hllj/quesmed huggingface dataset:
A seven-year-old girl is brought by her parents following a diagnosis of asthma. They have questions about her new inhaler regime.

What is the drug class of the "blue reliever" inhaler?

Options:
explanation: Long-acting beta-2 agonists such as salmeterol are used in the management of asthma, but are not the first-line reliever for acute symptoms. This is simply because they are long-acting so will take a while to work effectively.
name: Long-acting beta-2 agonist
label: c
answer: no
explanation: Theophylline is the main example of a xanthine. Theophylline is used in patients with inadequate control of their asthma despite the use of SABAs (short-acting beta-2 agonists) and ICS (inhaled corticosteroids). Therefore, it is unlikely to be given to this young girl as a first-line reliever therapy.
name: Xanthine
label: e
answer: no
explanation: The blue inhaler patients are given typically contains salbutamol, which is a short-acting beta-2 agonist. It works by relaxing the bronchial muscles to improve airflow to the lungs.
name: Short-acting beta-2 agonist
label: a
answer: yes
explanation: Inhaled corticosteroids are typically in a brown inhaler, and are used as preventers rather than relievers. This is because they are reducing the inflammation in the bronchi.
name: Inhaled corticosteroid
label: b
answer: no
explanation: Montelukast is an example of a leukotriene receptor antagonist. It is used in the management of asthma if SABA (short-acting beta-2 agonists) and ICS (inhaled corticosteroids) are not providing adequate control of their asthma symptoms. Therefore, this patient will have been started on these medications first.
name: Leukotriene receptor antagonist
label: d
answer: no

Correct answer: a
Based on a 70kg male, what is the approximate volume of fluid in the intracellular compartment?

Options:
explanation: The intracellular compartment makes up two-thirds of the total body water. As fluids make up 60% of body mass we can approximate that the total fluids in a 70kg male is 42L. Two-thirds of this is 28L. The extracellular fluid is the remaining 14L and the plasma volume is 25% of that- which is 3.5L.
name: 3.5 L
label: d
answer: no
explanation: The intracellular compartment makes up two-thirds of the total body water. As fluids make up 60% of body mass, we can approximate that the total fluids in a 70kg male is 42L. Two-thirds of this is 28L. 14L represents the extracellular fluid (one-third of 42L).
name: 14 L
label: b
answer: no
explanation: The intracellular compartment makes up two-thirds of the total body water. As fluids make up 60% of body mass, we can approximate that the total fluids in a 70kg male is 42L. Two-thirds of this is 28L.
name: 28 L
label: a
answer: yes
explanation: The intracellular compartment makes up two-thirds of the total body water. As fluids make up 60% of body mass, we can approximate that the total fluids in a 70kg male is 42L. Two-thirds of this is 28L. The extracellular fluid is the remaining 14L, the interstitial fluid makes up 75% of this so is 10.5 L.
name: 10.5 L
label: c
answer: no
explanation: The estimated volume of blood is 5L in a 70kg male.
name: 5 L
label: e
answer: no

Correct answer: a
A 57-year-old man presents to the GP with a longstanding history of cough and breathlessness, which is worse when lying down and at night. On examination, crackles can be heard bilaterally at the lung bases. His blood test results show a raised BNP. He is already taking an ACE inhibitor and a beta-blocker for this condition.

Which of the following is the most likely intervention to be offered annually to this patient?

Options:
explanation: The MenACWY vaccine helps to protect against meningitis infections. It is given as a single injection, most commonly to students going to university for the first time.
name: MenACWY vaccine
label: e
answer: no
explanation: This patient has the clinical signs and symptoms of heart failure and should be **offered an annual influenza vaccine** and a one-off pneumococcal vaccination. The vaccine is offered annually because this patient's chronic heart failure puts him into a clinical risk group. Patients in a clinical risk group are at a higher risk of getting seriously ill, in this case, from influenza infection.
name: Influenza vaccine
label: a
answer: yes
explanation: The MMR vaccine is usually given in 2 doses as a child and confers long-lasting protection. It is not necessary or indicated for a patient with heart failure.
name: MMR vaccine
label: b
answer: no
explanation: The pneumococcal vaccine helps to protect against meningitis and pneumonia. Children and adults who are in a clinical risk group and at higher risk of getting seriously ill are offered a one-off dose of the pneumococcal vaccine for extra protection.
name: Pneumococcal vaccine
label: c
answer: no
explanation: The BCG vaccine helps to protect against tuberculosis (TB). It is only given once in a lifetime and only when a patient has an increased risk of coming into contact with TB, either through their work or if they are travelling from or travelling to a country with a high rate of TB.
name: BCG vaccine
label: d
answer: no

Correct answer: a
An 8-year-old boy presents to A&E with pain in his arm following a fall off a bike. X-ray shows a fracture of the proximal ulna and a dislocation of the radial head.

