hllj/quesmed huggingface dataset:
A 68-year-old male presents to General Practice with symptoms of tiredness, increased thirst and frequent urination. A glycated haemoglobin (HbA1c) test is found to be elevated at 54 mmol/L (normal range 20-42 mmol/L). The patient is advised to make lifestyle changes, but a repeat HbA1c measured 3 months later remains elevated at 56 mmol/L.


What should be the next step in the management of this patient?

Options:
explanation: Whilst sulfonylureas, such as gliclazide, may be considered in the management of type 2 diabetes, metformin is usually started before them.
name: Start sulfonylurea
label: b
answer: no
explanation: As this patient is symptomatic and his symptoms have not improved with lifestyle changes alone, it is important to commence medical therapy.
name: No further management required
label: e
answer: no
explanation: Whilst insulin therapy may be considered in the later stages of type 2 diabetes, metformin is the recommended first-line medication after initial diagnosis.
name: Start insulin
label: d
answer: no
explanation: In patients with type 2 diabetes who do not respond to lifestyle changes alone, medical therapy should be commenced. In the absence of contraindications, metformin is usually the first medication started for type 2 diabetes.
name: Start metformin
label: a
answer: yes
explanation: As the patient's HbA1c levels have been raised on 2 occasions, it is important to start medical therapy, rather than repeating the test again.
name: Repeat HbA1c after 3 months
label: c
answer: no

Correct answer: a
A 28-year-old male presents with frequent diarrhoea, lethargy, and recurrent mouth ulcers. His symptoms started a few months ago, and are occasionally accompanied by abdominal pain. After initial investigations, a colonoscopy is performed, which reveals inflammatory changes with skip lesions. A colonic biopsy is also taken.

Which of the following features is most likely to be seen on histology?

Options:
explanation: Crohn's disease is associated with an increase in goblet cells, as opposed to a decrease.
name: Loss of goblet cells
label: d
answer: no
explanation: Based on the symptoms and initial investigations, this patient likely has Crohn's disease. The presence of mouth ulcers and skip lesions on colonoscopy lean more towards Crohn's disease, as opposed to ulcerative colitis. Some of the key histological changes in Crohn's disease include granulomas, goblet cells, and inflammation in all layers from the mucosa to the serosa.
name: Granulomas
label: a
answer: yes
explanation: In Crohn's disease, inflammation can affect any layer of the gastrointestinal tract, from the mucosa to the serosa.
name: No inflammation beyond the submucosal layer
label: c
answer: no
explanation: Crypt abscesses are classically seen in patients with ulcerative colitis, as opposed to Crohn's disease.
name: Crypt abscesses
label: e
answer: no
explanation: Pseudopolyps are classically seen in patients with ulcerative colitis, as opposed to Crohn's disease.
name: Pseudopolyps
label: b
answer: no

Correct answer: a
A 22-year-old female presents with bloody diarrhoea, lethargy, and weight loss. Her symptoms started a few months ago. After initial investigations, a colonoscopy is performed which reveals inflammatory changes affecting only the mucosal and submucosal layers of the rectum. There are no skip lesions present. A colonic biopsy is also taken.

Which of the following features is most likely to be seen on histology?

Options:
explanation: Ulcerative colitis may result in pseudopolyps, as opposed to polyps.
name: Polyps
label: e
answer: no
explanation: This patient is likely to be presenting with ulcerative colitis due to the presence of bloody diarrhoea and rectal inflammation with no skip lesions. Some of the key histological changes in ulcerative colitis include crypt abscesses, pseudopolyps, depletion of goblet cells, and inflammation affecting only the mucosal and submucosal layers.
name: Crypt abscesses
label: a
answer: yes
explanation: Ulcerative colitis typically results in increased neutrophilic infiltration.
name: Reduced neutrophilic infiltration
label: d
answer: no
explanation: Granulomas are classically seen in patients with Crohn's disease, as opposed to ulcerative colitis.
name: Granulomas
label: b
answer: no
explanation: Ulcerative colitis typically presents with a depletion in goblet cells, rather than an increase in goblet cells.
name: Increased goblet cells
label: c
answer: no

Correct answer: a
A 44-year-old male undergoes hepatitis B serology testing. His results are shown below:

Test | Result
---------- | ----------
Hepatitis B surface antigen (HBsAg) | Negative
Hepatitis B surface antibody (Anti-HBs) | Positive
Hepatitis B core antibody (Anti-HBc) | IgG Positive

What is the most likely interpretation of these findings?

