hllj/quesmed huggingface dataset:
A 19-year-old male is brought into the emergency department by his flatmates after taking an overdose of paracetamol. He states that he took a total of 8g of paracetamol at around 6pm and another 6g of paracetamol an hour and a half later. It is now 9pm.

Which of the following is the most appropriate management of this patient?

Options:
explanation: This patient has taken a staggered overdose, and therefore requires treatment with N-acetylcysteine.
name: Take paracetamol levels at one hour after the second dose
label: d
answer: no
explanation: This patient has taken a staggered overdose, and therefore requires treatment with N-acetylcysteine.
name: Take paracetamol levels at four hours after the second dose
label: c
answer: no
explanation: This patient has taken a staggered overdose, taking two doses over an hour apart. This means the patient should be treated with N-acetylcysteine. Other indications for N-acetylcysteine treatment include uncertainty over the timing of the overdose and the patient being unconscious.
name: Give N-acetylcysteine
label: a
answer: yes
explanation: IV fluids are not the most appropriate treatment for this patient. This patient has taken a staggered overdose, and therefore they require management with N-acetylcysteine.
name: Give IV fluids
label: e
answer: no
explanation: Activated charcoal should only be given to patients who are less than an hour post-overdose and have taken more than 75mg/kg. This patient has taken a staggered overdose, and therefore requires treatment with N-acetylcysteine.
name: Give activated charcoal
label: b
answer: no

Correct answer: a
A 17-year-old female patient is currently detained under the Mental Health Act with anorexia nervosa.

Which of the following is a consequence of anorexia nervosa?

Options:
explanation: A consequence of anorexia nervosa is hypercholesterolaemia, which is thought to be due to changes to  metabolic pathways as a consequence of the conditon.
name: Low cholesterol levels
label: c
answer: no
explanation: Anorexia nervosa causes the levels of sex hormones to decrease, so it would be typical to find low levels of testosterone, rather than high.
name: High testosterone levels
label: e
answer: no
explanation: Anorexia nervosa causes the levels of growth hormone to increase, rather than decrease.
name: Low growth hormone (GH) levels
label: d
answer: no
explanation: Anorexia nervosa causes low potassium levels, not high.
name: Hyperkalaemia
label: b
answer: no
explanation: A consequence of anorexia nervosa is low levels of lutenising hormone (LH) and FSH. It also causes lower levels of other sex hormones, including low oestrogen and testosterone levels.
name: Low follicle stimulating hormone (FSH)
label: a
answer: yes

Correct answer: a
An 18-year-old female student presents to the GP with a fever. She also reports a headache and neck stiffness. On examination, she has a temperature of 39 degree Celsius and you notice a purpuric rash on her abdomen. Cerebral spinal fluid analysis shows low glucose levels, high protein levels and an increased white cell count.

Which of the following is the most likely causative organism?

Options:
explanation: This would cause a viral meningitis, meaning the cerebral fluid analysis would show a high glucose and low protein content. This patient has a bacterial meningitis, and the most likely causative organism is *Neisseria meningitidis*.
name: Coxsackie Virus A
label: e
answer: no
explanation: *Listeria monocytogenes* causes infections in immunosuppressed patients and can be found in patients at the extremes of age. The patient in question is more likely to be caused by *Neisseria meningitidis*.
name: *Listeria monocytogenes*
label: c
answer: no
explanation: This patient is presenting with meningococcal disease. *Neisseria meningitidis* is the most likely causative organism. Typical features include fever, headache, neck stiffness and photophobia. The presence of a non-blanching rash indicates the infection has spread into the bloodstream.
name: *Neisseria meningitidis*
label: a
answer: yes
explanation: Herpes simplex virus 2 would cause a viral meningitis, meaning the cerebral spinal fluid would show a high glucose and low protein. This patient has a bacterial meningitis, and the most likely causative organism is *Neisseria meningitidis*.
name: Herpes simplex virus 2
label: d
answer: no
explanation: This is the most common cause of meningococcal sepsis in neonates, so is unlikely to be the cause of this patient's meningitis. The rash described in the question is more typical of *Neisseria meningitidis*, rather than Group B Streptococcus.
name: Group B Streptococcus
label: b
answer: no

Correct answer: a
A 55-year-old male presents to the emergency department with a three-week history of fevers, weight loss and chest pain. On examination, there are splinter haemorrhages on his nails and macules on his palms consistent with janeway lesions. He had a prosthetic valve replacement one month ago.