Which of the following is the most likely diagnosis?

Options:
explanation: A Monteggia fracture describes a fracture of the proximal ulna with an associated radial head dislocation.
name: Monteggia fracture
label: a
answer: yes
explanation: A Greenstick fracture happens when a bone breaks on one side only and not all the way through the bone. This is the most common type of fracture seen in children as they have softer bones than adults.
name: Greenstick fracture
label: e
answer: no
explanation: A Smith fracture is a fracture of the distal radius with volar displacement of the distal fragment. This means the fragment of the radius that has broken off projects towards the palm side of the hand. It usually happens after a fall onto the back of the hand while the wrist is flexed.
name: Smith fracture
label: c
answer: no
explanation: A Bennet fracture is a fracture of the first metacarpal at the base of the thumb. This usually happens from forced abduction of the first metacarpal.
name: Bennet fracture
label: d
answer: no
explanation: A Galeazzi fracture is a fracture of the radial shaft with dislocation of the distal radioulnar joint.
name: Galeazzi fracture
label: b
answer: no

Correct answer: a
A 79-year-old woman presents to the GP with a 6-hour history of a red eye. She reports no changes in vision, no pain, and no itching. Her pupillary reflexes are normal. Her drug history shows she is taking warfarin.

Which of the following is the most likely diagnosis?

Options:
explanation: Episcleritis is another cause of red eye, which is typically not painful but may cause discomfort and tenderness over the inflamed area.
name: Episcleritis
label: d
answer: no
explanation: Anterior uveitis often has a more insidious onset, with symptoms that develop gradually and persist over time. The characteristic features of anterior uveitis are a painful red eye, blurred vision, and photophobia. Patients may also present with constricted or irregular pupils due to synechiae, which are adhesions between the lens and iris.
name: Anterior uveitis
label: b
answer: no
explanation: Conjunctivitis typically presents with a red, itchy, irritated eye with increased lacrimation and discharge. The type of discharge would depend on the underlying cause, whether that is allergic, viral, or bacterial in origin.
name: Conjunctivitis
label: c
answer: no
explanation: Scleritis typically presents with a painful red eye and pain on eye movement. It is commonly associated with rheumatological conditions such as rheumatoid arthritis, so patients may also have systemic symptoms.
name: Scleritis
label: e
answer: no
explanation: A subconjunctival haemorrhage occurs when blood vessels in the conjunctiva rupture and leak blood into the surrounding tissue. It characteristically causes a painless red eye. Subconjunctival haemorrhages are more likely to occur in individuals taking warfarin because it is an anticoagulant which increases the risk of bleeding. This diagnosis is further supported because of the sudden onset presentation, normal visual acuity, lack of pain or itching and normal pupillary reflexes.
name: Subconjunctival haemorrhage
label: a
answer: yes

Correct answer: a
A 61-year-old man presents to the GP with a non-healing leg ulcer and crampy pain in his calf when walking uphill and downhill. The pain is relieved by rest. He has a past medical history of hypertension and hypercholesterolaemia.

Which of the following is the next best investigation?

Options:
explanation: Lying and standing blood pressure is a useful investigation when orthostatic hypotension is suspected.
name: Lying and standing blood pressure
label: d
answer: no
explanation: This man has presented with symptoms of peripheral arterial disease. ECG is not the primary investigation for peripheral arterial disease and is typically performed to assess the electrical activity and function of the heart.
name: Electrocardiogram (ECG)
label: b
answer: no
explanation: A duplex ultrasound scan is a non-invasive imaging test that can be used to assess the blood flow in the arteries and identify any blockages or narrowing of the blood vessels in the legs. However, it is not as readily available as an ABPI to perform in initial screening of peripheral arterial disease.
name: Duplex ultrasound
label: e
answer: no
explanation: CT angiography is an advanced imaging technique that uses contrast dye and X-rays to create detailed images of blood vessels. However, it is more invasive and costly, so simple investigations like ABPI are more appropriate to perform first.
name: CT angiography
label: c
answer: no
explanation: An ABPI is a non-invasive investigation used to assess blood flow to the lower extremities and diagnose peripheral arterial disease. When performed, it measures the ratio of the systolic blood pressure at the ankle to that in the arm. The score helps to determine the appropriate treatment and if a referral for specialist vascular assessment is required.
name: Ankle-Brachial Pressure Index (ABPI)
label: a
answer: yes