Options:
explanation: Negative HBsAg, negative anti-HBc, and negative anti-HBs would suggest susceptibility to hepatitis B infection.
name: Unvaccinated and has no previous hepatitis B infection
label: e
answer: no
explanation: Hepatitis B surface antigen (HBsAg) is a marker of acute or chronic hepatitis B infection. As HBsAg is negative in this case, there is no active infection present. Additionally, the hepatitis B core antibody (anti-HBc) is only IgG positive if there is a resolved infection or a chronic infection. There cannot be a chronic infection (as HBsAg is negative), meaning that a resolved infection is the most likely interpretation.
name: Previous hepatitis B infection
label: a
answer: yes
explanation: Acute hepatitis B infection would typically show positive HBsAg, IgM positive anti-HBc, and negative anti-HBs.
name: Acute hepatitis B infection
label: c
answer: no
explanation: A hepatitis B vaccination with no active infection would show a negative HBsAg, negative anti-HBc, and a positive anti-HBs.
name: Previous hepatitis B vaccination
label: b
answer: no
explanation: Chronic hepatitis B infection would typically show positive HBsAg, IgG positive anti-HBc, and negative anti-HBs.
name: Chronic hepatitis B infection
label: d
answer: no

Correct answer: a
Which of the following options is the most common cause of hepatocellular carcinoma worldwide?

Options:
explanation: Whilst alpha-1 antitrypsin deficiency is a known risk factor for the development of hepatocellular carcinoma, it is not as common as hepatitis B infections.
name: Alpha-1 antitrypsin deficiency
label: c
answer: no
explanation: Whilst primary biliary cirrhosis is a known risk factor for the development of hepatocellular carcinoma, hepatitis B is the more common cause worldwide.
name: Primary biliary cirrhosis
label: e
answer: no
explanation: Whilst haemochromatosis is a known risk factor for the development of hepatocellular carcinoma, it is not as common as hepatitis B infections.
name: Haemochromatosis
label: b
answer: no
explanation: One of the most important complications of hepatitis B or hepatitis C infections is the development of chronic hepatitis. This chronic inflammation of the liver can eventually lead to hepatocellular carcinoma, especially if the condition is left untreated. Chronic hepatitis B infection is currently the most common cause of hepatocellular carcinoma worldwide.
name: Chronic hepatitis B
label: a
answer: yes
explanation: Whilst non-alcoholic fatty liver disease is a known risk factor for the development of hepatocellular carcinoma, hepatitis B is the more common cause worldwide.
name: Non-alcoholic fatty liver disease
label: d
answer: no

Correct answer: a
A 29-year-old female presents to General Practice with symptoms of fatigue, weakness and mild shortness of breath which have been present for the past 3 months. She also mentions that she has started to feel slightly unsteady on her feet. She has no previous medical history, and only takes the combined oral contraceptive pill. A full blood count is conducted and the results are shown below:


||||
|--------------|:-------:|---------------|
|Haemoglobin|90  g/L|(M) 130 - 170, (F) 115 - 155|
|Mean Cell Volume (MCV)|112 fL|80 - 96|
|White Cell Count|5.0x10<sup>9</sup>/L|3.0 - 10.0|
|Platelets|300x10<sup>9</sup>/L|150 - 400|
|Neutrophils|3.5x10<sup>9</sup>/L|2.0 - 7.5|
|Lymphocytes|1.5x10<sup>9</sup>/L|1.5 - 4.0|


What is the most likely diagnosis?

Options:
explanation: Anaemia of chronic disease would typically present with a normocytic anaemia, as opposed to a macrocytic anaemia.
name: Anaemia of chronic disease
label: e
answer: no
explanation: Thalassaemia would typically present with a microcytic anaemia, as opposed to a macrocytic anaemia.
name: Thalassaemia
label: d
answer: no
explanation: This patient is presenting with signs and symptoms characteristic of vitamin B12 deficiency anaemia, corroborated by the macrocytic anaemia seen on the full blood count. Aside from the typical features of anaemia (e.g. fatigue/shortness of breath), B12 deficiency may also lead to neurological symptoms, such as loss of proprioception or vibration sensation. This is known as subacute combined degeneration of the cord.
name: Vitamin B12 deficiency anaemia
label: a
answer: yes
explanation: Iron deficiency anaemia would typically present with a microcytic anaemia, as opposed to a macrocytic anaemia.
name: Iron deficiency anaemia
label: b
answer: no
explanation: Aplastic anaemia would typically present with a normocytic anaemia, as opposed to a macrocytic anaemia.
name: Aplastic anaemia
label: c
answer: no

Correct answer: a
Which of the following neurotransmitters is the main inhibitory neurotransmitter in the central nervous system (CNS)?

