hllj/quesmed huggingface dataset:
A 77-year-old woman is admitted to the respiratory ward of her local hospital with a diagnosis of community acquired pneumonia.


On examination, she has bronchial breath sounds and a temperature of 38.3 degrees Celsius. She is well-oriented and does not display any signs of cyanosis. She has a pulse of 78, a respiratory rate of 24, and a blood pressure of 88/63 mmHg. Her O2 saturation is 96% on air.


All of her blood results are unremarkable, with the exception of her urea which is 9 mmol/L (normal range 2.5-7.8 mmol/L), and her creatinine which is 54 µmol/L (normal range 60-120 µmol/L).


What is her CURB-65 score?

Options:
explanation: To calculate the CURB-65 a point is awarded for each of the following:

C – confusion: An abbreviated mental test of ≤8

U – urea: >7mmol/L

R - Respiratory rate: ≥30/ min

B - blood pressure <90 systolic and/ or <60mmHg diastolic

65 - age: >65year old

This patient will score 1 point for each of the following: urea (over 7mmol/L), blood pressure (<90/60 mmHg, age > 65). Therefore, her CURB-65 score is 3, not 1.
name: 1
label: b
answer: no
explanation: To calculate the CURB-65 a point is awarded for each of the following:

C – confusion: An abbreviated mental test of ≤8

U – urea: >7mmol/L

R - Respiratory rate: ≥30/ min

B - blood pressure <90 systolic and/ or <60mmHg diastolic

65 - age: >65year old

This patient will score 1 point for each of the following: urea (over 7mmol/L), blood pressure (<90/60 mmHg, age > 65). Therefore, her CURB-65 score is 3.
name: 3
label: a
answer: yes
explanation: To calculate the CURB-65 a point is awarded for each of the following:

C – confusion: An abbreviated mental test of ≤8

U – urea: >7mmol/L

R - Respiratory rate: ≥30/ min

B - blood pressure <90 systolic and/ or <60mmHg diastolic

65 - age: >65year old

This patient will score 1 point for each of the following: urea (over 7mmol/L), blood pressure (<90/60 mmHg, age > 65). Therefore, her CURB-65 score is 3, not 4.
name: 4
label: d
answer: no
explanation: To calculate the CURB-65 a point is awarded for each of the following:

C – confusion: An abbreviated mental test of ≤8

U – urea: >7mmol/L

R - Respiratory rate: ≥30/ min

B - blood pressure <90 systolic and/ or <60mmHg diastolic

65 - age: >65year old

This patient will score 1 point for each of the following: urea (over 7mmol/L), blood pressure (<90/60 mmHg, age > 65). Therefore, her CURB-65 score is 3, not 2.
name: 2
label: c
answer: no
explanation: To calculate the CURB-65 a point is awarded for each of the following:

C – confusion: An abbreviated mental test of ≤8

U – urea: >7mmol/L

R - Respiratory rate: ≥30/ min

B - blood pressure <90 systolic and/ or <60mmHg diastolic

65 - age: >65year old

This patient will score 1 point for each of the following: urea (over 7mmol/L), blood pressure (<90/60 mmHg, age > 65). Therefore, her CURB-65 score is 3, not 5.
name: 5
label: e
answer: no

Correct answer: a
A 79-year-old woman is an inpatient at her local hospital while she is receiving broad-spectrum antibiotics for a lower respiratory tract infection. During her stay, she develops abdominal cramps and two episodes of watery diarrhoea. On examination, she is apyrexial and appears well hydrated.

Which of the following is the most appropriate management of this patient's diarrhoea?

Options:
explanation: The most likely diagnosis, in this case, is hospital-acquired Clostridium difficile infection. Although paracetamol may be of benefit in addressing this patient's abdominal cramps, it would not address her Clostridium difficile infection or ongoing diarrhoea.
name: Paracetamol
label: b
answer: no
explanation: The most likely diagnosis, in this case, is hospital-acquired Clostridium difficile infection. Penicillin is not a suitable antibiotic for this type of infection. In fact, a patient undergoing treatment with penicillin is at an increased risk of developing C. difficile.
name: Penicillin
label: c
answer: no
explanation: The most likely diagnosis, in this case, is hospital-acquired Clostridium difficile infection. Ciprofloxacin is not a suitable antibiotic for this type of infection. In fact, a patient undergoing treatment with ciprofloxacin is at an increased risk of developing C. difficile.
name: Ciprofloxacin
label: d
answer: no
explanation: The most likely diagnosis, in this case, is hospital-acquired Clostridium difficile infection. Co-Amoxiclav is widely prescribed in hospitals and it may also be linked to an increased susceptibility of Clostridium difficile infection. It is therefore not suitable for treating this infection.
name: Co-Amoxiclav
label: e
answer: no
explanation: The most likely diagnosis, in this case, is hospital-acquired Clostridium difficile infection. This patient has multiple risk factors for this infection: hospital stay, age > 65, and treatment with broad-spectrum antibiotics. Vancomycin is therefore the most appropriate treatment option. If the infection is severe, IV metronidazole can be added.
name: Vancomycin
label: a
answer: yes