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

Options:
explanation: *Streptococcus viridans* is found in dental plaque and is a common cause of endocarditis in patients with poor dental hygiene. However, this patient is most likely to be colonised with *staph. epidermis* as he has had a prosthetic valve replacement a month ago.
name: *Streptococcus viridans*
label: d
answer: no
explanation: The most common causative organism of infective endocarditis overall is *Staph. aureus*. However, this patient has had a prosthetic valve replacement a month ago and therefore is at risk of colonisation with *staph. epidermis*.
name: *Staphylococcus aureus*
label: b
answer: no
explanation: This patient has the typical findings of infective endocarditis: fevers (most common), weight loss, and chest pain. You may also find night sweats, muscle pains and lethargy as well as typical nail signs like splinter haemorrhages. The first two months after prosthetic valve surgery would put a patient at risk of infective endocarditis with *staph. epidermis*. Therefore, the most likely causative organism in this case is *staph. epidermis*.
name: *Staphlococcus epidermis*
label: a
answer: yes
explanation: This is an uncommon cause of infective endocarditis and therefore is not the most likely causative organism of this patient’s infective endocarditis.
name: *Coxiella burnetii*
label: e
answer: no
explanation: This organism is associated with colorectal cancer. The question gives us no indications the patient has colorectal cancer. Therefore, *strep. bovis* is not a likely cause of this patient's infective endocarditis.
name: *Streptococcus bovis*
label: c
answer: no

Correct answer: a
Which structure control paralysis during sleep?

Options:
explanation: This is an excitatory neurotransmitter that interacts with nuclei in the midbrain during sleep. It does not control paralysis during sleep.
name: Hypocretin
label: d
answer: no
explanation: This structure stabilizes the sleep-wake switch. It does not control paralysis during sleep.
name: Hypothalamic orexin
label: e
answer: no
explanation: The suprachiasmatic nucleus controls the circadian rhythm, meaning it controls the regulation of sleep across 24 hours. Circadian rhythm is affected by both light and melatonin. It does not control paralysis during sleep.
name: Suprachiasmatic nucleus
label: b
answer: no
explanation: This structure is located in the brainstem and is silenced during REM (rapid eye movement) atonia. The ventrolateral preorbital nucleus controls paralysis during sleep.
name: Locus coeruleus
label: c
answer: no
explanation: The ventrolateral preorbital nucleus is the structure in the brain responsible for paralysis during sleep.
name: Ventrolateral preorbital nucleus
label: a
answer: yes

Correct answer: a
A 50-year-old female attends the GP for a medication review. She has recently been started on haloperidol by her psychiatrist.

Which of the following side effects is most likely to occur with this medication?

Options:
explanation: Haloperidol is associated with a reduced seizure threshold, rather than an increased seizure threshold.
name: Increased seizure threshold
label: d
answer: no
explanation: Haloperidol is a first-generation antipsychotic. Dystonia is a type of extra-pyramidal side effect that can occur with use of these medications. Other extra-pyramidal side effects include akathisia, parkinsonism and tardive dyskinesia.
name: Dystonia
label: a
answer: yes
explanation: Agranulocytosis is more likely to occur with second-generation antipsychotics like clozapine. Haloperidol is more likely to cause side effects like dystonia and akathisia.
name: Agranulocytosis
label: b
answer: no
explanation: Dyslipidaemia is a side effect more likely to occur with the use of second-generation antipsychotics like clozapine and olanzapine, not first-generation antipsychotics like haloperidol.
name: Dyslipidaemia
label: e
answer: no
explanation: Weight gain is more likely to occur with second-generation antipsychotics like olanzapine, rather than first-generation antipsychotics like haloperidol.
name: Weight gain
label: c
answer: no

Correct answer: a
A 24-year-old male presents to A+E after a paracetamol overdose. He reports a history of unstable relationships, and often alternates between isolating partners to believing 'they are the best thing to have ever happened to him'. He finds he can have difficulty controlling anger and acts impulsively.