Options:
explanation: Glutamate is the main excitatory neurotransmitter in the CNS, as opposed to the main inhibitory neurotransmitter.
name: Glutamate
label: b
answer: no
explanation: Noradrenaline is an excitatory neurotransmitter in the CNS, as opposed to an inhibitory neurotransmitter.
name: Noradrenaline
label: e
answer: no
explanation: Whilst serotonin is also an inhibitory neurotransmitter, GABA is the main inhibitory neurotransmitter in the CNS.
name: Serotonin
label: c
answer: no
explanation: Dopamine is a complex neurotransmitter which has both inhibitory and excitatory effects, as opposed to GABA which is the main inhibitory neurotransmitter.
name: Dopamine
label: d
answer: no
explanation: The main inhibitory neurotransmitter in the CNS is gamma-aminobutyric acid (GABA). GABA is a naturally occurring amino acid which reduces neuronal excitability throughout the central nervous system.
name: Gamma-aminobutyric acid
label: a
answer: yes

Correct answer: a
Which of the following options correctly identifies the 3 cardinal features of Parkinson's disease?

Options:
explanation: Whilst rigidity is classically identified as a hallmark feature of Parkinson's disease, muscle wasting is not. Parkinson's patients may occasionally develop hallucinations as well, but this is usually at later stages of the disease.
name: Muscle wasting, hallucinations, rigidity
label: d
answer: no
explanation: Muscle wasting, tongue fasciculations, and slurred speech may be signs of motor neurone disease, as opposed to Parkinson's disease.
name: Muscle wasting, tongue fasciculations, slurred speech
label: b
answer: no
explanation: Ataxia, action tremor, and reduced coordination may occur in cerebellar disease. Notably, Parkinson's disease is associated with a resting tremor, whereas cerebellar disease usually involves an intention tremor which worsens with movement.
name: Ataxia, intention tremor, reduced coordination
label: c
answer: no
explanation: Parkinson's disease is a neurodegenerative condition caused by the loss of dopaminergic neurones in the substantia nigra of the brain. The reduced levels of dopamine usually result in initial motor symptoms: bradykinesia (slow movements), a unilateral resting tremor, and increased cogwheel rigidity.
name: Bradykinesia, resting tremor, rigidity
label: a
answer: yes
explanation: Whilst a resting tremor is a hallmark feature of Parkinson's disease, ataxia and brisk reflexes are not.
name: Ataxia, brisk reflexes, resting tremor
label: e
answer: no

Correct answer: a
Which region of the brain is predominantly affected by Parkinson's disease?

Options:
explanation: Whilst the thalamus can be affected in some cases of Parkinson's disease, the basal ganglia is the area which is most predominantly affected.
name: Thalamus
label: d
answer: no
explanation: The hippocampus is one of the first regions damaged in Alzheimer's disease, as opposed to Parkinson's disease.
name: Hippocampus
label: c
answer: no
explanation: Parkinson's disease is a neurodegenerative condition caused by the loss of dopaminergic neurones in the substantia nigra of the brain. The substantia nigra consists is a group of cells in the basal ganglia which usually secretes dopamine, enabling the control of movement and coordination.
name: Basal ganglia
label: a
answer: yes
explanation: The diencephalon consists of the epithalamus, thalamus, hypothalamus, ventral thalamus, and third ventricle structures of the brain. Whilst some of these structures can be affected in Parkinson's disease, the basal ganglia is the area which is most predominantly affected.
name: Diencephalon
label: e
answer: no
explanation: Whilst there are multi-synaptic loops between the basal ganglia and cerebellum to aid with balance/coordination, it is the basal ganglia which is predominantly affected in Parkinson's disease.
name: Cerebellum
label: b
answer: no

Correct answer: a
A 74-year-old male presents to the neurology clinic after a recent diagnosis of Parkinson's disease with symptoms of worsening tremor at rest. He is finding it more difficult to move around the house, and his motor symptoms are beginning to interfere with his activities of daily living. His past medical history includes hypertension, for which he takes amlodipine and losartan.