Correct answer: a
A 20-year-old woman suffers from recurrent epigastric pain, nausea, and a feeling of abdominal fullness. She undergoes a rapid urease test which is positive and suggestive of an H. pylori infection.

Which of the following is the first-line treatment regimen for H. pylori?

Options:
explanation: This answer is incorrect as it only mentions two out of the three medications needed to eradicate the H. pylori infection. Patients should receive amoxicillin, clarithromycin, and a proton pump inhibitor (PPI) twice daily for seven days
name: Amoxicillin and a PPI twice daily for seven days
label: c
answer: no
explanation: This correctly describes the treatment of H. Pylori. This triple therapy (two antibiotics and a PPI) is given once the presence of H. pylori has been confirmed.
name: Amoxicillin, clarithromycin and a proton pump inhibitor (PPI) twice daily for seven days
label: a
answer: yes
explanation: This answer is incorrect as although it mentions a triple therapy, it is for the incorrect time and ciprofloxacin is not a first-line antibiotic used for the treatment of H. pylori. Patients should receive amoxicillin, clarithromycin, and a proton pump inhibitor (PPI) twice daily for seven days
name: Amoxicillin, Ciprofloxacin and a PPI twice daily for fourteen days
label: e
answer: no
explanation: Despite mentioning all the correct medications, this answer is incorrect due to the duration of treatment which is seven days, not fourteen.
name: Amoxicillin, clarithromycin and a PPI twice daily for fourteen days
label: b
answer: no
explanation: This answer is incorrect as it fails to mention a PPI. Patients should receive amoxicillin, clarithromycin and a proton pump inhibitor (PPI) twice daily for seven days, Metronidazole is the alternative antibiotic of choice for a patient with a penicillin allergy.
name: Clarithromycin and metronidazole twice daily for seven days
label: d
answer: no

Correct answer: a
A 45-year-old man has just finished running a marathon. He is now feeling unwell, and his friends are concerned because he looks pale and sweaty. A paramedic on the scene examines him and determines that he is tachycardic with a low blood pressure of 100/65.

The marathon runner admits to not keeping himself hydrated throughout the day as well as for a few days prior to the marathon. He has not passed any urine over the past 16 hours.

What stage of Acute Kidney Injury (AKI) is he in?

Options:
explanation: According to the KDIGO staging, AKI Stage 1 involves at least one of:

- Creatinine rise of 1.5x compared to baseline
- Urine output <0.5 ml/kg/hour for 6-12 hours.

There should be no features of stage 2 or 3 AKI. In this case, there is no access to blood tests to determine the creatinine but the urine output has been 0 for the past 16 hours, which meets the criteria for a stage 3 AKI.
name: Stage 1
label: b
answer: no
explanation: There is not stage 4 for AKI according to the KDIGO staging.
name: Stage 4
label: d
answer: no
explanation: According to the KDIGO staging, AKI Stage 3 involves at least one of:

-  A creatinine rise of 3x compared to baseline

- Urine output <0.3 ml/kg/hour for 24 hours (or anuria for 12 hours)

- Serum creatinine >354umol/dl.

  In this case, the marathon runner has not passed urine for more than 16 hours so has a stage 3 AKI.
name: Stage 3
label: a
answer: yes
explanation: According to the KDIGO staging, AKI Stage 2 involves at least one of:

- Creatinine rise of 2x compared to baseline
- Urine output <0.5 ml/kg/hour for 12 hours.

There should be no features of stage 3 AKI.  In this case, there is no access to blood tests to determine the creatinine but the urine output has been 0 for the past 16 hours, which meets the criteria for a stage 3 AKI.
name: Stage 2
label: c
answer: no
explanation: There is not stage 5 for AKI according to the KDIGO staging.
name: Stage 5
label: e
answer: no

Correct answer: a
An 87-year-old female visits the GP with concerns regarding urine leakage. This has been troubling her for several years and occurs whenever she coughs or sneezes. She previously gave birth to 4 children, all delivered by uneventful vaginal deliveries. She has tried pelvic floor exercises for the past 2 months with no improvement.

