hllj/quesmed huggingface dataset:
A 47-year-old man presents to the GP complaining of a productive cough for the past 5 months. He moved to the United Kingdom from South East Asia 3 years ago, and has been working as a secondary school teacher ever since. Upon questioning, he also reports sweating a great deal at night. He has been steadily losing weight despite a good appetite.

The doctor takes a sputum sample for culture, which comes back as positive for M. Tuberculosis.

What medications makes up the treatment regimen for tuberculosis (TB)?

Options:
explanation: Pyrazinamide and ethambutol are used in the treatment of tuberculosis, but must be combined with isoniazid and rifampicin.
name: Pyrazinamide and Ethambutol
label: e
answer: no
explanation: Isoniazid and rifampicin are used in the treatment of tuberculosis, in conjunction with pyrazinamide and ethambutol. Isoniazid, rifampicin, ethambutol, and pyrazinamide are used for 2 months, then isoniazid and rifampicin for a further 4 months.
name: Isoniazid and Rifampicin
label: b
answer: no
explanation: This is the correct answer as the management of tuberculosis is with isoniazid, rifampicin, ethambutol, and pyrazinamide for 2 months, then isoniazid and rifampicin for a further 4 months.
name: Rifampicin, Isoniazid, Pyrazinamide, Ethambutol
label: a
answer: yes
explanation: Isoniazid and pyrazinamide are used in the treatment of tuberculosis. However, it is not used in conjunction with ceftriaxone.
name: Ceftriaxone, Pyrazinamide and Isoniazid
label: d
answer: no
explanation: Isoniazid and rifampicin are used in the treatment of tuberculosis. However, it is not in conjunction with amoxicillin.
name: Rifampicin, Isoniazid, Amoxicillin
label: c
answer: no

Correct answer: a
A 36-year-old female patient attends her GP surgery with concerns that her voice is more hoarse than usual. It has been this way ever since undergoing thyroid surgery 6 months ago.

Which of the following nerves was likely damaged during the procedure?

Options:
explanation: The trigeminal nerve supplies sensation to the dermatomes of the face as well as contributing to the sensation of the external ear, but does not extend to the pharynx or larynx. Therefore it would not be responsible for voice hoarseness.
name: Trigeminal nerve
label: c
answer: no
explanation: The vagus nerve is located in proximity to the thyroid and it innervates the external acoustic meatus, laryngopharynx and larynx. It regulates autonomic functions such as heart rate, respiratory rate, and digestion. Damage to the vagus nerve can cause a wide range of effects, but it is not classically associated with voice hoarseness.
name: Vagus nerve
label: b
answer: no
explanation: The recurrent laryngeal nerve innervates the muscles of the larynx and the vocal cords. Its position makes it vulnerable to damage during thyroid surgery. Damage to the recurrent laryngeal nerve can lead to hoarseness and dyspnoea.
name: Recurrent laryngeal nerve
label: a
answer: yes
explanation: The glossopharyngeal nerve is responsible for elevating the larynx and the pharynx. It is involved in the gag reflex and also has a sensory component. It is very unlikely for this nerve to be affected by thyroid surgery and damage to it would not cause hoarseness.
name: Glossopharyngeal nerve
label: d
answer: no
explanation: The hypoglossal nerve is responsible for tongue movements. It travels from the medulla to the dorsal aspect of the tongue, making it very unlikely to be affected by thyroid surgery. Damage to it would cause tongue weakness, not hoarseness of voice.
name: Hypoglossal nerve
label: e
answer: no

Correct answer: a
A 6-year-old boy is brought to the GP by his mother. She is concerned as his eyes appear very puffy and his ankles are swollen. She has also noticed her son’s urine to be more frothy recently. He is apyrexial and has no other urinary symptoms.

The GP performs a urine dip which reveals proteinuria. He suspects the boy is suffering from nephrotic syndrome.

Which of the following is most likely cause of his nephrotic syndrome?