Which of the following is the most likely diagnosis?

Options:
explanation: Generalised anxiety disorder would not normally present in this manner. It can cause symptoms such as feeling restless or worried a lot of the time, having trouble concentrating or physical symptoms like palpations and shortness of breath.
name: Generalised Anxiety disorder
label: b
answer: no
explanation: This is the most likely diagnosis in this patient. Although this condition is more common in women, it should not be ignored in the male population. Individuals often have unstable moods and difficulty in relationships.
name: Emotionally unstable personality disorder (EUPD)
label: a
answer: yes
explanation: This often presents as intense fears of abandonment, excess reliance on caregivers and low self-esteem. They would find it difficult to make decisions or complete tasks without caregiver support.
name: Dependant personality disorder
label: d
answer: no
explanation: Individuals with histrionic personality disorder often engage in attention-seeking behaviour, and can be flirtatious. The individual in this question is described as having a low self-esteem and unstable moods which fits in better with a diagnosis of emotionally unstable personality disorder. It is not common for these individuals to display self-harm or suicidal behaviours.
name: Histrionic personality disorder
label: e
answer: no
explanation: Individuals with schizoid personality disorder would present with a lack of interest in social relationships. They often have limited emotional expression, and can present as cold or detached from people. Unlike the individual in the question, they often have very few relationships and do not typically display heightened emotions.
name: Schizoid personality disorder
label: c
answer: no

Correct answer: a
A 30-year-old female with known bipolar disorder has started shouting at staff in the emergency department. The police believe she is a risk to herself and others and wish to place her under a section of the mental health act.

Which of the following sections of the mental health act can be used by the police for this purpose?

Options:
explanation: This section can be used by police to enter private premises and remove a person to a place of safety. This can last up to 24 hours. Because this patient is in A+E, the police can use a section 136 to detain this patient.
name: Section 135
label: e
answer: no
explanation: A section 136 can be used by police to bring someone in from a public place if the police believe they are mentally unwell. This section can last up to 24hours, after which they should have a mental health act assessment. Because this patient is in A+E, this counts as a public place.
name: Section 136
label: a
answer: yes
explanation: A section 5(4) can be used by nurses and means they can detain an individual for six hours if they believe this individual is suffering from a mental disorder. However, this patient is in a public place (A+E), and therefore require a Section 136 by the police to be detained.
name: Section 5(4)
label: b
answer: no
explanation: A Section 5(2) is used by doctors to detain a person for up to 72 hours.  However, this patient is in a public place (A+E), and therefore require a Section 136 by the police to be detained.
name: Section 5(2)
label: c
answer: no
explanation: This patient is in the emergency department which is classed as a public place, and therefore require a section 136 instead of a Section 5(3).
name: Section 5(3)
label: d
answer: no

Correct answer: a
Which of the following describes a role of the golgi apparatus?

Options:
explanation: The golgi apparatus has a role in modifying proteins and lipids before transporting them to the correct destination.
name: Adding carbohydrate groups to glycoproteins
label: a
answer: yes
explanation: This describes a role of a lysosome.
name: Destruction of foreign particles
label: c
answer: no
explanation: This is a role of nuclear pores within the nuclear envelope.
name: Allow passage of molecules in and out of the nucleus
label: d
answer: no
explanation: Transcription occurs in the nucleus.
name: Site of transcription
label: e
answer: no
explanation: This describes a role of the mitochondria.
name: Conducting ATP synthesis to provide energy
label: b
answer: no

Correct answer: a
Which of the following describes the secondary structure of a protein?

Options:
explanation: This describes the quaternary structure of a protein.
name: The three dimensional structure involving at least two polypeptides
label: b
answer: no
explanation: This describes the primary structure of a protein.
name: Specific sequence of amino acids
label: d
answer: no
explanation: This does not describe any stage of protein structure
name: The R group of the amino acid is swapped for another
label: e
answer: no
explanation: The secondary structure of a protein involves formation of α-helixes and β-sheets using hydrogen bonds.
name: Polypeptide chains forming α-helixes and β-sheets
label: a
answer: yes
explanation: This describes the tertiary structure of a protein.
name: Specific hydrophobic interactions form a larger globular strcucture
label: c
answer: no

Correct answer: a
Which of the following statements is true regarding translation?