Which of the following is the most appropriate management of this type of urinary incontinence?

Options:
explanation: Oxybutynin is an anticholinergic medication used in the treatment of urge incontinence and overactive bladder syndrome. Therefore it would not be suitable for this patient, who demonstrates symptoms of stress incontinence.
name: Oxybutynin
label: b
answer: no
explanation: Doxazosin is an alpha adrenergic antagonist which causes urethral relaxation which may cause or exacerbate urinary incontinence. It is therefore not a suitable treatment for this patient.
name: Doxazosin
label: c
answer: no
explanation: The history, of urine leakage upon coughing/sneezing, is suggestive of stress incontinence. A history of vaginal deliveries is a known risk factor in developing this. Duloxetine can help with stress incontinence, but it is only recommended if conservative measures have failed, and the patient is not a candidate for surgical intervention.
name: Duloxetine
label: a
answer: yes
explanation: Tolterodine is an example of an anticholinergic agent used in the treatment of urge incontinence and overactive bladder syndrome. Therefore it would not be suitable for this patient, who demonstrates symptoms of stress incontinence.
name: Tolterodine
label: d
answer: no
explanation: Nifedipine is a calcium channel blocker which can cause mild urinary retention and is sometimes used for overflow incontinence. Therefore it would not be suitable for this patient, who demonstrates symptoms of stress incontinence.
name: Nifedipine
label: e
answer: no

Correct answer: a
A 54-year-old male patient with a previous diagnosis of type II diabetes is taking a medication called sitagliptin.

Which of the following classes of medication does sitagliptin belong to?

Options:
explanation: An example of a GLP-1 analogue is exenatide, which works by increasing insulin secretion and sensitivity. However, sitagliptin is a DPP4 inhibitor.
name: GLP-1 analogues
label: b
answer: no
explanation: Metformin is the most common example of a biguanide. It works by increasing peripheral insulin sensitivity and hepatic glucose uptake. However, sitagliptin is a DPP4 inhibitor.
name: Biguanides
label: c
answer: no
explanation: Sitagliptin works by inhibiting DPP4, which in turn increases levels of incretins (GLP-1 and GIP) by decreasing their peripheral breakdown.
name: DPP4-Inhibitors
label: a
answer: yes
explanation: Dapagliflozin is an SGLT2 inhibitor and works by increasing urinary glucose loss. However, sitagliptin is a DPP4 inhibitor.
name: SGLT2 inhibitors
label: d
answer: no
explanation: An example of a sulfonylurea is gliclazide, which works by depolarising islet cells in the pancreas thus increasing insulin release. By contrast, sitagliptin is a DPP4 inhibitor.
name: Sulfonlyureas
label: e
answer: no

Correct answer: a
A 81-year-old woman attends her GP surgery with a two-week history of breathlessness, fever and a productive cough. On examination, there are coarse crackles heard at the base of the right lung. After having a chest x-ray, she is diagnosed with community-acquired pneumonia and is commenced on amoxicillin.

Which of the following describes the mechanism of action of amoxicillin?

Options:
explanation: This is the mechanism of action of trimethoprim, an antibiotic used for the treatment of urinary tract infections. However, it is not how penicillins such as amoxicillin work.
name: Inhibits dihydrofolate reductase
label: e
answer: no
explanation: This is the mechanism of action of other antibiotics, such as ciprofloxacin and metronidazole. However, it is not how amoxicillin works.
name: Inhibits DNA synthesis
label: b
answer: no
explanation: Amoxicillin acts on penicillin-binding proteins that inhibit a process called transpeptidation (the cross-linking process in cell wall synthesis). This leads to the activation of autolytic enzymes in the bacterial cell wall, therefore preventing its synthesis and bringing about bacterial cell death.
name: Inhibition of bacterial cell wall synthesis
label: a
answer: yes
explanation: This is the mechanism of action of tetracycline antibiotics. However, it is not how penicillins such as amoxicillin work.
name: Inhibits bacterial ribosomal subunit 30S
label: c
answer: no
explanation: This is the mechanism of action of antibiotics such as erythromycin, azithromycin and clarithromycin. However, it is not how penicillins such as amoxicillin work.
name: Inhibits bacterial ribosomal subunit 50S
label: d
answer: no

Correct answer: a
A 55-year-old woman with a past medical history of asthma visits A&E with new-onset chest tightness, shortness of breath, and wheezing. She was recently started on a new medication for her heart.