Correct answer: a
A 45-year-old woman presents to the GP with a longstanding history of itching, jaundice and dark urine. Her blood results show raised alkaline phosphatase (ALP) and bilirubin levels and anti-mitochondrial antibodies.

What is the most likely diagnosis?

Options:
explanation: Primary sclerosing cholangitis (PSC) is a chronic liver disease characterised by inflammation and scarring of the bile ducts. It can also lead to raised liver enzymes and cholestasis. PSC is often associated with inflammatory bowel disease and has a strong association with ulcerative colitis.
name: Primary sclerosing cholangitis
label: c
answer: no
explanation: Autoimmune hepatitis is characterised by autoimmune-mediated inflammation of the liver. It can also present with raised ALP and bilirubin however, it is typically associated with anti-smooth muscle antibodies and not anti-mitochondrial antibodies.
name: Autoimmune hepatitis
label: b
answer: no
explanation: Hepatocellular carcinoma is a malignancy of the liver and usually occurs in patients with underlying liver disease such as cirrhosis. It can cause raised liver enzymes, jaundice and dark urine.
name: Hepatocellular carcinoma
label: d
answer: no
explanation: Non-alcoholic fatty liver disease (NAFLD) is characterised by the accumulation of fat in the liver and can progress to non-alcoholic steatohepatitis (NASH). Raised liver enzymes can also occur in NAFLD, but NAFLD does not cause the characteristic cholestasis as seen in PBC.
name: Non-alcoholic fatty liver disease
label: e
answer: no
explanation: Primary biliary cholangitis (PBC) is a chronic autoimmune disease characterised by the progressive destruction of small bile ducts within the liver. The symptoms of itching, jaundice and dark urine with raised bilirubin are indicative of cholestasis resulting from impaired bile flow. Raised ALP is found due to damage to the bile ducts. Anti-mitochondrial antibodies are found in more than 90% of individuals with PBC.
name: Primary biliary cholangitis
label: a
answer: yes

Correct answer: a
A 35-year-old woman on an inpatient ward appears agitated and is complaining that her insides are rotting. She tells the staff on the ward that she plans to solve this using medication she has stockpiled.

Which of the following sections of the Mental Health Act would be most appropriate to use in this situation?

Options:
explanation: Section 17 of the Mental Health Act allows a guardian to be appointed to oversee the care and treatment of a patient with a psychiatric condition while they are living in the community. This may be used when patients are discharged from the hospital and require ongoing support and treatment.
name: Section 17
label: e
answer: no
explanation: Section 5 (2) of the Mental Health Act allows registered medical practitioners in a hospital to detain patients who need assessment and treatment for up to 72 hours. It is used in emergency situations when a patient's safety is at risk.
name: Section 5 (2)
label: a
answer: yes
explanation: Section 4 of the Mental Health Act allows for the detention of patients who require immediate treatment for a psychiatric condition but who are unable or unwilling to consent to it. This can be converted into a Section 2 if required.
name: Section 4
label: c
answer: no
explanation: Section 3 of the Mental Health Act allows for the detention of patients who have a formal psychiatric diagnosis in place and who require treatment. Patients detained under Section 3 can be kept in the hospital for up to 6 months.
name: Section 3
label: b
answer: no
explanation: Section 2 of the Mental Health Act allows for the detention of patients for a maximum of 28 days to determine if they have a psychiatric condition and if they require treatment. This can only occur if two medical practitioners agree that it is necessary.
name: Section 2
label: d
answer: no

Correct answer: a
A 65-year-old woman presents to the emergency department with a sudden-onset headache and scalp tenderness. On fundoscopy, her optic disc is swollen and pale with blurred margins.

Which of the following is the next best investigation?