Options:
explanation: This is a cause of glomerulonephritis in adults associated with sickle cell disease and HIV. It is not commonly seen in children. Therefore, this is not the correct answer.
name: Focal segmental glomerulosclerosis
label: c
answer: no
explanation: This is a type of glomerulonephritis which presents as haematuria following an upper respiratory tract infection. It is more common in the late teenage years and late 30s, and it would not usually cause nephrotic syndrome.
name: IgA nephropathy
label: e
answer: no
explanation: A urinary tract infection is common in children but it would not present as described above. Common features of a urinary tract infection include urinary frequency, dysuria and suprapubic pain. It is also not a cause of nephrotic syndrome, therefore it is not the correct answer.
name: Urinary tract infection
label: d
answer: no
explanation: This is the most common cause of nephrotic syndrome in adults. It presents in a similar way but not in this age group. Therefore, this answer is not correct.
name: Membranous nephropathy
label: b
answer: no
explanation: This is the correct answer. Minimal change disease is the most common cause of nephrotic syndrome in children. It presents with periorbital and peripheral oedema, proteinuria and frothy urine; exactly as described in this case.
name: Minimal change disease
label: a
answer: yes

Correct answer: a
A 45-year-old woman presents to A&E with a severe, sudden-onset headache, nausea, and vomiting. She had just finished a vigorous fitness class when the headache came on. She describes this as being ‘the worst headache that she’s ever experienced’.

She has no previous medical history and is not on any regular medication. She does not drink alcohol but she smokes 12 cigarettes a day and has done so since the age of 20.

Which of the following is the most likely diagnosis?

Options:
explanation: This is bleeding into the outermost meningeal layer. It most commonly occurs around the frontal and parietal lobes. Risk factors include old age, alcoholism and anticoagulation, none of which are present in this patient. There is a gradual onset of symptoms over hours to days, and there may be fluctuating confusion. This is therefore not the correct answer.
name: Subdural haemorrhage
label: d
answer: no
explanation: This is the correct answer as it best matches the presentation. A subarachnoid haemorrhage would present as a sudden onset ‘thunderclap’ headache. It usually occurs after exercise and it is more common in smokers.
name: Subarachnoid haemorrhage
label: a
answer: yes
explanation: An intracerebral (or intraparenchymal) haemorrhage is a collection of blood within the substance of the brain. It can be caused by hypertension, a vascular lesion, trauma, brain tumour, or infarct. Patients will present similarly to an ischaemic stroke. This answer is not correct as it does not reflect the presentation described above.
name: Intracranial haemorrhage
label: e
answer: no
explanation: An extradural haemorrhage is characterised by bleeding between the outer dura mater and the inner surface of the skull. The most common source of bleeding is a tear of the middle meningeal artery following a head injury. There is typically a brief loss of consciousness, followed by regaining of normal consciousness level (the lucid interval), with subsequent deterioration of consciousness and headache. This patient did not experience head trauma, and there is no loss of consciousness.
name: Extradural haemorrhage
label: b
answer: no
explanation: A stroke occurs when the brain is deprived of oxygen. There are two types of stroke; ischaemic and haemorrhagic. They are more common in older people and present with sudden onset of motor weakness, speech impairment, visual field defects and balance problems. This is not in line with the scenario and therefore not the right answer.
name: Stroke
label: c
answer: no

Correct answer: a
A 40-year-old woman presents to A&E with severe right upper quadrant pain. On examination, she is pyrexial and appears jaundiced. Her pulse is raised but her blood pressure is low. Her oxygen saturation is 96% on air.

Which of the following is the most likely diagnosis?

Options:
explanation: Acute cholecystitis is an acute or chronic inflammation of the gallbladder, that usually occurs secondary to gallstones. It presents with right upper quadrant pain and fever. Patients are not usually jaundiced unless there is associated obstruction of the biliary tree, and nausea and vomiting are common. Generally, patients are less unwell than those with ascending cholangitis, making this option incorrect.
name: Acute cholecystitis
label: c
answer: no
explanation: Acute pancreatitis can occasionally present as right upper quadrant pain, but usually the pain is epigastric and radiates to the back. It is typically associated with vomiting and signs of dehydration due to third-space fluid loss. This is not the most likely diagnosis in this case.
name: Acute pancreatitis
label: e
answer: no
explanation: Ascending cholangitis is a bacterial infection of the biliary tree which presents with Charcot’s triad: right upper quadrant pain, jaundice and a fever. The patient would also display signs of sepsis, as described in this case. Therefore, this is the most likely diagnosis and the correct answer.
name: Ascending cholangitis
label: a
answer: yes
explanation: Biliary colic would present with colicky right upper quadrant pain which is worse after eating and no fever. Patients are generally systemically well, without the abnormal observations indicating sepsis in this case. Therefore this answer is not correct.
name: Biliary colic
label: b
answer: no
explanation: A gastric ulcer can present as right upper quadrant pain but would not be associated with jaundice or signs of sepsis. Therefore this is not the correct answer.
name: Gastric ulcer
label: d
answer: no

Correct answer: a
A 35-year-old man is brought in by ambulance to the Emergency department. He reports breathlessness and severe chest pain that began earlier that afternoon while watching television.