Which of the following medications, if prescribed in error, could account for her symptoms?

Options:
explanation: Losartan is an angiotensin receptor blocker (ARB) that can be used for the treatment of hypertension. It can cause a cough, but not chest pain or wheezing. It is not contraindicated in asthma, and is therefore very unlikely to have led to the presentation described above.
name: Losartan
label: e
answer: no
explanation: Aspirin is a common antiplatelet medication, used to reduce an individual's cardiovascular risk. There is a very low chance that it will cause an asthma exacerbation or bronchospasm. Therefore, it is not the most likely medication to have been initiated in error in this case.
name: Aspirin
label: c
answer: no
explanation: Furosemide is a loop diuretic that can be used for the treatment of resistant hypertension. It is not known to cause the symptoms described above or to have an effect on a prior asthma diagnosis. Therefore, it is not the correct answer.
name: Furosemide
label: d
answer: no
explanation: Digoxin is a cardiac glycoside that increases the force of myocardial contraction and reduces conductivity within the atrioventricular (AV) node. It is not known to cause the symptoms described above and it is not contraindicated in asthma. Therefore, this is not the correct answer.
name: Digoxin
label: b
answer: no
explanation: Propranolol is a non-selective beta-blocker. It can cause airway narrowing and lead to an acute exacerbation of asthma. This entirely accounts for this patient's presentation and is therefore the most likely medication to have been initiated in error. Beta-blockers are contraindicated in patients with a previous asthma diagnosis.
name: Propranolol
label: a
answer: yes

Correct answer: a
A 5-year-old boy attends a friend's birthday party. Soon after the food is served, he develops generalised urticaria and repeated vomiting. His tongue is swollen and he is struggling to breathe. His mother decides to call the ambulance.

Which of the following is the most likely explanation for his symptoms?

Options:
explanation: Allergic rhinitis is a common inflammatory condition of the nasal mucosa that is characterised by nasal pruritus, sneezing, rhinorrhoea, and nasal congestion. It is not triggered by food and does not cause systemic features, therefore this answer is not correct.
name: Allergic rhinitis
label: d
answer: no
explanation: Based on the presentation, this is the most appropriate answer. Anaphylaxis is a quick IgE-mediated type I hypersensitivity reaction that is characterised by tongue swelling, shortness of breath, urticaria, pruritus, gastrointestinal manifestation, and signs of shock. It is in keeping with the urticaria and angioedema demonstrated by this patient.
name: Anaphylactic shock
label: a
answer: yes
explanation: Asthma is an inflammatory airway condition that can be worsened by certain triggers such as dust, pet hair, and pollen. However, it would not manifest with urticaria and vomiting, and so is not the correct answer.
name: Asthma
label: b
answer: no
explanation: Acute urticaria is an IgE mediated reaction to certain allergens such as pet hair and insect bites. It is characterised by local inflammation manifesting as itchy red wheals, sometimes associated with swelling. It does not present with systemic features such as shortness of breath or tongue swelling.
name: Acute urticaria
label: c
answer: no
explanation: A simple food allergy would not be expected to cause tongue swelling or shortness of breath. Most commonly, it presents as pruritus, urticaria, and diarrhoea/vomiting after eating food that the patient is allergic to.
name: Simple food allergy
label: e
answer: no

Correct answer: a
A 45-year-old man attends an allergy clinic with concerns that he is allergic to the protective equipment he is required to wear at work. The doctor explains to him that there are different types of hypersensitivity reactions that could account for his symptoms.

Which of the following is an example of a type IV hypersensitivity reaction?

Options:
explanation: Anaphylaxis is an example of type I hypersensitivity mediated by IgE and mast cells. Other examples include asthma and hayfever.
name: Anaphylaxis
label: c
answer: no
explanation: Autoimmune haemolytic anaemia is an example of a type II hypersensitivity reaction mediated by IgG or IgM bound to antigens of cell surface. Other examples include Immune thrombocytopaenia (ITP) and haemolytic transfusion reactions.
name: Autoimmune haemolytic anaemia
label: e
answer: no
explanation: Allergic contact dermatitis is an example of a type IV hypersensitivity reaction. Type IV hypersensitivity is also called ‘delayed hypersensitivity’, and it is mediated by T cells. Examples include granulomatous sensitivity (caused by tuberculosis/tuberculin protein), allergic contact dermatitis, and graft versus host disease (GVHD).
name: Allergic contact dermatitis
label: a
answer: yes
explanation: Rheumatoid arthritis is an example of a type III hypersensitivity reaction mediated by immune complexes between IgG/IgA/IgM and free antigens. Other examples include transfusion reactions, systemic lupus erythematosus and post-streptococcal glomerulonephritis.
name: Rheumatoid arthritis
label: d
answer: no
explanation: Eczema is an example of type I hypersensitivity mediated by IgE and mast cells. Other examples include asthma and hayfever.
name: Eczema
label: b
answer: no

Correct answer: a
A 35-year-old man presents to A&E following a fall. It appears that he has fractured the right elbow joint. Imaging also reveals damage to the structure immediately lateral to the biceps tendon.