What is the most likely first-line medical therapy for this patient?

Options:
explanation: Tolcapone is an example of a catechol-O-methyl transferase inhibitor. This is often offered as an adjunct to other medications in the later stages of Parkinson's disease.
name: Tolcapone
label: c
answer: no
explanation: Procyclidine is an example of an antimuscarinic medication which is often used to treat drug-induced parkinsonism, as opposed to idiopathic Parkinson's disease.
name: Procyclidine
label: e
answer: no
explanation: Bromocriptine is an example of a dopamine agonist. These may be offered as an adjunct to levodopa if symptoms of Parkinson's disease worsen.
name: Bromocriptine
label: d
answer: no
explanation: In cases of Parkinson's disease where motor symptoms are interfering with a patient's quality of life, levodopa should be the first-line medication offered. Levodopa is a precursor molecule to dopamine, which enables more dopamine to be formed, thereby assisting with the motor symptoms of Parkinson's disease. Levodopa is often combined with carbidopa (which reduces the peripheral breakdown of dopamine) to reduce the side effects of the medication.
name: Levodopa
label: a
answer: yes
explanation: Selegiline is an example of a monoamine oxidase B (MAO-B) inhibitor. This is often offered as an adjunct to other medications in the later stages of Parkinson's disease.
name: Selegiline
label: b
answer: no

Correct answer: a
A 75-year-old female presents to general practice with worsening joint pain, predominantly affecting her right knee and right hip. She finds that her symptoms are usually worst at the end of the day. The GP orders an x-ray of the affected joints.

Given the most likely diagnosis, which of the following changes are most likely to be seen on an x-ray?

Options:
explanation: Periarticular erosions are commonly seen in the late stages of rheumatoid arthritis, as opposed to osteoarthritis.
name: Periarticular erosions
label: c
answer: no
explanation: Subluxation refers to the partial dislocation of a joint. It is usually seen in the late stages of rheumatoid arthritis, as opposed to osteoarthritis.
name: Subluxation
label: d
answer: no
explanation: Juxta-articular osteoporosis is more commonly seen in rheumatoid arthritis, as opposed to osteoarthritis. This would typically present with bilateral joint pain in small joints, which is worse in the morning.
name: Juxta-articular osteoporosis
label: b
answer: no
explanation: Mixed lytic and sclerotic lesions may be seen in Paget's disease of the bone, as opposed to osteoarthritis.
name: Mixed lytic and sclerotic lesions
label: e
answer: no
explanation: This patient is presenting with symptoms suggestive of osteoarthritis, given the unilateral joint pain in large joints which is worse at the end of the day. The key osteoarthritic changes on x-ray are loss of joint space, osteophytes, subchondral cysts, and subchondral sclerosis.
name: Osteophytes at the joint margin
label: a
answer: yes

Correct answer: a
An 80-year-old female on the geriatric ward is recovering from a fragility fracture which occurred 3 days ago. She has a past medical history of hypertension and COPD, for which she takes amlodipine, ramipril and salbutamol.

Which of the following options should be considered next in the management of this patient?

Options:
explanation: Denosumab is a monoclonal antibody which inhibits the maturation of osteoclasts. It may be considered in the later stages of osteoporosis management.
name: Start denosumab
label: b
answer: no
explanation: As this patient is older than 75 years of age, bisphosphonate treatment can be commenced without the need for a DEXA scan.
name: Perform a DEXA scan before starting treatment
label: d
answer: no
explanation: As this patient is above the age of 75 years, any fragility fractures which occur should be attributed to underlying osteoporosis. The first-line therapy for this is an oral bisphosphonate (e.g. alendronic acid), which should help to reduce the risk of further fractures by inhibiting osteoclast activity.
name: Start oral alendronic acid
label: a
answer: yes
explanation: Raloxifene is a selective oestrogen receptor modulator which helps to reduce the risk of vertebral fractures. It may be considered in some cases of osteoporosis, however, bisphosphonates are still the first-line medical management.
name: Start raloxifene
label: e
answer: no
explanation: Although hormone replacement therapy may be considered in the later stages of osteoporosis, bisphosphonates are the first-line medical therapy.
name: Start hormone replacement therapy
label: c
answer: no

Correct answer: a
Which of the following pathophysiological changes are most likely to be seen in Alzheimer's disease?