Options:
explanation: ANCA testing is used to evaluate for certain types of vasculitis, such as granulomatosis with polyangiitis. GCA is not associated with the presence of ANCA.
name: Antineutrophil cytoplasmic antibodies (ANCA)
label: d
answer: no
explanation: A temporal artery biopsy is the definitive investigation to confirm GCA. The characteristic findings in GCA include granulomatous inflammatory changes within the artery wall and giant cells. However, it is not a first-line test in suspected GCA.
name: Temporal artery biopsy
label: c
answer: no
explanation: A non-contrast CT head can help identify certain causes of headaches, such as intracranial bleeding, but may not provide specific information about GCA.
name: Non-contrast CT head
label: b
answer: no
explanation: This presentation is highly suggestive of giant cell arteritis (GCA), a type of vasculitis that primarily affects the temporal arteries. ESR is an important investigation in the context of GCA as it is a non-specific inflammatory marker that is commonly raised in this condition and can help support the diagnosis.
name: Erythrocyte Sedimentation Rate (ESR)
label: a
answer: yes
explanation: An FBC may provide information about a patient's overall health and detect anaemias or other abnormalities.
name: Full blood count (FBC)
label: e
answer: no

Correct answer: a
A 50-year-old woman presents to an outpatient clinic. She states she has joint pain, fatigue, red, gritty eyes, and is frequently drinking due to a dry mouth.

Which of the following is most likely to be found in her blood results?

Options:
explanation: Rheumatoid factor is an autoantibody commonly associated with rheumatoid arthritis.
name: Rheumatoid factor
label: b
answer: no
explanation: dsDNA antibodies are a hallmark of systemic lupus erythematosus (SLE).
name: dsDNA antibodies
label: c
answer: no
explanation: The combination of symptoms described is suggestive of Sjogren's syndrome, an autoimmune disorder that primarily affects the exocrine glands of the eyes and mouth. The presence of auto-antibodies Anti-Ro and Anti-La supports the diagnosis of Sjogren's.
name: Anti-Ro and Anti-La antibodies
label: a
answer: yes
explanation: ANCA testing is used to evaluate for certain types of vasculitis, such as granulomatosis with polyangiitis.
name: Antineutrophil cytoplasmic antibodies (ANCA)
label: d
answer: no
explanation: HLA-B27 is a genetic marker associated with several autoimmune conditions, such as ankylosing spondylitis.
name: HLA-B27
label: e
answer: no

Correct answer: a
A 17-year-old male presents with sudden onset unilateral testicular pain and vomiting. He reports no recent trauma or trigger.

What is the most common risk factor for the most likely diagnosis?

Options:
explanation: Undescended testes are more prone to torsion. However, it is not as strong of a risk factor compared to a bell clapper deformity.
name: Undescended testes
label: c
answer: no
explanation: Paraphimosis is a medical condition in which the foreskin becomes trapped behind the glans, causing swelling. It is not a common risk factor for testicular torsion.
name: History of paraphimosis
label: d
answer: no
explanation: Trauma can precipitate testicular torsion, but it is not the most common risk factor out of the options given.
name: Trauma
label: b
answer: no
explanation: A UTI does not typically lead to acute testicular pain and vomiting.
name: UTI
label: e
answer: no
explanation: Bell clapper deformity is an anatomical abnormality where the testicles are not fixed to the scrotum, allowing them to rotate freely. This increases the risk of testicular torsion, which occurs when the spermatic cord twists and cuts off blood flow to the testicle, causing severe pain.
name: Bell clapper deformity
label: a
answer: yes

Correct answer: a
A 44-year-old man with type 2 diabetes attends his GP with his ambulatory blood pressure monitoring (ABPM) results.

His average blood pressure result is 152/78 mmHg.

What is the next best step in the management of this patient?

Options:
explanation: Lying and standing blood pressure is a useful investigation when orthostatic hypotension is suspected.
name: Lying and standing blood pressure
label: e
answer: no
explanation: An ECG is typically performed to assess the electrical activity and function of the heart. It is not involved in the treatment of hypertension.
name: Do an ECG
label: d
answer: no
explanation: This patient has high blood pressure and a background of type 2 diabetes and, therefore, should be initiated on an ACE inhibitor such as Rampiril.
name: Start Ramipril
label: a
answer: yes
explanation: Amlodipine is a calcium channel blocker used to lower blood pressure. It is the first-line treatment in patients with hypertension without type 2 diabetes if they are >55 years old or of black African or African-Caribbean family origin. It is not the first-line treatment for a patient with type 2 diabetes.
name: Start amlodipine
label: b
answer: no
explanation: Spironolactone is a potassium-sparing diuretic that can be used in the management of hypertension, but it is not typically used as first-line therapy.
name: Start spironolactone
label: c
answer: no

Correct answer: a
A 53-year-old man presents to the GP with a 1-month history of hoarseness. He has no other symptoms. He does not drink alcohol but has a 5-pack-year smoking history.

