysuria and frequency point towards a urinary tract infection (UTI). Intravenous ciprofloxacin can be used in the management of urinary tract infections. However, it is not the first-line treatment option in a patient with normal observations who does not require hospital admission. A 3 day oral course of trimethoprim/nitrofurantoin is most appropriate in this case.
name: Intravenous ciprofloxacin twice daily for 5 days
label: b
answer: no

Correct answer: a
A 35 year old woman discusses the results of a recent endoscopy with her GP. It notes the presence of multiple gastric ulcers.

She has been experiencing symptoms of dyspepsia for the past 6 months. She also suffers with chronic back pain and asthma, for which she takes a range of prescribed medications.

Which of the following repeat prescriptions is most likely to have contributed to her gastric ulcers?

Options:
explanation: Naproxen is a non-steroidal anti-inflammatory drug (NSAID). This class of drugs works through the inhibition of COX-1 enzymes in the gastrointestinal tract, disrupting prostaglandin secretion which usually has a cytoprotective effect on the gastric mucosa. Naproxen therefore increases the risk of gastric ulcers (peptic ulcer disease), and so is often prescribed with a proton pump inhibitor to reduce this risk.
name: Naproxen
label: a
answer: yes
explanation: Omeprazole is a proton pump inhibitor. It works by inhibiting gastric acid secretion, thus reducing the incidence of gastric ulceration. It can also be used in the management of Helicobacter Pylori (H. Pylori) disease. This option is therefore incorrect.
name: Omeprazole
label: e
answer: no
explanation: Co-codamol is a combination drug consisting of paracetamol and the opioid codeine. Neither is commonly associated with damage to the gastric mucosa. This option is therefore incorrect.
name: Co-codamol
label: b
answer: no
explanation: Amoxicillin is an antibiotic. It is not commonly associated with damage to the gastric mucosa. It can, however, be used in the management of Helicobacter Pylori (H. Pylori) disease, reducing the incidence of gastric ulceration. This option is therefore incorrect.
name: Amoxicillin
label: c
answer: no
explanation: Salbutamol is a beta-2 agonist typically used in the management of conditions such as asthma & chronic obstructive pulmonary disorder (COPD). It is not thought to contribute to gastric ulcer formation. This option is therefore incorrect.
name: Salbutamol
label: d
answer: no

Correct answer: a
A 26 year old woman has been suffering from severe mood swings, anxiety and fatigue for the past 6 months. She tells her GP that her symptoms significantly worsen in the week before her period starts, and then get somewhat better once her period has ended. She is otherwise fit and well with no regular medications.

Which of the following is the most likely diagnosis?

Options:
explanation: The build-up of symptoms in the week before menstruation makes them more likely to be pre-menstrual in origin, rather than due to GAD. GAD sufferers tend to have persistent anxiety throughout the month that does not usually get better after menstruation has finished.
name: General anxiety disorder (GAD)
label: d
answer: no
explanation: The build-up of symptoms in the week before menstruation makes them more likely to be pre-menstrual in origin, rather than due to depression. There is no pattern of monthly alleviation and deterioration in pure depressive disease.
name: Depression
label: c
answer: no
explanation: An acute stress reaction develops in response to severe physical and/or mental stress, for example witnessing a fatal road traffic accident. It should last no more than one month. This patient does not make reference to a traumatic event, and her symptoms have been ongoing for more than one month. This, plus the variation in symptom severity according to menstruation, is more in keeping with pre-menstrual syndrome than an acute stress reaction.
name: Acute stress reaction
label: e
answer: no
explanation: Any long-standing psychiatric symptoms such as mood swings should always be investigated and not dismissed as normal. In this case the women is likely  suffering from pre-menstrual syndrome, as her symptoms and fatigue seem to peak in the week before her period starts.
name: Normal physiology
label: b
answer: no
explanation: Psychological symptoms and fatigue that seem to peak in the week before menstruation in a pre-menopausal women should raise suspicion of pre-menstrual syndrome. This typically occurs in a relapsing-remitting fashion over a number of months.
name: Pre-menstrual syndrome
label: a
answer: yes

Correct answer: a
A 27 year old women presents to her GP with a 3 month history of abdominal pain. This pain tends to be worse after eating, and is relieved by opening her bowels. She has noticed mucus in her stool during this time, and feels quite bloated.