Options:
explanation: Transcription is catalysed by RNA polymerase, not translation.
name: Translation is catalysed by RNA polymerase
label: e
answer: no
explanation: The tRNA anticodon is compelentary to the mRNA codon.
name: The tRNA anticodon is identical to the mRNA codon
label: c
answer: no
explanation: Each tRNA molecule contains an amino acid. They join together in the correct order to form a polypeptide.
name: tRNA molecules carry an amino acid
label: a
answer: yes
explanation: The AUG codon is the start codon.
name: The AUG codon is the stop codon in translation
label: d
answer: no
explanation: They are read as codons of three bases.
name: The mRNA nucleotide bases are read as codons of four bases
label: b
answer: no

Correct answer: a
Which of the following statements is true regarding the cerebellum?

Options:
explanation: The posterolateral fissure separates the posterior and flocculonodular lobes
name: Posterolateral fissure separates the anterior and posterior lobes
label: d
answer: no
explanation: It lies in the posterior cranial fossa of the skull.
name: The cerebellum lies anatomically in the anterior cranial fossa of the skull
label: e
answer: no
explanation: The vermis is acutally in the midline of the cerebellum.
name: The vermis describes the lateral aspect of the cerebellum
label: b
answer: no
explanation: This is correct.
name: Three paired peduncles connect the cerebellum to the brainstem
label: a
answer: yes
explanation: The cerebellum is involved in coordinating smooth motor activities. Personality is predominantly controlled by the frontal lobe.
name: The cerebellum is involved in determining personality
label: c
answer: no

Correct answer: a
A six-month-old baby boy has recently been diagnosed with congenital adrenal hyperplasia (CAH).

Which hormone is most likely to be deficient in this patient?

Options:
explanation: This hormone is produced by the pancreas, not the adrenal gland.
name: Insulin
label: d
answer: no
explanation: This hormone is produced by the posterior pituitary gland, not the adrenal gland.
name: Oxytocin
label: b
answer: no
explanation: This hormone is produced by the anterior pituitary gland, not the adrenal gland.
name: Growth hormone
label: c
answer: no
explanation: The adrenal glands produce cortisol, aldosterone and androgens. Cortisol is the most commonly affected hormone in CAH.
name: Cortisol
label: a
answer: yes
explanation: This hormone is produced by the thyroid gland, not the adrenal gland.
name: Thyroxine
label: e
answer: no

Correct answer: a
Which of the following is true regarding the process of gram staining bacteria?

Options:
explanation: The first stain is purple (the cyrstal violet stain). This is washed away, and then the sample is stained pink (the safranin or Carbol fuchsin stain).
name: The bacteria is stained pink and then purple
label: c
answer: no
explanation: Gram-negative bacteria appear pink with gram-staining as the crystal violet-iodine purple stain is washed away from their cell wall, and they then turn pink with the counterstain.
name: Gram-negative bacteria appear purple
label: e
answer: no
explanation: It is actually the cell wall that determines the staining of bacteria, and hence the colour of the bacteria.
name: It is the cell membrane which determines the colour of the bacteria
label: b
answer: no
explanation: The first stain added in a gram stain is crystal violet stain, which will stain all of the bacteria present purple. Next, an iodine stain is added. The iodine forms a complex with the crystal violet stain to stabilise it. Thirdly, alcohol or acetone is added which will wash the crystal violet-iodine complex away from the gram-negative bacteria. Lastly, a safranin or Carbol fuchsin stain is added to stain the gram-negative bacteria pink.
name: Iodine binds the crystal violet stain within the cell wall
label: a
answer: yes
explanation: It is actually either ethanol or acetone is used for decolourisation.
name: Nitrofurantoin is used to decolourise the sample before the final stain is added
label: d
answer: no

Correct answer: a
A 57-year-old white male comes to the GP for a health check. Their blood pressure is measured at 150/95, and this is confirmed with ambulatory blood pressure monitoring. The patient has a past medical history of type 2 diabetes and eczema.