What is the most appropriate management?

Options:
explanation: Laryngeal cancer should be suspected in patients who are 45 years and over with persistent and unexplained hoarseness. The smoking history also adds to the suspicion of laryngeal cancer.
name: Urgent 2-week wait cancer referral
label: a
answer: yes
explanation: Whilst referral to ENT is necessary, an urgent referral is more appropriate in this case due to the red flag symptoms and risk factors.
name: Routine referral to ENT
label: b
answer: no
explanation: Referral to a smoking cessation service is important, but it is not the most important management at this point in time. Immediate evaluation for laryngeal cancer is the priority.
name: Refer to a smoking cessation service
label: d
answer: no
explanation: Discharging the patient without a referral for further evaluation could lead to a delay in cancer diagnosis and a poorer prognosis.
name: Send the patient home
label: c
answer: no
explanation: Admission to hospital is not the first step for a patient presenting with hoarseness. An outpatient referral for evaluation is more appropriate.
name: Admit to hospital
label: e
answer: no

Correct answer: a
A 42-year-old man with type 2 diabetes presents to the GP with symptoms of dizziness and fatigue. He has a past medical history of a myocardial infarction.

His HbA1c is 65 mmol/mol. He is currently taking metformin for his diabetes.

What is the mechanism of action of the most appropriate medication to add in this situation?

Options:
explanation: Thiazolidinediones increase insulin sensitivity of muscle and adipose tissue. An example of a drug in this drug class is pioglitazone. These drugs can be used as part of second-line therapy for diabetes but are not the appropriate choice for a patient with established cardiovascular disease.
name: Increases insulin sensitivity of muscle and adipose tissue
label: b
answer: no
explanation: Insulin stimulates glucose uptake by insulin-sensitive cells and is used in the management of Type 1 and Type 2 diabetes. It is not an appropriate management choice in this situation.
name: Stimulates glucose uptake by insulin-sensitive cells
label: d
answer: no
explanation: SGLT-2 inhibitors should be started as this patient has established cardiovascular disease. SGLT-2 inhibitors work by blocking the sodium-glucose transporter in the kidney, thus increasing urinary excretion of glucose.
name: Blocks renal sodium-glucose transporter
label: a
answer: yes
explanation: Dipeptidyl peptidase-4 (DDP-4) inhibitors reduce the inactivation of incretins. An example of a drug in this class is sitagliptin. These drugs can be used in the second-line therapy of diabetes.
name: Reduces the inactivation of incretins
label: c
answer: no
explanation: Oral biguanides such as metformin inhibit hepatic gluconeogenesis. This patient is already on metformin.
name: Inhibits hepatic gluconeogenesis
label: e
answer: no

Correct answer: a
A 78-year-old woman presents with headache, fatigue and dizziness. Her past medical history includes hypertension and osteoarthritis. She is currently taking ramipril, indapamide, nifedipine, paracetamol and ibuprofen.

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

Options:
explanation: Paracetamol is used for pain relief and is unlikely to cause the symptoms described when taken at the recommended doses.
name: Paracetamol
label: e
answer: no
explanation: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that relieves pain and inflammation. Whilst it can have side effects such as gastrointestinal discomfort or headache, it is less likely to cause electrolyte imbalances.
name: Ibuprofen
label: d
answer: no
explanation: Indapamide is a thiazide-like diuretic commonly prescribed for hypertension. Thiazide-like diuretics can cause electrolyte imbalances such as hypokalaemia, which manifests with symptoms like headache, fatigue and dizziness. These symptoms are indicative of hypokalaemia, a known side effect of indapamide.
name: Indapamide
label: a
answer: yes
explanation: Nifedipine has side effects such as ankle oedema and dizziness; however, it does not typically cause hypokalaemia.
name: Nifedipine
label: c
answer: no
explanation: Ramipril can cause hyperkalaemia by blocking the aldosterone pathway, leading to potassium retention.
name: Ramipril
label: b
answer: no

Correct answer: a