Full investigations are performed. Blood tests, including an IgA anti-tissue transglutaminase test, show no abnormalities. Urine pregnancy test, faecal calprotectin and stool microscopy are also normal.

Which of the following is the most likely underlying diagnosis?

Options:
explanation: Ulcerative colitis is also characterised by a change in bowel habit with abdominal pain. However, in ulcerative colitis the faecal calprotectin level will be raised. In this case, the normal faecal calprotectin is indicative of irritable bowel syndrome (IBS) instead. Relief of the pain by defecation is also characteristic of IBS rather than ulcerative colitis.
name: Ulcerative colitis
label: c
answer: no
explanation: The combination of abdominal pain relieved by defecation, mucus in the stool and abdominal distension is in keeping with IBS. By contrast, type 1 diabetes is characterised by signs of endocrine dysfunction such as polyuria and polydipsia.
name: Type 1 diabetes mellitus
label: e
answer: no
explanation: Crohn's disease is also characterised by a change in bowel habit with abdominal pain. However, in Crohn's disease the faecal calprotectin level will be raised. In this case, the normal faecal calprotectin is indicative of irritable bowel syndrome (IBS) instead. Relief of the pain by defecation is also characteristic of IBS rather than Crohn's disease.
name: Crohn's disease
label: b
answer: no
explanation: The combination of abdominal pain relieved by defecation, mucus in the stool and abdominal distension is in keeping with IBS. It is important to rule out alternative causes of these symptoms including irritable bowel disease (IBD) and coeliac disease, before a diagnosis of IBS is made.
name: Irritable bowel syndrome (IBS)
label: a
answer: yes
explanation: Colorectal cancer is associated with red flag features such as rectal bleeding, weight loss and in some cases, a palpable mass. These are not present in this case. Abdominal pain that is relieved by defecation, mucus in the stool and abdominal distension are all indicative of irritable bowel syndrome.
name: Colorectal cancer
label: d
answer: no

Correct answer: a
A 75 year old man presents to the GP surgery with his wife. She reports that her husband has been getting gradually more muddled over the past 8 months, forgetting where he puts things and the names of certain relatives. In the same period, his movements have become noticeably slower. He reports sometimes seeing animals in their living room that his wife says are not really there. He is otherwise fit and well, and takes no regular medications.

Which of the following is the most likely underlying diagnosis?

Options:
explanation: Given the long-term nature of the symptoms, this is unlikely to be delirium. Delirium is a more acute change in mental state caused by an underlying abnormality such as an infection or electrolyte imbalance. The combination of cognitive decline with visual hallucinations and bradykinesia is characteristic of Lewy body dementia (DLB).
name: Delirium
label: e
answer: no
explanation: The combination of cognitive decline with visual hallucinations and bradykinesia is characteristic of Lewy body dementia (DLB). By contrast, patients with vascular dementia are more likely to have underlying cardiovascular risk factors such as hypertension and hyperlipidaemia. Vascular dementia is also characterised by a 'stepwise' decline rather than the more gradual and fluctuating presentation seen in DLB.
name: Vascular dementia
label: b
answer: no
explanation: The combination of cognitive decline with visual hallucinations and bradykinesia is characteristic of Lewy body dementia (DLB). By contrast, Alzheimer's disease does not typically feature bradykinesia or visual hallucinations.
name: Alzheimer's disease
label: c
answer: no
explanation: The combination of cognitive decline with visual hallucinations and bradykinesia is characteristic of Lewy body dementia (DLB). By contrast, fronto-temporal dementia usually presents with changes to behaviour, personality and language.
name: Fronto-temporal dementia
label: d
answer: no
explanation: The combination of cognitive decline with visual hallucinations and bradykinesia is characteristic of Lewy body dementia (DLB). DLB makes up 10-15% of dementia cases.
name: Dementia with Lewy bodies
label: a
answer: yes

Correct answer: a
A 34 year old women is counselled by her GP regarding a new diagnosis of Addison's disease. She is told the disease has lead to destruction of the zona fasciculata in her adrenal cortex.