What drug would be a suitable first-line option for his hypertension?

Options:
explanation: This is an example of a calcium channel blocker. The patient should be started on an ACE inhibitor or ARB as they have a diagnosis of diabetes.
name: Amlodipine
label: b
answer: no
explanation: This is an example of a thiazide-like diuretic, which can be used as a second-line drug.
name: Indapamide
label: c
answer: no
explanation: Whilst this may be appropriate to manage their diabetes, the question asks for a drug to manage their hypertension.
name: Metformin
label: d
answer: no
explanation: This is an example of an angiotensin-converting enzyme (ACE) inhibitor and this patient is a diabetic with stage 1 hypertension. NICE guidelines state that under 80s with diabetes and stage 1 hypertension should be considered for drug treatment, and an ACE inhibitor or angiotensin-receptor blocker (ARB) is first-line for this due to the presence of type 2 diabetes.
name: Lisinopril
label: a
answer: yes
explanation: This can be used as a further management option if the patient also has low blood potassium level.
name: Spironolactone
label: e
answer: no

Correct answer: a
A patient has a review of a newly prescribed anti-hypertensive. Since beginning to take it they have developed a persistent dry cough and they would like to change medication.

Which anti-hypertensive is most likely to cause a dry cough?

Options:
explanation: This is a calcium-channel blocker. Common side effects include angioedema, dizziness and a dry mouth.
name: Amlodipine
label: b
answer: no
explanation: This is a thiazide diuretic. Common side effects include constipation and hyperglycaemia.
name: Bendroflumethiazide
label: c
answer: no
explanation: This is an angiotensin-receptor blocker. They can cause an increased risk of infection.
name: Candesartan
label: d
answer: no
explanation: Angiotensin-converting enzyme (ACE) inhibitors cause a dry cough in 10% of patients, and is a common reason for drug discontinuation.
name: Ramipril
label: a
answer: yes
explanation: A side effect of this drug to be aware of is acute kidney injury.
name: Spironolactone
label: e
answer: no

Correct answer: a
During a clinic session, you are talking to a 23-year-old woman about her lifestyle and risk factors for health problems later in life. She mentions that she is particularly concerned about having a heart attack as her father has just had one.

Which of the following factors is least likely to contribute to atheroma formation?

Options:
explanation: Whilst hyperlipidaemia can contribute to atheroma formation, HDL cholesterol removes cholesterol from the blood and takes it back to the liver so is considered the 'good' cholesterol. Therefore, it is not as likely to contribute to atheroma formation.
name: High levels of high-density lipoprotein (HDL) cholesterol
label: a
answer: yes
explanation: Hypertension is a risk factor for atheroma formation due to physical stress on the arterial wall.
name: Hypertension
label: d
answer: no
explanation: People with diabetes are more likely to develop atherosclerosis for multiple reasons - one of which includes high blood glucose levels and the macrovascular complications of this.
name: Diabetes mellitus
label: c
answer: no
explanation: The chance of atheroma formation increases as people get older.
name: Increasing age
label: b
answer: no
explanation: This is a risk factor for atheroma formation for multiple reasons including hypertension and hyperglycaemia.
name: Obesity
label: e
answer: no

Correct answer: a
A 65-year-old male has a CT scan as it is suspected he has interstitial lung disease. The radiographer is testing your knowledge of thoracic anatomy and asks you the following question.

In which part of the thorax will the thymus be found in this man?

Options:
explanation: In children, the thymus could be seen here. However, it regresses during puberty.
name: Anterior mediastinum
label: c
answer: no
explanation: This contains the oesophagus and thoracic aorta.
name: Posterior mediastinum
label: e
answer: no
explanation: This contains the heart and great vessels, and is the biggest part of the mediastinum.
name: Middle mediastinum
label: d
answer: no
explanation: This is the region where gas exchange occurs within the lung.
name: Lung parenchyma
label: b
answer: no
explanation: At this age, the thymus gland will have reduced in size from childhood and so will only be found in the superior mediastinum.
name: Superior mediastinum
label: a
answer: yes

Correct answer: a