He is usually fit and well with no medical conditions, and has recently returned from a trip to Australia. However he reports his father suffered a blood clot at a young age.


An arterial blood gas reveals the following:

||||
|--------------|:-------:|------------------|
|pH|7.51|7.35 - 7.45|
|PaO₂|10.5 kPa|11 - 15|
|PaCO₂|4.0 kPa|4.6 - 6.4|
|Bicarbonate|23 mmol/L|22 - 30|

Which of the following best describes this patient's acid-base balance?

Options:
explanation: This answer is not correct as the pH is high, pointing towards alkalosis and not acidosis. Moreover, the HCO3 is normal suggesting a respiratory rather than metabolic cause.
name: Fully compensated metabolic acidosis
label: e
answer: no
explanation: This is the correct answer as the pH is high and pointing towards alkalosis. The pCO2 is low and the HCO3 is normal, therefore leading to an uncompensated respiratory alkalosis. In this case, the most likely cause is a pulmonary embolism, which can lead to a respiratory alkalosis through reflex hyperventilation.
name: Uncompensated respiratory alkalosis
label: a
answer: yes
explanation: This answer is not correct as this patient’s HCO3 level is normal therefore pointing towards a respiratory alkalosis, not a metabolic one.
name: Uncompensated metabolic alkalosis
label: d
answer: no
explanation: There is no compensation in this case. The patient's HCO3 level is within the normal range, making this option incorrect.
name: Partially compensated respiratory alkalosis
label: c
answer: no
explanation: This answer is not correct as the pH is high, pointing towards alkalosis and not acidosis.
name: Uncompensated respiratory acidosis
label: b
answer: no

Correct answer: a
A 83-year-old female is brought to the hospital by ambulance feeling weak and generally unwell. She has been experiencing diarrhoea up to six times a day for the past week, after eating some out-of-date meat at a barbecue.

She takes furosemide for peripheral oedema, and amlodipine for blood pressure control. She mobilises with two sticks but is primarily housebound.

On examination, she has a blood pressure of 118/90 mmHg and a respiratory rate of 12 breaths per minute. A venous blood gas reveals a potassium level of 2.2 mmol / L.

Which of the following ECG changes is most likely to be present?

Options:
explanation: T wave inversion, ST depression and the presence of U waves are characteristic ECG features of hypokalaemia. Risk factors for hypokalaemia in this patient are her advanced age, general frailty, use of furosemide and diarrhoea.
name: T wave inversion
label: a
answer: yes
explanation: These ECG changes would be consistent with a diagnosis of hypothermia and would not be present in a patient with hypokalaemia.
name: J waves and QRS prolongation
label: c
answer: no
explanation: ST elevation is characteristic of a myocardial infarction. A localised ST elevation can also be seen in pericarditis. ST depression, rather than elevation, is seen in hypokalaemia. This option is therefore incorrect.
name: ST elevation
label: b
answer: no
explanation: These ECG changes would be consistent with a diagnosis of hyperkalaemia and would not be present in a patient with hypokalaemia.
name: Peaked T wave PR interval prolongation
label: e
answer: no
explanation: These ECG changes would be consistent with a diagnosis of pulmonary embolism and would not be present in a patient with hypokalaemia.
name: Pathological Q waves and inverted T waves
label: d
answer: no

Correct answer: a
A 13-year-old boy undergoes investigations for suspected asthma after reporting shortness of breath during his school sports lessons. He also has a cough that is worse at night.

Which of the following spirometry patterns is consistent with a diagnosis of asthma?