Which of the following hormones are secreted by the zona fasciculata of the adrenal cortex?

Options:
explanation: The zona glomerulosa produces and secretes the mineralocorticoid aldosterone into the bloodstream, responding to altered serum potassium or decreased blood flow to the kidneys as part of the renin-angiotensin system. The zona fasciculata is responsible for glucocorticoid production and secretion.
name: Mineralocorticoids
label: b
answer: no
explanation: This is a hormone released from the posterior pituitary gland in response to hyperosmolality, acting upon the collecting duct of the kidney. Addison's disease involves the adrenal glands and affects glucocorticoid production and secretion from the zona fasciculata.
name: Anti-diuretic hormone
label: e
answer: no
explanation: The zona fasciculata is the biggest part of the adrenal cortex and secretes glucocorticoids such as cortisol in response to adrenocorticotrophic hormone. Glucocorticoids have a vital role in regulating glucose within the body, as well as impacting blood pressure and immune function.
name: Glucocorticoids
label: a
answer: yes
explanation: Oxytocin is a hormone released from the posterior pituitary gland in response to sexual activity and childbirth. By contrast, Addison's disease involves the adrenal glands and affects glucocorticoid production and secretion from the zona fasciculata.
name: Oxytocin
label: d
answer: no
explanation: The adrenal medulla is responsible for secreting catecholamines. These include adrenaline and noradrenaline and are released in response to sympathetic nervous system stimulation. By contrast, Addison's disease involves the adrenal cortex and affects glucocorticoid production and secretion from the zona fasciculata.
name: Catecholamines
label: c
answer: no

Correct answer: a
A 32 year old woman attends her GP practice for a cervical screen (smear test). The doctor explains that the sample is tested for viruses that increase your risk of developing cervical cancer.

Which of the following two viral serotypes are most commonly associated with an increased risk of cervical cancer?

Options:
explanation: HSV 1 and 2 are both viruses commonly implicated in genital herpes. They are not typically associated with cervical cancer. By contrast, infection with HPV 16 or 18 is a key risk factor in the development of cervical cancer.
name: Herpes simplex virus (HSV) 1 & 2
label: c
answer: no
explanation: Hepatitis B and C viruses are associated with blood-borne infections damaging the liver. They are not implicated in cervical cancer. By contrast, infection with HPV 16 or 18 is a key risk factor in the development of cervical cancer. Cervical screening therefore tests for HPV 16 and 18.
name: Hepatitis B & C
label: e
answer: no
explanation: Infection with HPV 16 or 18 is a key risk factor in the development of cervical cancer. Cervical screening therefore tests for these two viral serotypes.
name: Human papillomavirus (HPV) 16 & 18
label: a
answer: yes
explanation: Whilst this is the correct virus species, it is HPV 16 and 18 that are more commonly associated with cervical cancer. Cervical screening therefore tests for HPV 16 and 18.
name: Human papillomavirus (HPV) 10 & 14
label: d
answer: no
explanation: Epstein-Barr virus infection is not associated with an increased risk of cervical cancer. This virus is more commonly associated with glandular fever. By contrast, infection with HPV 16 or 18 is a key risk factor in the development of cervical cancer.
name: Epstein-Barr virus type 1 & 2
label: b
answer: no

Correct answer: a
A 41 year old man is counselled on the use of proton pump inhibitors by an advanced nurse practitioner, after a recent diagnosis of gastro-oesophageal reflux disease. The nurse explains that the stomach contains chief cells that have a secretory function.