Options:
explanation: The two main pathophysiological changes which occur in Alzheimer's disease are the build-up of beta-amyloid plaques and the development of neurofibrillary tangles. As a result of these changes, there is a reduction in the neuronal connections within the brain, which leads to symptoms of dementia.
name: Formation of neurofibrillary tangles
label: a
answer: yes
explanation: Autoimmune demyelination of neurones is more commonly seen in multiple sclerosis, as opposed to Alzheimer's disease.
name: Autoimmune demyelination of neurones
label: e
answer: no
explanation: Loss of dopaminergic neurones in the substantia nigra occurs in Parkinson's disease, as opposed to Alzheimer's disease.
name: Loss of dopaminergic neurones
label: b
answer: no
explanation: Although deposition of alpha-synuclein may be seen in some cases of Alzheimer's disease, it is more commonly seen in Lewy body dementia and Parkinson's disease.
name: Deposition of alpha-synuclein
label: d
answer: no
explanation: Loss of brainstem motor nuclei occurs in motor neurone disease, as opposed to Alzheimer's disease.
name: Loss of brainstem motor nuclei
label: c
answer: no

Correct answer: a
An 84-year-old female presents to the neurology clinic with worsening memory, difficulty following instructions, and feeling more confused than usual. Her husband mentions that these symptoms have been ongoing for the past few months and have gradually been getting worse. The patient has a past medical history of hypertension, for which she takes amlodipine and ramipril. A CT brain scan is conducted which reveals cerebral atrophy and enlargement of the cortical sulci.

Given the most likely diagnosis, what is the best first-line medical therapy for this patient?

Options:
explanation: There is currently no indication for steroid medications in the medical management of Alzheimer's disease.
name: Prednisolone
label: e
answer: no
explanation: Riluzole is a medication option available for the treatment of motor neurone disease, as opposed to Alzheimer's disease. This would typically present with muscle wasting, fasciculations, and difficulties with mobility.
name: Riluzole
label: d
answer: no
explanation: Levodopa is usually the first-line medication for Parkinson's disease, as opposed to Alzheimer's disease. This would classically present with bradykinesia, resting tremor and increased rigidity.
name: Levodopa
label: c
answer: no
explanation: This patient is presenting with symptoms of Alzheimer's disease, corroborated by the cerebral atrophy seen on the CT scan. Donepezil is an acetylcholinesterase inhibitor which is usually used first-line to improve symptoms in mild-moderate Alzheimer's disease.
name: Donepezil
label: a
answer: yes
explanation: Memantine is an NMDA receptor antagonist which is typically used in the later stages of Alzheimer's disease, or if acetylcholinesterase inhibitors are not deemed suitable for first-line management.
name: Memantine
label: b
answer: no

Correct answer: a
Which of the following options is a risk factor for the development of Alzheimer's disease?

Options:
explanation: Marfan syndrome is a genetic connective tissue disorder which usually occurs due to a mutation in the fibrillin-1 gene. There is currently no known link between Marfan syndrome and the development of Alzheimer's disease.
name: Marfan syndrome
label: c
answer: no
explanation: Motor neurone disease involves the destruction of motor neurones in the spinal ventral horns, brainstem motor nuclei, and the motor cortex. There is currently no known link between motor neurone disease and the development of Alzheimer's disease.
name: Motor neurone disease
label: d
answer: no
explanation: Mutations in the LRRK 2 gene are more commonly seen in Parkinson's disease, as opposed to Alzheimer's disease.
name: Mutation in LRRK 2 gene
label: b
answer: no
explanation: Current research indicates that Alzheimer's disease is far more common in females than males.
name: Male sex
label: e
answer: no
explanation: Down's syndrome is an important risk factor in the development of Alzheimer's disease, with around 30% of Down's syndrome individuals developing dementia by their 50s. One of the reasons for this is that chromosome 21 carries the amyloid precursor protein (APP) gene, which codes for amyloid protein development and deposition. In Down's syndrome, the extra chromosome 21 can result in excessive amyloid protein formation, leading to Alzheimer's disease.
name: Down's syndrome
label: a
answer: yes

Correct answer: a