Which of the following structures has been damaged?

Options:
explanation: The cubital fossa contains the following structures, from lateral to medial: radial nerve, tendon of the biceps muscle, brachial artery, and median nerve. This means that the radial nerve is the structure immediately lateral to the biceps tendon. Therefore, this is the correct answer.
name: Radial nerve
label: a
answer: yes
explanation: The cubital fossa contains the following structures, from lateral to medial: radial nerve, tendon of the biceps muscle, brachial artery, and median nerve. The median nerve is the most medial structure within the cubital fossa, therefore this answer is wrong.
name: Median nerve
label: d
answer: no
explanation: The cubital fossa contains the following structures, from lateral to medial: radial nerve, tendon of the biceps muscle, brachial artery and median nerve. The pronator teres muscle forms the medial border of the fossa, therefore this answer is wrong.
name: Pronator teres muscle
label: e
answer: no
explanation: The cubital fossa contains the following structures, from lateral to medial: radial nerve, tendon of the biceps muscle, brachial artery, and median nerve. The brachial artery is the structure immediately medial to the biceps muscle, while the brachial artery is more medical. Therefore, this answer is incorrect.
name: Brachial artery
label: b
answer: no
explanation: The cubital fossa contains the following structures, from lateral to medial: radial nerve, tendon of the biceps muscle, brachial artery, and median nerve. The brachioradialis muscle forms the lateral border of the fossa. Therefore, this answer is incorrect.
name: Brachioradialis muscle
label: c
answer: no

Correct answer: a
A 36-year-old woman presents to A&E following a traumatic injury to her brachial plexus.

Which of the following nerve roots make up the axillary nerve?

Options:
explanation: These are the nerve roots that make up the thoracodorsal nerve. Therefore, this answer is not correct.
name: C6, C7, C8
label: e
answer: no
explanation: These are the nerve roots that make up the radial nerve. Therefore, this answer is not correct.
name: C5, C6, C7, C8, T1
label: d
answer: no
explanation: These are the nerve roots that make up the musculocutaneous nerve. Therefore, this answer is not correct.
name: C5, C6, C7
label: c
answer: no
explanation: These are the nerve roots that make up the axillary nerve. Therefore, this answer is correct.
name: C5, C6
label: a
answer: yes
explanation: These are the nerve roots that make up the ulnar nerve. Therefore, this answer is not correct.
name: C8, T1
label: b
answer: no

Correct answer: a
A 77-year-old man gets diagnosed with Parkinson’s disease following months of declining motor and cognitive function.

Which of the following form the classic triad of core motor symptoms in Parkinson’s disease?

Options:
explanation: While the first two symptoms are correct, micrographia is not a core feature of Parkinson’s, though it is common in a lot of patients.
name: Bradykinesia, tremor, micrographia
label: b
answer: no
explanation: Parkinson's disease is a progressive neurodegenerative condition caused by the degeneration of dopaminergic neurons in the substantia nigra. This results in a classic triad of features: bradykinesia, tremor, and rigidity. The symptoms of Parkinson's disease are characteristically asymmetrical.
name: Bradykinesia, tremor, rigidity
label: a
answer: yes
explanation: Rigidity and tremor are common motor symptoms seen in Parkinson's disease. However, postural hypertension is not typically seen in Parkinson's disease. Instead, postural hypotension is a non-motor feature that can affect patients suffering from Parkinson’s disease.
name: Tremor, rigidity and postural hypertension
label: e
answer: no
explanation: Rigidity and tremor are common motor symptoms seen in Parkinson's disease. Although depression is also common, affecting around 40% of patients with Parkinson's disease, it is not a core motor feature. This is therefore not the correct answer.
name: Rigidity, tremor, depression
label: d
answer: no
explanation: While rigidity and tremor are commonly seen in Parkinson's disease, chorea is not. Chorea involves involuntary jerking movements that are more typical of Huntington's disease. This is therefore not the correct answer.
name: Rigidity, tremor, chorea
label: c
answer: no

Correct answer: a