Which of the following compounds is secreted by chief cells of the stomach?

Options:
explanation: Parietal cells of the stomach secrete hydrochloric acid. This hydrochloric acid converts the pepsinogen secreted by the chief cells into pepsin, which breaks down the protein in food into amino acids and peptides.
name: Hydrochloric acid
label: c
answer: no
explanation: There is no evidence to indicate sulphuric acid secretion by any cells in the stomach. Chief cells secrete pepsinogen, which reacts with hydrochloric acid to form pepsin, the endopeptidase which breaks down the protein in food into amino acids and peptides.
name: Sulphuric acid
label: d
answer: no
explanation: This is close to being correct. The chief cells secrete pepsinogen, a proenzyme, that is converted to pepsin through a reaction with hydrochloric acid in the stomach. Pepsin is an endopeptidase involved in the initial digestion of proteins within food to amino acids and peptides.
name: Pepsin
label: b
answer: no
explanation: Correct - pepsinogen is a proenzyme secreted by chief cells of the stomach. It reacts with hydrochloric acid to form pepsin, the endopeptidase involved in the initial digestion of proteins within food to amino acids and peptides.
name: Pepsinogen
label: a
answer: yes
explanation: There is no evidence to indicate magnesium sulphate secretion by any cells in the stomach. Chief cells secrete pepsinogen, which reacts with hydrochloric acid to form pepsin, the endopeptidase involved in the initial digestion of proteins within food to amino acids and peptides.
name: Magnesium sulphate
label: e
answer: no

Correct answer: a
A 15 year old boy presents to the emergency department with sudden-onset diffuse abdominal pain, as well as extensive nausea and vomiting. His mother comments that his breath smells a bit like pear drops. He has never felt like this before. He has no known medical conditions and takes no regular medications.

Which of the following is the most likely underlying diagnosis?

Options:
explanation: This patient is suffering from diabetic ketoacidosis (DKA). In a young individual with no past medical history presenting with abdominal pain and vomiting, together with pear-drop breath, DKA should be top of the differential list. DKA is far more common in individuals suffering from type 1 than type 2 diabetes.
name: Type 2 diabetes mellitus
label: c
answer: no
explanation: There is no indication this is an asthmatic attack, given the absence of shortness of breath or wheeze. This patient is suffering from diabetic ketoacidosis (DKA). In a young individual with no past medical history presenting with abdominal pain and vomiting, together with pear-drop breath, DKA should be top of the differential list. The most likely underlying cause of a DKA is type 1 diabetes mellitus.
name: Acute asthmatic attack
label: e
answer: no
explanation: This patient is suffering from diabetic ketoacidosis (DKA). In a young individual with no past medical history presenting with abdominal pain and vomiting, together with pear-drop breath, DKA should be top of the differential list. The most likely underlying cause of DKA is type 1 diabetes mellitus. Diabetes insipidus is a condition characterised by reduced production of anti-diuretic hormone. It is unrelated to the more common diabetes mellitus which revolves around insulin insufficiency.
name: Diabetes insipidus
label: d
answer: no
explanation: Alcoholic ketoacidosis presents similarly with abdominal pain, nausea and vomiting but on a background of chronic alcohol misuse. There is no indication of chronic alcohol misuse in this case, making this option incorrect.
name: Alcoholic ketoacidosis
label: b
answer: no
explanation: This is a classic presentation of diabetic ketoacidosis (DKA), caused by an underlying type 1 diabetes mellitus. In a young individual with no past medical history presenting with abdominal pain and vomiting, DKA as a first presentation of type 1 diabetes should always be towards the top of the differential list. It is made even more likely to be DKA given the classic pear drop breath sign.
name: Type 1 diabetes mellitus
label: a
answer: yes

Correct answer: a