Options:
explanation: The ratio FEV 1 / FVC < 0.7 is seen in obstructive airway diseases such as asthma, COPD, and cystic fibrosis. A bronchodilator reversibility test can be carried out to distinguish between asthma and COPD, which would be positive in someone suffering from asthma. Therefore this is the correct answer.
name: FEV1 / FVC < 0.7 and bronchodilator reversibility
label: a
answer: yes
explanation: The ratio FEV 1 / FVC > 0/7  is consistent with a restrictive airway disease such as pulmonary fibrosis, acute respiratory distress syndrome or myasthenia gravis. Bronchodilator reversibility tests are not normally carried out in restrictive airway disease. It is therefore not the correct answer.
name: FEV 1 / FVC > 0.7 and no bronchodilator reversibility
label: d
answer: no
explanation: This value represents a normal reading in a person not suffering from a respiratory condition. Therefore this is not the correct answer.
name: FEV 1 / FVC = 0.78
label: e
answer: no
explanation: The ratio FEV 1 / FVC < 0.7 is seen in obstructive airway diseases such as asthma, COPD and cystic fibrosis. A bronchodilator reversibility test can be carried out to distinguish between asthma and COPD, which would be positive in someone suffering from asthma. Therefore this is not the correct answer for a diagnosis of asthma, as it is more indicative of COPD.
name: FEV1 / FVC < 0.7 and no bronchodilator reversibility
label: b
answer: no
explanation: The ratio FEV 1 / FVC > 0/7  is consistent with a restrictive airway disease such as pulmonary fibrosis, acute respiratory distress syndrome or myasthenia gravis. Bronchodilator reversibility tests are not normally carried out in restrictive airway disease. It is therefore not the correct answer.
name: FEV 1 / FVC > 0.7 and bronchodilator reversibility
label: c
answer: no

Correct answer: a
A 34-year-old woman is 39 weeks pregnant. This is her first pregnancy and regular uterine contractions started 3 hours ago. The midwife examines her and reports that she is in the first stage of labour.

Which of the following best describes the active first stage of labour?

Options:
explanation: The first stage of labour begins with regular uterine contractions and ends when there is complete cervical dilation of 10cm. The latent phase is between 0-3 cm cervical dilatation and the active phase is between 3-10cm cervical dilatation. The second stage of labour involves the foetus being engaged in the cervical canal after complete cervical dilation. Therefore this is not the correct answer.
name: Foetus engaged in the cervical canal
label: d
answer: no
explanation: The first stage of labour begins with regular uterine contractions and ends when there is complete cervical dilation of 10cm. The latent phase is between 0-3 cm cervical dilatation and the active phase is between 3-10cm cervical dilatation. The stages of labour are not measured in hours, therefore this is not the correct answer.
name: 3-6 hours after the start of regular contractions
label: c
answer: no
explanation: The first stage of labour begins with regular uterine contractions and ends when there is complete cervical dilation of 10cm. The latent phase is between 0-3 cm cervical dilatation and the active phase is between 3-10cm cervical dilatation. The stages of labour are not measured in hours, therefore this is not the correct answer.
name: 1-5 hours after the start of regular contractions
label: e
answer: no
explanation: The first stage of labour begins with regular uterine contractions and ends when there is complete cervical dilation of 10cm. The latent phase is between 0-3 cm cervical dilatation and the active phase is between 3-10cm cervical dilatation. Therefore this is not the correct answer, as it describes the latent phase rather than the first stage of labour.
name: Cervical dilatation of 0-3 centimetres
label: b
answer: no
explanation: The first stage of labour begins with regular uterine contractions and ends when there is complete cervical dilation of 10cm. The latent phase is between 0-3 cm cervical dilatation and the active phase is between 3-10cm cervical dilatation. Therefore this is the correct answer.
name: Cervical dilatation of 3-10 centimetres
label: a
answer: yes

Correct answer: a
A 77-year-old woman suffers a fall as she is walking downstairs. She calls 999 as she is unable to stand due to severe pain.

On examination, her left leg is visibly deformed. An x-ray shows an intracapsular neck of femur fracture.

Which of the following deformities is most likely to be seen in this patient?

Options:
explanation: This is the expected presentation of an intracapsular neck of femur fracture. The classically described presentation is a shortened and externally rotated limb due to the unopposed pull of the iliopsoas muscle that attaches to the lesser trochanter.
name: Shortened, externally rotated leg
label: a
answer: yes
explanation: This would be the presentation in the case of an anterior hip dislocation and is therefore not the correct answer in this case.
name: Abducted, externally rotated leg
label: c
answer: no
explanation: This is not the correct answer as a fractured neck of femur would not cause leg lengthening or abduction.
name: Lengthened, abducted leg
label: e
answer: no
explanation: This would be the presentation in the case of a posterior hip dislocation and is therefore not the correct answer in this case.
name: Shortened, internally rotated leg
label: b
answer: no
explanation: This is not the correct answer as a fractured neck of femur would not cause leg lengthening.
name: Lengthened, externally rotated leg
label: d
answer: no

Correct answer: a
A 49-year-old man visits his GP with a 6 month history of stomach pain and acid reflux.

Which of the following pairing of gastric secretions and their cells of origin is correct?

Options:
explanation: This is the correct answer. Gastrin is a hormone released by G cells in the pyloric antrum of the stomach, duodenum and pancreas that stimulates the secretion of gastric acid by parietal cells. Cholecystokinin, secreted by I cells in the duodenum, is responsible for stimulating the digestion of fat and protein. Secretin,  which plays a role in regulating fluid balance, is secreted by S cells of the duodenum. Somatostatin has a range of neuroendocrine effects, and is released by D cells in the stomach and pancreas.
name: Gastrin – G cells; Cholecystokinin (CCK) – I cells; Secretin – S cells; Somatostatin – D cells; gastric acid – parietal cells
label: a
answer: yes
explanation: This answer is not correct as somatostatin is secreted by D cells in the stomach and pancreas.
name: Gastrin – G cells; Cholecystokinin (CCK) – I cells; Secretin – S cells; Somatostatin – S cells; gastric acid – parietal cells
label: b
answer: no
explanation: This answer is not correct as glucagon is mainly produced by alpha cells of the pancreas. G cells secrete gastrin.
name: Glucagon – G cells; Cholecystokinin (CCK) – I cells; Secretin – S cells; Somatostatin – D cells; gastric acid – parietal cells
label: e
answer: no
explanation: This answer is not correct as amylase is mainly produced by the salivary cells and the pancreas. G cells secrete gastrin.
name: Amylase – G cells; Cholecystokinin (CCK) – I cells; Secretin – S cells; Somatostatin – D cells; gastric acid – parietal cells
label: d
answer: no
explanation: This answer is not correct as gastrin is secreted by G cells and gastric acid is secreted by parietal cells.
name: Gastrin – endocrine cells; Cholecystokinin (CCK) – I cells; Secretin – S cells; Somatostatin – D cells; gastric acid – chief cells
label: c
answer: no

Correct answer: a
A 5-year-old girl is brought to A&E with new onset sore throat, drooling, and noisy inspiratory breath sounds. Her dad mentions that they do not believe in vaccines and that his daughter did not receive any vaccinations.

On examination, she is pyrexia and is sitting very still, with her mouth open. She does not have a cough.

Which of the following is the most likely diagnosis?

Options:
explanation: Foreign body inhalation could present with difficulty breathing and stridor. However, it would also cause a cough and not a fever.
name: Foreign body inhalation
label: d
answer: no
explanation: Bacterial tracheitis is a rare but dangerous condition that presents similarly to viral croup, but the child has a high fever and rapidly progressive airway obstruction with copious thick airway secretions. It is most commonly caused by Staphylococcus aureus, typically following a viral upper respiratory tract infection. This patient does not fit this presentation, therefore this is not the correct answer.
name: Bacterial tracheitis
label: e
answer: no
explanation: Tonsillitis is common in children of this age. However, it does not commonly present with drooling and difficulty breathing, unless the tonsils are sufficiently enlarged as to cause obstruction.
name: Tonsillitis
label: c
answer: no
explanation: Croup is an infection of the upper airway caused by parainfluenza virus. It is most common in children between 6 months and 3 years old. It presents with a barking, seal-like cough, fever and shortness of breath. The girl in this scenario does not have a cough, therefore this answer is not correct.
name: Croup
label: b
answer: no
explanation: Epiglottitis is a rapidly progressive infection causing inflammation of the epiglottis and tissues around the epiglottis that may lead to abrupt blockage of the upper airway. It is caused by Haemophilus influenza B and is most common in children between 1 and 6 years old who have not been vaccinated. It presents with a very painful throat, high fever, drooling, inspiratory stridor, and difficulty breathing. This is the correct answer as it best matches the scenario.
name: Epiglottitis
label: a
answer: yes

Correct answer: a